An Observational, Prospective Multicentre Clinical Study to Assess the Safety and Clinical Performance of a New Single-use Negative Pressure Wound Therapy System (PICO 7Y) for the Simultaneous Management of Bilateral Closed Incisions in Oncoplastic Breast Surgery Patients

It is thought that Negative Pressure Wound Therapy may have numerous mechanisms of action when used to manage surgical incisions, including reducing oedema, stimulating perfusion and managing exudate. Post-operative oedema in the peri-wound tissue is thought to limit tissue perfusion and high levels of wound fluid loss have been correlated with increased risk of post-operative infection and dehiscence23. Application of NPWT to the closed wound has been reported to improve patient comfort through reduced dressing changes and to lessen the period during which post-operative fluid discharges from the incision. Xia et al (2014)24 demonstrated that in 20 patients with infected wounds, NPWT resulted in significantly increased blood flow in the wounds when compared to pre application levels. In a study by Young et al (2013)25 four patients with pressure ulcers had oedema and wound bed thickness assessed during follow-up. They demonstrated a rapid reduction of peri-wound tissue oedema over four days and a 20% increase in the thickness of the wound bed by seven days of therapy.

Risk factors such as smoking and obesity have shown to increase complications follow oncoplastic surgery26 and it is possible that such populations could benefit more from the application of the NPWT. Furthermore there are a number of bilateral or multi wound indications where provision of a single device with the Y connection may represent a cost saving to the healthcare system. However, ultimately the use of NPWT for oncoplastic breast surgery closed incisions will be judged on whether it can increase the healing success rate while minimising complications. Holt and Murphy (2015)27 assessed the use of PICO single use NPWT system when applied to 24 patients with closed incisions following therapeutic resection. The contralateral breast underwent simultaneous symmetrising breast reduction with standard care dressings applied allowing for direct comparison. Although the cohort was too small to draw meaningful statistical conclusions they noted a lower incidence of wound breakdown (4.2% vs. 16.7%) and shorter time to healing (10.7 days vs. 16.1 days) in the NPWT group. However, this difference was partly attributed to the more extensive and complex nature of the therapeutic surgery. Similarly in a category of patients undergoing breast surgery with primary wound closure, Pellino et al (2014)19 showed significantly lower surgical site events when treated with PICO.