Abul Ahmad, Abel Ali, Al-Saffar Mohammad, Iskeirjeh Sara, Badran Saif
Department of Plastic and Reconstructive Surgery, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait; Al-Babtain Center for Burns & Plastic Surgery, Ibn Sina Hospital, Ministry of Health, Kuwait.
Department of Plastic and Reconstructive Surgery, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait; Department of Plastic and Reconstructive Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
J Plast Reconstr Aesthet Surg. 2025 Aug;107:151-161. doi: 10.1016/j.bjps.2025.06.032. Epub 2025 Jul 1.
Abdominal-based free tissue transfers, such as the Deep Inferior Epigastric Perforator (DIEP) flap, are widely utilized in autologous breast reconstruction. These procedures are often complicated by wound healing issues at the donor site, including wound dehiscence, seroma formation, and surgical site infections (SSIs). Closed Incision Negative Pressure Wound Therapy (ciNPWT) has been suggested to improve healing outcomes and reduce the incidence of postoperative complications. This synthesis evaluated the efficacy of ciNPWT compared to standard dressings in abdominal-based autologous breast reconstruction.
A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials and observational studies assessing ciNPWT versus standard dressings in patients undergoing abdominal-based free flap breast reconstruction were included. Primary and secondary outcomes analyzed were wound dehiscence, SSIs, seroma formation, and length of stay. Data from multiple databases were independently reviewed and synthesized using Review Manager 5.4 and Microsoft Excel. Studies were rigorously selected and assessed for risk of bias.
Of the 348 identified articles, 13 studies met the inclusion criteria, comprising three randomized controlled trials and 10 observational studies, totaling 2882 patients. The ciNPWT group showed a 42% reduction in wound dehiscence (OR 0.58, 95% CI 0.42-0.79; p = 0.0007), with moderate heterogeneity (I² = 36%). No significant differences were found for surgical site infections (OR 0.77, 95% CI 0.50-1.18; p = 0.23) and seroma formation (OR 0.66, 95% CI 0.38-1.12; p = 0.15). Variations in length of stay data prevented quantitative analysis.
ciNPWT demonstrates a significant reduction in wound dehiscence, highlighting its value in enhancing postoperative care, especially for high-risk patients. However, further research involving larger, multicenter randomized controlled trials is necessary to fully elucidate ciNPWT's role in reducing other complications and its broader clinical applicability.
基于腹部的游离组织移植，如腹壁下深动脉穿支（DIEP）皮瓣，广泛应用于自体乳房重建。这些手术常常因供区伤口愈合问题而复杂化，包括伤口裂开、血清肿形成和手术部位感染（SSIs）。闭合切口负压伤口治疗（ciNPWT）已被建议用于改善愈合效果并降低术后并发症的发生率。本综述评估了ciNPWT与标准敷料相比在基于腹部的自体乳房重建中的疗效。
按照PRISMA指南进行系统综述和荟萃分析。纳入评估ciNPWT与标准敷料在接受基于腹部的游离皮瓣乳房重建患者中的随机对照试验和观察性研究。分析的主要和次要结局包括伤口裂开、SSIs、血清肿形成和住院时间。来自多个数据库的数据使用Review Manager 5.4和Microsoft Excel进行独立审查和综合。对研究进行严格筛选并评估偏倚风险。
在348篇已识别的文章中，13项研究符合纳入标准，包括3项随机对照试验和10项观察性研究，共2882例患者。ciNPWT组伤口裂开减少42%（OR 0.58，95% CI 0.42 - 0.79；p = 0.0007），异质性中等（I² = 36%）。手术部位感染（OR 0.77，95% CI （0.50 - 1.18；p = 0.23）和血清肿形成（OR 0.66，95% CI 0.38 - 1.12；p = 0.15）未发现显著差异。住院时间数据的差异妨碍了定量分析。
ciNPWT显示伤口裂开显著减少，突出了其在加强术后护理中的价值，特别是对于高危患者。然而，需要进一步开展涉及更大规模、多中心随机对照试验的研究，以充分阐明ciNPWT在减少其他并发症方面的作用及其更广泛的临床适用性。
