A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

Background Mastectomy flap necrosis is a common and challenging complication of direct-to-implant (DTI) breast reconstruction. The PICO single-use negative-pressure wound therapy device may reduce the complications associated with skin flap necrosis. We evaluated the relationship between PICO use and the incidence of mild, moderate, and severe skin flap necrosis in patients at high risk of necrosis. Methods Using medical records from January 2015 to March 2019, we retrospectively analyzed patients who underwent DTI breast reconstruction after oncological breast surgery at a single institution and identified those at high risk for skin flap necrosis. During this period, PICO was used selectively for patients deemed to be at particularly high risk. Patient demographics, operative characteristics, and the degree of skin flap necrosis were compared according to whether PICO was used. Results Of 117 patients (122 breasts), 45 were deemed to be at high risk of skin flap necrosis. PICO was applied to 38 of these breasts, and seven breasts received a conventional dressing. Skin flap necrosis occurred in 30 breasts (24 in the PICO group [63.2%] vs. 6 in the no-PICO group [85.7%]). Significantly fewer cases of severe skin flap necrosis were observed in the PICO group (2/38 [5.3%]) than in the no-PICO group (3/7 [42.9%]) (P=0.004). There were no significant between-group differences in outcomes measured using BREAST-Q scores. Conclusions Use of a single-use negative-pressure wound therapy device can reduce the risk of severe skin flap necrosis in patients at high risk of skin flap complications associated with DTI breast reconstruction.