Incisional negative pressure wound therapy following abdominoplasty and abdominal free flap surgery: a meta-analysis of outcomes and review of costs

Objective: Incisional negative pressure wound therapy (iNPWT) is purported to enhance wound healing and reduce the incidence of surgical site wound complications (SSWCs). This systematic review and meta-analysis aimed to evaluate the efficacy and associated costs of iNPWT for abdominoplasty or abdominal free flap donor site surgeries. Method: A literature review was undertaken for studies relating to iNPWT and SSWCs following abdominoplasty or abdominal free flap procedures. Results: After applying the exclusion criteria, 12 studies were identified, incorporating 517 and 589 patients in the iNPWT and control groups, respectively. Pooled analysis identified a significant reduction in the incidence of wound dehiscence in the iNPWT group compared with the control arm (11.7% versus 20.2%, respectively; p<0.05), with meta-analysis demonstrating a relative risk (RR) of 0.60 in the iNPWT group versus controls (RR: 0.60, 95% confidence interval: 0.42-0.87, I2=0%; p=0.85). Incidence of all other SSWCs was comparable between both groups. The two studies which reported associated healthcare costs found iNPWT to be comparable with standard of care. Conclusion: This systematic review and meta-analysis provides evidence to support the judicious use of iNPWT to reduce wound dehiscence in high-risk abdominoplasty and abdominal free flap donor site surgeries. The evidence for reduction of other SSWCs is lacking, and any effect is likely to be minimal. Heterogeneity and poor study design limit the strength of these quantitative findings, and higher quality randomised controlled trials are required in this area.