Skip to main content
Top
Published in: Aesthetic Plastic Surgery 4/2018

Open Access 01-08-2018 | Original Article

Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality

Authors: V. Tanaydin, J. Beugels, A. Andriessen, J. H. Sawor, R. R. W. J. van der Hulst

Published in: Aesthetic Plastic Surgery | Issue 4/2018

Login to get access

Abstract

Background

Negative pressure wound therapy (NPWT) for postsurgical incision treatment has demonstrated benefits. A prospective randomized study was developed including 32 patients who underwent bilateral breast reduction mammoplasty. Patients served as their own control and received NPWT to one breast and fixation strips to the other breast.

Methods

The primary outcome was the number of wound healing complications within 21 days when comparing NPWT treatment with fixation strips. The secondary outcome was aesthetic appearance and quality of scarring using questionnaires [visual analogue scale (VAS) and Patient and Observer Scar Assessment Scale (POSAS)] scored at day 42-, 90-, 180- and 365-day follow-up using additional scar measurement modalities, such as viscoelasticity.

Results

For the 32 included patients, the number of wound complications was significantly lower (p < 0.004) for the NPWT treated sites compared to fixation strips. POSAS and VAS scores at 42 and 90 days revealed a significantly better quality of scarring in the NPWT treatment breasts than in fixation strips. At 180-day follow-up, there was a significant improvement in VAS scores, as well as a comparable improvement in POSAS scores. No consistent significant improvement in scar quality was demonstrated with the assays that were used.

Conclusions

Our study showed less complications and a significant improvement in quality of scarring in favor of the NPWT-treated sites. The results indicate NPWT to be an attractive option for these patients.

