Complications associated with abdominal incisional wound vacuum assisted closure following deep inferior epigastric perforator flap harvest for breast reconstruction: A single institution retrospective study.

Background: The deep inferior epigastric perforator (DIEP) free flap reconstruction is a preferred breast reconstruction technique due to its muscle-sparing approach and patient satisfaction. However, donor-site complications, particularly wound dehiscence, remain a concern. Closed incision negative pressure wound therapy using wound vacuum assisted closure (VAC) systems may reduce these complications by enhancing perfusion and minimizing edema. This study evaluated the association between postoperative wound VAC use and complications in DIEP flap reconstruction.

Methods: A retrospective cohort study was conducted at the University of Colorado, comparing the postoperative outcomes in patients who received closed incision negative pressure therapy (VAC) during DIEP flap reconstruction to those who did not (No VAC). Demographic and clinical characteristics, as well as 90-day abdominal complications, were compared between the cohorts. Statistical analyses included t-test, Wilcoxon rank-sum test, Chi-squared test, and multivariable logistic regression, with a p-value of ≤0.05 considered significant.

Results: From 2021 to 2023, 302 patients were identified, with 114 (38%) receiving a wound VAC. The VAC group was older (mean age 53±10 vs. 50±10 years, p=0.03) and had longer operative times (534±108 vs. 495±110 min, p=0.003). No significant differences were observed in body mass index, ASA class, or most comorbidities. Complications such as hematoma, seroma, infection, wound dehiscence, bulge, hernia, ED visits, and readmissions showed no significant differences between the groups. Multivariable regression indicated a non-significant trend toward fewer complications with VAC use (adjusted OR 0.549, 95% CI 0.277-1.088, p=0.08).

Conclusion: The use of incisional VAC did not significantly reduce abdominal complications following DIEP flap reconstruction. However, a nonsignificant trend toward fewer complications suggests that further investigation with larger, multi-institutional studies is warranted.