Negative Pressure Wound Therapy and Donor Site Morbidity in DIEP and Tram Flap Reconstruction: A Single-Center Longitudinal Review

Abstract Abdominally based breast free flap reconstruction exposes patients to potential significant donor site morbidity. Utilization of postoperative Incisional Negative Pressure Wound Therapy (iNPWT) has been proposed to minimize incision site complications. This study aims to assess if iNPWT reduces rates of donor site complications after DIEP and TRAM flap harvest. This single-center, retrospective study included patients who underwent Deep Inferior Epigastric Artery (DIEP) or Transverse Rectus Abdominis Muscle (TRAM) flap reconstruction from 2022 to 2024. Patients' abdominal donor sites received either standard wound care or iNPWT at the time of reconstruction. A total of 362 patients were identified with a median age of 51.3 (IQR: 43.3–59.6) years. Rates of delayed healing at the donor site were lower in the iNPWT cohort compared to standard of care (13.4% vs. 35.3%, p < 0.001). Controlling for tobacco exposure, diabetes, hypertension, and laterality, there was a lower likelihood of delayed healing in the iNPWT cohort (OR: 0.249 [0.14–0.43], p < 0.001). This finding persisted in current and former smokers (OR: 0.269 [0.16–0.46], p < 0.001) and patients with comorbid hypertension (OR: 0.257 [0.15–0.44], p < 0.001). These results suggest iNPWT usage is associated with lower rates of donor site delayed healing after DIEP and TRAM procedures in the general patient population and should be considered in those with two or more vascular risk factors. Further investigation is required to stratify the risk of delayed healing for patients with concomitant hypertension, tobacco exposure, diabetes, and/or obesity.