Level of Evidence II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
go back to reference Shermak MA, Chang D, Buretta K, Mithani S, Mallalieu J, Manahan M (2011) Increasing age impairs outcomes in breast reduction surgery. Plast Reconstr Surg 128:1182–1187CrossRefPubMed Shermak MA, Chang D, Buretta K, Mithani S, Mallalieu J, Manahan M (2011) Increasing age impairs outcomes in breast reduction surgery. Plast Reconstr Surg 128:1182–1187CrossRefPubMed
2.
go back to reference Eggert E, Schuss R, Edsander-Nord A (2009) Clinical outcome, quality of life, patients’ satisfaction, and aesthetic results, after reduction mammaplasty. Scand J Plast Reconstr Surg Hand Surg 43:201–206CrossRefPubMed Eggert E, Schuss R, Edsander-Nord A (2009) Clinical outcome, quality of life, patients’ satisfaction, and aesthetic results, after reduction mammaplasty. Scand J Plast Reconstr Surg Hand Surg 43:201–206CrossRefPubMed
3.
go back to reference Cunningham BL, Gear AJ, Kerrigan CL, Collins ED (2005) Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg 115:1597–1604CrossRefPubMed Cunningham BL, Gear AJ, Kerrigan CL, Collins ED (2005) Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg 115:1597–1604CrossRefPubMed
4.
go back to reference Henry SL, Crawford JL, Puckett CL (2009) Risk factors and complications in reduction mammaplasty: novel associations and preoperative assessment. Plast Reconstr Surg 124(4):1040–1046CrossRefPubMed Henry SL, Crawford JL, Puckett CL (2009) Risk factors and complications in reduction mammaplasty: novel associations and preoperative assessment. Plast Reconstr Surg 124(4):1040–1046CrossRefPubMed
5.
go back to reference Makki AS, Ghanem AA (1998) Long-term results and patient satisfaction with reduction mammaplasty. Ann Plast Surg 41:370–377CrossRefPubMed Makki AS, Ghanem AA (1998) Long-term results and patient satisfaction with reduction mammaplasty. Ann Plast Surg 41:370–377CrossRefPubMed
6.
go back to reference Meshulam-Derazon S, Barnea Y, Zaretski A, Leshem D, Miller U, Meilik B et al (2009) Large-volume breast reduction: long-term results. Scand J Plast Reconstr Surg Hand Surg 43:65–70CrossRefPubMed Meshulam-Derazon S, Barnea Y, Zaretski A, Leshem D, Miller U, Meilik B et al (2009) Large-volume breast reduction: long-term results. Scand J Plast Reconstr Surg Hand Surg 43:65–70CrossRefPubMed
7.
go back to reference Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38(6):563–576 (discussion 577) CrossRefPubMed Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38(6):563–576 (discussion 577) CrossRefPubMed
8.
go back to reference Armstrong DG, Lavery LA, Diabetic Foot Study Consortium (2005) Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 366(9498):1704–1710CrossRefPubMed Armstrong DG, Lavery LA, Diabetic Foot Study Consortium (2005) Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 366(9498):1704–1710CrossRefPubMed
9.
go back to reference Mandal A (2007) Role of topical negative pressure in pressure ulcer management. J Wound Care 16:33–35CrossRefPubMed Mandal A (2007) Role of topical negative pressure in pressure ulcer management. J Wound Care 16:33–35CrossRefPubMed
10.
go back to reference Morykwas MJ, Simpson J, Punger K, Argenta A, Kremers L, Argenta J (2006) Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg 117(7 Suppl):121S–126SCrossRefPubMed Morykwas MJ, Simpson J, Punger K, Argenta A, Kremers L, Argenta J (2006) Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg 117(7 Suppl):121S–126SCrossRefPubMed
11.
go back to reference Wilkes RP, Kilpad DV, Zhao Y, Kazala R, McNulty A (2012) Closed incision management with negative pressure wound therapy (CIM): biomechanics. Surg Innov 19(1):67–75CrossRefPubMed Wilkes RP, Kilpad DV, Zhao Y, Kazala R, McNulty A (2012) Closed incision management with negative pressure wound therapy (CIM): biomechanics. Surg Innov 19(1):67–75CrossRefPubMed
12.
go back to reference Stannard JP, Robinson JT, Anderson ER, McGwin G Jr, Volgas DA, Alonso JE (2006) Negative pressure wound therapy to treat hematomas and surgical incisions following highenergy trauma. J Trauma 60:1301–1306CrossRefPubMed Stannard JP, Robinson JT, Anderson ER, McGwin G Jr, Volgas DA, Alonso JE (2006) Negative pressure wound therapy to treat hematomas and surgical incisions following highenergy trauma. J Trauma 60:1301–1306CrossRefPubMed
