Abstract: Use of Negative Pressure Wound Therapy with Instillation in Acute Post-Surgical Breast Reconstruction Infections—Retrospective Review

Abstract

INTRODUCTION: In recent years, combining instillation of a topical wound solution with negative pressure wound therapy (NPWT) has facilitated wound cleansing. Furthermore, published studies have positively reported on the use of a NPWT system with automated instillation and a dwell time (NPWTi-d) that provides a method of cyclically instilling and dwelling topical solutions to help improve healing outcomes of acute and chronic wounds. Our purpose was to analyze our outcomes of patients who received adjunctive NPWTi-d with a polyhexanide solution to address surgical site occurrences (SSO) following first stage expander-implant breast reconstruction. METHODS: A retrospective record review was conducted. Patient data were extracted from the electronic medical record by means of manual review and stored in a database. Adult patient records were included for analysis if the patient underwent a mastectomy followed by immediate or delayed expander reconstruction, had infection of at least one pocket confirmed via culture, had received oral and systemic antibiotics for at least one week, and subsequently received NPWTi-d. All procedures were completed between January 1, 2016 and February 1, 2017. Demographics, surgical approach, comorbidities and expander salvage rate were recorded and analyzed. Six female patients with a median age of 50.8 were included in the analysis. Five of 6 patients had undergone sub-pectoral expander reconstruction and one patient received pre-pectoral expander reconstruction. Antibiotics were also continued based on specific cultures. All surgical site infections were thoroughly debrided and irrigated. Adjunctive NPWTi-d was initiated: instillation of a polyhexanide solution with a 20-minute dwell time, followed by 3.5 hours of -125 mmHg negative pressure. Duration of therapy ranged from 1–3 days. RESULTS: Salvage of the expander was achieved in all 6 patients. None of the pockets showed signs of infection after application of NPWTi-d. Healthy granulation tissue was present in all NPWTi-d treated pockets. All breast incisions were successfully closed with good cosmetic results and without further sequelae. CONCLUSION: Tissue expanders could be salvaged in all 6 patients with SSOs in this series who received NPWTi-d. This small sample size does not allow for a reliable extrapolation to the general population. Although further studies are needed, the results from these 6 patients suggest that NPWTi-d may represent an important new adjunctive therapy option in device salvage for breast reconstruction patients.