Impact of closed-incision negative pressure therapy in donor-site complications in DIEP flap breast reconstruction: Analysis of 705 patients and 1125 flaps

Maria J Escobar-Domingo; Valeria P Bustos; Amir-Ala Mahmoud; Micaela J Tobin; John B Park; Daniela Lee; Benjamin Rahmani; Reinhard M Knerr; Chamilka Merle; Joshua A Bloom; Samuel J Lin; Bernard T Lee

doi:10.1016/j.bjps.2025.04.010

Impact of closed-incision negative pressure therapy in donor-site complications in DIEP flap breast reconstruction: Analysis of 705 patients and 1125 flaps

J Plast Reconstr Aesthet Surg. 2025 Jun:105:177-184. doi: 10.1016/j.bjps.2025.04.010. Epub 2025 Apr 15.

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami, Miami, FL, USA.
³ Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: sjlin@bidmc.harvard.edu.
⁴ Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: blee3@bidmc.harvard.edu.

PMID: 40305888
DOI: 10.1016/j.bjps.2025.04.010

Abstract

Background: Closed-incision negative pressure therapy (ciNPT) has been shown to reduce complication rates in breast reconstruction (BR). This study aimed to evaluate postoperative outcomes in deep inferior epigastric perforator (DIEP) donor-site incisions managed with ciNPT compared to standard dressings.

Methods: We performed a retrospective study of patients ≥18 years who underwent DIEP flap BR from 2015 to 2023. Patients who underwent reconstruction with alternative flaps or converted to transverse rectus abdominus myocutaneous were excluded. Patients were categorized according to the use of ciNPT vs. standard dressings. The unpaired t- and Fisher's Exact tests were used to assess the differences between the groups. Multivariable logistic regression models were used to evaluate postoperative complications.

Results: A total of 705 patients were included, with 68 (9.6%) managed with ciNPT. Patients treated with ciNPT had significantly higher mean body mass index (BMI) (34.0 vs. 28.5 kg/m²; p<0.001) compared to the control group. Higher rates of alcohol use (59.2% vs. 41.2%; p=0.006) and hormonal therapy use (41.3% vs. 17.9%; p<0.001) were found in the standard dressing group. Univariate analyses showed no significant differences in donor-site postoperative outcomes across the groups. However, multivariate logistic regression models demonstrated a reduced likelihood of surgical site infection (OR 0.187; 95% CI 0.045-0.768); p=0.020), and wound dehiscence (OR 0.338; 95% CI 0.155-0.738); p=0.006) among the ciNPT users. Particularly, in patients with BMI >30 kg/m², ciNPT use (OR 0.282; 95% CI 0.098-0.812; p=0.019) was found to be a significant protective factor against wound complications compared to the standard of care.

Conclusions: Our findings suggest that ciNPT may improve wound complication rates in DIEP flap donor sites, especially in patients with high BMI. Further research is necessary to elucidate the cost-effectiveness of ciNPT based on the patient risk profiles.

Keywords: Breast Neoplasm; Female; Free Tissue Flaps; Negative Pressure Wound Therapy; Postoperative Complications; Retrospective Studies.

MeSH terms

Adult
Epigastric Arteries / transplantation
Female
Humans
Mammaplasty* / adverse effects
Mammaplasty* / methods
Middle Aged
Negative-Pressure Wound Therapy* / methods
Perforator Flap* / blood supply
Perforator Flap* / transplantation
Postoperative Complications* / etiology
Postoperative Complications* / prevention & control
Retrospective Studies
Surgical Wound Infection / prevention & control
Transplant Donor Site*