13.
go back to reference Stannard JP, Volgas DA, McGwin G 3rd et al (2012) Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma 26(1):37–42CrossRefPubMed Stannard JP, Volgas DA, McGwin G 3rd et al (2012) Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma 26(1):37–42CrossRefPubMed
15.
go back to reference Draaijers LJ et al (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113(7):1960–1965 (discussion 1966–1967) CrossRefPubMed Draaijers LJ et al (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113(7):1960–1965 (discussion 1966–1967) CrossRefPubMed
16.
go back to reference van de Kar AL et al (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 116(2):514–522CrossRefPubMed van de Kar AL et al (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 116(2):514–522CrossRefPubMed
17.
go back to reference Duncan JA et al (2006) Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plast Reconstr Surg 118(4):909–918CrossRefPubMed Duncan JA et al (2006) Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plast Reconstr Surg 118(4):909–918CrossRefPubMed
18.
go back to reference Durani P, McGrouther DA, Ferguson MW (2009) Current scales for assessing human scarring: a review. J Plast Reconstr Aesthet Surg 62(6):713–720CrossRefPubMed Durani P, McGrouther DA, Ferguson MW (2009) Current scales for assessing human scarring: a review. J Plast Reconstr Aesthet Surg 62(6):713–720CrossRefPubMed
19.
go back to reference Micomonaco DC et al (2009) Development of a new visual analogue scale for the assessment of area scars. J Otolaryngol Head Neck Surg 38(1):77–89PubMed Micomonaco DC et al (2009) Development of a new visual analogue scale for the assessment of area scars. J Otolaryngol Head Neck Surg 38(1):77–89PubMed
20.
go back to reference Enomoto DN et al (1996) Quantification of cutaneous sclerosis with a skin elasticity meter in patients with generalized scleroderma. J Am Acad Dermatol 35(3 Pt 1):381–387CrossRefPubMed Enomoto DN et al (1996) Quantification of cutaneous sclerosis with a skin elasticity meter in patients with generalized scleroderma. J Am Acad Dermatol 35(3 Pt 1):381–387CrossRefPubMed
21.
go back to reference Fong SS, Hung LK, Cheng JC (1997) The cutometer and ultrasonography in the assessment of postburn hypertrophic scar—a preliminary study. Burns 23(Suppl 1):S12–S18CrossRefPubMed Fong SS, Hung LK, Cheng JC (1997) The cutometer and ultrasonography in the assessment of postburn hypertrophic scar—a preliminary study. Burns 23(Suppl 1):S12–S18CrossRefPubMed
22.
go back to reference Draaijers LJ et al (2004) Skin elasticity meter or subjective evaluation in scars: a reliability assessment. Burns 30(2):109–114CrossRefPubMed Draaijers LJ et al (2004) Skin elasticity meter or subjective evaluation in scars: a reliability assessment. Burns 30(2):109–114CrossRefPubMed
23.
go back to reference Suissa D, Danino A, Nikolis A (2011) Negative-pressure therapy versus standard wound care: a meta-analysis of randomized trials. Plast Reconstr Surg 128(5):498e–503eCrossRefPubMed Suissa D, Danino A, Nikolis A (2011) Negative-pressure therapy versus standard wound care: a meta-analysis of randomized trials. Plast Reconstr Surg 128(5):498e–503eCrossRefPubMed
24.
go back to reference Stannard JP, Volgas DA, Stewart R, McGwin G Jr, Alonso JE (2009) Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma 23:552–557CrossRefPubMed Stannard JP, Volgas DA, Stewart R, McGwin G Jr, Alonso JE (2009) Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma 23:552–557CrossRefPubMed
25.
go back to reference Kanakaris NK, Thanasas C, Keramaris N, Kontakis G, Granick MS, Giannoudis PV (2007) The efficacy of negative pressure wound therapy in the management of lower extremity trauma: review of clinical evidence. Injury 38(Suppl 5):S9–S18PubMed Kanakaris NK, Thanasas C, Keramaris N, Kontakis G, Granick MS, Giannoudis PV (2007) The efficacy of negative pressure wound therapy in the management of lower extremity trauma: review of clinical evidence. Injury 38(Suppl 5):S9–S18PubMed
26.
go back to reference Molnar JA, Simpson JL, Voignier DM, Morykwas MJ, Argenta LC (2005) Management of an acute thermal injury with subatmospheric pressure. J Burns Wounds 4:e5PubMedPubMedCentral Molnar JA, Simpson JL, Voignier DM, Morykwas MJ, Argenta LC (2005) Management of an acute thermal injury with subatmospheric pressure. J Burns Wounds 4:e5PubMedPubMedCentral
