Randomized controlled trial comparing single-use negative-pressure wound therapy (sNPWT) with standard dressings during tissue expander-to-implant exchanges. Assessment of risk factors for impaired wound healing and clinical indications for sNPWT.

BACKGROUND

Breast reconstruction is a key step in the physical and social recovery of breast cancer patients. Optimal wound healing is crucial not only for aesthetic outcomes but also for the uninterrupted continuation of adjuvant oncologic therapy, which can significantly impact overall prognosis.

PURPOSE: The study compared single-use negative pressure wound therapy (sNPWT) with standard dressings during the second stage of breast reconstruction - tissue expander-to-implant exchanges. Additionally, it aimed to identify factors associated with an increased risk of impaired wound healing and postoperative complications, to determine clinical conditions in which the prophylactic use of sNPWT is most beneficial.

METHODS

The study evaluated 38 women undergoing the second stage of two-stage breast reconstruction after unilateral mastectomy. Each patient received either sNPWT or a standard dressing postoperatively, with allocation randomized and independent of both physician and patient. Scar characteristics, including elasticity, temperature, healing, and appearance, were assessed.

RESULTS

A significant difference in skin elasticity in favor of sNPWT was observed after 7 days, while the most pronounced difference was seen after 6 months (mean 0.688 vs. 0.480). No significant differences were found in temperature. Visually, sNPWT-treated scars appeared narrower and less prominent. The mathematical model identified radiotherapy as the only factor significantly associated with poor healing (p-value = 0.025).

CONCLUSION

Compared to standard dressings, sNPWT demonstrates clear advantages in improving scars' elasticity and aesthetic appearance. Its application significantly reduces postoperative complications, including the risk of implant loss, making it a valuable option in breast reconstruction.