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The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis

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Abstract

Background

Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery.

Methods

This systematic review was reported according to PRISMA guidelines. The protocol was published in PROSPERO (CRD42018114625). Medline, Embase, CINAHL and Cochrane Library databases were searched for studies which compare the efficacy of NPWT versus non-NPWT dressings for closed incisions in breast surgery. Specific outcomes of interest were total wound complications, surgical site infection (SSI), seroma, haematoma, wound dehiscence and necrosis.

Results

Seven studies (1500 breast incisions in 904 patients) met the inclusion criteria. NPWT was associated with a significantly lower rate of total wound complications [odds ratio (OR) 0.36; 95% CI 0.19–069; P = 0.002], SSI (OR 0.45; 95% CI 0.24–0.86; P = 0.015), seroma (OR 0.28; 95% CI 0.13–0.59; P = 0.001), wound dehiscence (OR 0.49; 95% CI 0.32–0.72; P < 0.001) and wound necrosis (OR 0.38; 95% CI 0.19–0.78; P = 0.008). There was no significant difference in haematoma rate (OR 0.8; 95% CI 0.19–3.2; P = 0.75). Statistically significant heterogeneity existed for total wound complications, but no other outcomes.

Conclusion

Compared with conventional non-NPWT dressings, prophylactic application of NPWT is associated with significantly fewer surgical site complications including SSI, seroma, wound dehiscence and wound necrosis for closed breast incisions.

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Author information

Authors and Affiliations

  1. Department of Surgery, Cork University Hospital, Cork, Ireland

    David Cagney, Lydia Simmons, Donal Peter O’Leary, Mark Corrigan, Louise Kelly, M. J. O’Sullivan & Henry Paul Redmond

  2. National University of Ireland, Galway, Ireland

    Aaron Liew

  3. Portiuncula University Hospital, Galway, Ireland

    Aaron Liew

  4. Breast Cancer Research Centre, Cork University Hospital, Cork, Ireland

    Mark Corrigan, Louise Kelly & M. J. O’Sullivan

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  1. David Cagney
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Appendices

Appendix 1

See Table

Table 2 PRISMA checklist
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2.

Appendix 2. PubMed search strategy

(((((negative[All Fields] AND ("pressure"[MeSH Terms] OR "pressure"[All Fields])) OR ("negative-pressure wound therapy"[MeSH Terms] OR ("negative-pressure"[All Fields] AND "wound"[All Fields] AND "therapy"[All Fields]) OR "negative-pressure wound therapy"[All Fields] OR ("negative"[All Fields] AND "pressure"[All Fields] AND "dressing"[All Fields]) OR "negative pressure dressing"[All Fields])) OR VAC[All Fields]) OR PICO[All Fields]) OR ("negative-pressure wound therapy"[MeSH Terms] OR ("negative-pressure"[All Fields] AND "wound"[All Fields] AND "therapy"[All Fields]) OR "negative-pressure wound therapy"[All Fields] OR ("negative"[All Fields] AND "pressure"[All Fields] AND "wound"[All Fields] AND "therapy"[All Fields]) OR "negative pressure wound therapy"[All Fields])) AND (((((("breast"[MeSH Terms] OR "breast"[All Fields]) AND ("surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgery"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields])) OR ("mammaplasty"[MeSH Terms] OR "mammaplasty"[All Fields] OR ("breast"[All Fields] AND "reconstruction"[All Fields]) OR "breast reconstruction"[All Fields])) OR (("breast"[MeSH Terms] OR "breast"[All Fields]) AND augmentation[All Fields])) OR (("breast"[MeSH Terms] OR "breast"[All Fields]) AND reduction[All Fields])) OR ("mastectomy, simple"[MeSH Terms] OR ("mastectomy"[All Fields] AND "simple"[All Fields]) OR "simple mastectomy"[All Fields] OR "mastectomy"[All Fields] OR "mastectomy"[MeSH Terms])).

Appendix 3

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Fig. 7
figure 7

PRISMA flow diagram

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7.

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Cagney, D., Simmons, L., O’Leary, D.P. et al. The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis. World J Surg 44, 1526–1537 (2020). https://doi.org/10.1007/s00268-019-05335-x

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