27.
go back to reference Llanos S, Danilla S, Barraza C, Armijo E, Piñeros JL, Quintas M, Searle S, Calderon W (2006) Effectiveness of negative pressure closure in the integration of split thickness skin grafts: a randomized, double masked, controlled trial. Ann Surg 244:700–705CrossRefPubMedPubMedCentral Llanos S, Danilla S, Barraza C, Armijo E, Piñeros JL, Quintas M, Searle S, Calderon W (2006) Effectiveness of negative pressure closure in the integration of split thickness skin grafts: a randomized, double masked, controlled trial. Ann Surg 244:700–705CrossRefPubMedPubMedCentral
28.
go back to reference Stevens P (2009) Vacuum-assisted closure of laparotomy wounds: a critical review of the literature. Int Wound J 6:259–266CrossRefPubMed Stevens P (2009) Vacuum-assisted closure of laparotomy wounds: a critical review of the literature. Int Wound J 6:259–266CrossRefPubMed
29.
go back to reference Sjogren J, Gustafsson R, Nilsson J, Lindstedt S, Nozohoor S, Ingemansson R (2011) Negative-pressure wound therapy following cardiac surgery: bleeding complications and 30-days mortality in 176 patients with deep sternal wound infection. Interact CardioVasc Thorac Surg 12(12):117–120CrossRefPubMed Sjogren J, Gustafsson R, Nilsson J, Lindstedt S, Nozohoor S, Ingemansson R (2011) Negative-pressure wound therapy following cardiac surgery: bleeding complications and 30-days mortality in 176 patients with deep sternal wound infection. Interact CardioVasc Thorac Surg 12(12):117–120CrossRefPubMed
30.
go back to reference Atkins BZ, Wooten MK, Kistler J, Hurley K, Hughes GC, Wolfe WG (2009) Does negative pressure wound therapy have a role in preventing poststernotomy wound complications? Surg Innov 16(2):140–146CrossRefPubMed Atkins BZ, Wooten MK, Kistler J, Hurley K, Hughes GC, Wolfe WG (2009) Does negative pressure wound therapy have a role in preventing poststernotomy wound complications? Surg Innov 16(2):140–146CrossRefPubMed
31.
go back to reference Reddix RN Jr, Tyler HK, Kulp B, Webb LX (2009) Incisional vacuum-assisted wound closure in morbidly obese patients undergoing acetabular fracture surgery. Am J Orthop 38:32–35 Reddix RN Jr, Tyler HK, Kulp B, Webb LX (2009) Incisional vacuum-assisted wound closure in morbidly obese patients undergoing acetabular fracture surgery. Am J Orthop 38:32–35
32.
go back to reference Reddix RN Jr, Leng XI, Woodall J, Jackson B, Dedmond B, Webb LX (2010) The effect of incisional negative pressure therapy on wound complications after acetabular fracture surgery. J Surg Orthop Adv 19:91–97PubMed Reddix RN Jr, Leng XI, Woodall J, Jackson B, Dedmond B, Webb LX (2010) The effect of incisional negative pressure therapy on wound complications after acetabular fracture surgery. J Surg Orthop Adv 19:91–97PubMed
34.
go back to reference Galiano RD, Hudson D, Shin J, van der Hulst R, Tanaydin V, Djohan R, Duteille F, Cockwill J, Megginson S, Huddleston E (2018) Incisional negative pressure wound therapy for prevention of wound healing complications following reduction mammaplasty. Plast Reconstr Surg Global Open. https://doi.org/10.1097/GOX.0000000000001560 Galiano RD, Hudson D, Shin J, van der Hulst R, Tanaydin V, Djohan R, Duteille F, Cockwill J, Megginson S, Huddleston E (2018) Incisional negative pressure wound therapy for prevention of wound healing complications following reduction mammaplasty. Plast Reconstr Surg Global Open. https://​doi.​org/​10.​1097/​GOX.​0000000000001560​
35.
go back to reference Posnett J, Gottrup F, Lundgren H, Saal G (2009) The resource impact of wounds on healthcare providers in Europe. J Wound Care 18(4):154–161CrossRefPubMed Posnett J, Gottrup F, Lundgren H, Saal G (2009) The resource impact of wounds on healthcare providers in Europe. J Wound Care 18(4):154–161CrossRefPubMed
Metadata
Title
Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality
Authors
V. Tanaydin
J. Beugels
A. Andriessen
J. H. Sawor
R. R. W. J. van der Hulst
Publication date
01-08-2018
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 4/2018
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-018-1095-0

Other articles of this Issue 4/2018

Aesthetic Plastic Surgery 4/2018 Go to the issue