Negative Pressure in PAP Donor Sites

Study Overview
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Brief Summary
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A retrospective chart review will be conducted to identify patients who received breast reconstruction using free profunda artery perforator (PAP) flap by the investigators from January 2015 to August 2021. The included patients will be grouped into two according to the application of incisional negative pressure wound therapy (NP) on the donor site. Patients' demographic data including their age at the surgery, body mass index (BMI), medical comorbidities including the hypertension and diabetes, and smoking history will be obtained from the retrospective chart review. Parameters of the flap will be carefully reviewed, including the flap harvested width, and flap harvested length, the flap harvested and used size, the size of the mastectomy, the ischemia time of the flap. The major interest is in the donor site management and patient's overall recovery. The complications of the donor site will be categorized into acute and chronic ones depending on the time of presence. Donor site complications, such as wound break down, hematoma, seroma, the total amount of the drainage will be recorded. The cutting time point for acute and chronic complications is 1 month. The total amount of drainage from the drainage tube inserted and the patients' off-bed time (day) will also be recorded. Besides, for patients with follow up time of more than 1 year, the scar will be evaluated using Vancouver scar scale. Statistics Data will be analyzed using graphing and statistical analysis software SPSS 21 software (IBM, Chicago, Illinois, USA). Rank sum and independent t test will be applied to calculate continuous variables in demographic values, while Chi-square will be applied to calculate categorical variables such as postoperative complications. A probability of less than 0.05 will be considered significant. Potential risks: No Confidentiality: All the patient identifiable information, which includes name, chart number and birthday, involved in the study will be strictly confidential.

Official Title
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Closed Incision Negative Pressure Therapy in Transverse Donor Site Closure of Free Profunda Artery Perforator Flap for Breast Reconstruction

Conditions
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Breast Reconstruction

Intervention / Treatment
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* Device: Closed incisional negative pressure wound therapy (iNPWT) system


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients who underwent unilateral microsurgical breast reconstruction using PAP flaps from the PI (JJH) from November 2016 to August 2020 Exclusion Criteria: patients with delayed reconstruction
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control<br>Patients who did not receive the application of iNPWT at the donor site. | |
| Negative pressure<br>Patients who received the application of iNPWT at the donor site. | Device: Closed incisional negative pressure wound therapy (iNPWT) system<br>* The closed incisional negative pressure wound therapy (iNPWT) system (PREVENA Incision Management System, KCI, an Acelity company, San Antonio, Texas, USA)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Off-bed time (days) |  | post-operative 14 days | 
| Drainage amount (ml) |  | post-operative 14 days | 
| Vacuum ball removed timing |  | post-operative 14 days | 
| Vancouver Scar Scale (VSS) | Score range from 0-13, used to measure scar the scar appearance. The lower means a better outcome. | 1 year after surgery | 
| Re-open | Whether the patient return to the operation room to check the blood flow or re-do the anastomosis. | post-operative 14 days | 
| Donor site acute complication (< 30 days) |  | post-operative 30 days | 
| Donor site chronic complication (> 30 days) |  | 1 year after surgery | 
| Donor site revision | Whether the patient received scar revision surgery on the donor site where the tissue harvested for breast reconstruction. | 1 year after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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breast reconstruction, profunda artery perforator flap, tensioned wound healing, negative pressure