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Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-23-00938
00002
10.1097/GOX.0000000000006115
3
Cosmetic
Ideas and Innovations
Optimizing Negative Pressure Wound Therapy in Abdominoplasty Incisions: Chevron Modification
Ali Stephen R. BM, MMedSc (Hons), PGCert (MedEd), PGCert (Mgmt), MAcadMEd, FHEA, DMCC, MRCS (Eng) *†
Swarnkar Parinita MBBS, iBSc (Hons) *†
Whitaker Iain S. MA Cantab, PhD, FRCS(Plast), FAcadTM *†
From the * Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, United Kingdom
† Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom.
Parinita K. Swarnkar, MBBS, iBSc, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, United Kingdom, E-mail: pariswarnkar@hotmail.com
9 2024
03 9 2024
12 9 e611516 10 2023
17 6 2024
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Summary:

There has been increased use of negative pressure wound therapy (NPWT) to aid closure of abdominoplasty incisions; this obviates previous complications, including delayed wound healing. We describe a reproducible method of NPWT-assisted wound healing applicable to abdominal wounds. We propose a modified method of NPWT application, specific to the to Avance Solo NPWT system, to achieve optimal wound healing by promoting a suitable environment and decreasing high-tension forces. Postoperatively, this technique enables patient and nursing ease owing to increased durability and drainless follow-up. This is further emphasized by the results of a quantitative analysis of a 100-patient case series measuring clinically relevant objective and patient-satisfaction outcomes, and the cost analysis of use.

OPEN-ACCESSTRUE
COUNTRYUNITED KINGDOM
SDCT
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pmcTakeaways

Question: How can dressings for negative pressure wound therapy be applied to provide a robust seal and promote optimal healing in abdominoplasty surgery?

Findings: Introducing a vertical dressing limb into the horizontal dressing limb has theoretical advantage in dissipating the pressure and providing a more robust central seal.

Meaning: By applying a vertical dressing limb into the conventionally used horizontal dressing limb, we are able to dissipate pressure, provide a robust seal and promote optimal healing.

Negative pressure wound therapy (NPWT) has become an important tool for promoting wound healing in plastic surgery, and is emerging as a tool in the management of closed abdominoplasty incisions. Studies such as the retrospective case-control series by Abatangelo et al, and the prospective study by Abesamis et al have showcased its benefits.1,2 Their findings, along with a systematic review by Gallo et al, highlight the promising effects of NPWT in reducing complications and promoting wound healing.3 Before the adoption of NPWT, our clinical experience involved occasional delayed wound healing and stretched scarring, particularly at the central portion of the abdominoplasty closure (point of maximal tension), in addition to pooling of fluid in the umbilicus. This prompted our search for a more effective wound management approach, steering us toward the exploration and eventual integration of NPWT into our practice.

However, in the senior author’s experience, it has been observed that if the neo-umbilicus is not incorporated into the closed system, it can become wet and macerated with convention dressings. In our practice, we use the Avance Solo (Mölnlycke, Sweden) NPWT system for 2 weeks, which is a portable and easy-to-use battery-powered NPWT device that administers continuous negative pressure at -125 mm Hg. We prefer to modify the NPWT system by introducing a vertical dressing limb into the horizontal dressing limb. Our findings suggest that the combined effect of the dressing and negative pressure significantly enhances wound healing, as evidenced by reduced pooling in the umbilicus and a theoretical extravertical vector to reduce tension.

The absorptive multilayer dressing used in the Avance Solo NPWT system is an important component that helps to absorb excess fluid and promote healing (Fig. 1). However, it is important to avoid overlapping the vertical and horizontal limbs to prevent a poor seal. The wound contact layer is composed of a semipermeable silicone layer, which, if it overlaps the backing material, compromises the effectiveness of the NPWT and alarms the device. By modifying the dressing with the creation of a chevron incision pattern at the T-junction, the cross-sectional 3D surface area is increased and contact between the horizontal and vertical limbs of the NPWT system enhanced, improving the ability to distribute negative pressure throughout the dressing. (See figure, Supplemental Digital Content 1, which displays dressing modification at the T-junction. http://links.lww.com/PRSGO/D467.) It is important to avoid any gapping at the T-junction, as we have noticed that the intervening skin can become macerated. However, a silicone-based dressing (eg, Atrauman) can be used in addition to the system and placed under the primary dressing to mitigate this. This is not included in the standard Avance Solo system but is an adjunct we have found useful in enhancing the dressing protocol. A border dressing is then used to close the system and maintain negative pressure.

Fig. 1. Cross section of Avance Solo multilayer border dressing.

In our experience, the modified NPWT dressing proves to be highly manageable and patient-friendly. The dressing is designed to be waterproof, with excellent adhesive quality and flexibility, allowing it to remain in place effectively for up to 2 weeks without the need for a change. This durability significantly contributes to the ease of maintenance. Patients are advised to wear an abdominal binder for a period of 6 weeks postoperation to ensure optimal healing and support. The duration of the hospital stay varies from a day case to overnight, depending on the individual patient and the extent of the surgery performed. Throughout the course of the dressing being in place, patients are instructed to avoid heavy lifting or bending for 6 weeks to facilitate unimpeded healing. This technique is drainless, further simplifying postoperative care. We conduct a follow-up at our dressing clinic 2 weeks and 3 months postoperatively to assess the progress and address any concerns.

In a retrospective analysis of the last 100 abdominoplasty procedures undertaken by the senior author, predominantly in patients without massive weight loss (90%), with a body mass index of less than 28 kg per m2, all nonsmokers, and with an ASA score of less than 2, we noted the following outcomes: infection requiring oral antibiotics (3%), no cases requiring re-admission for intravenous antibiotics, wound necrosis requiring re-admission and debridement (2%), seroma (3%), and no cases of umbilical necrosis. Our data substantiate a high level of patient satisfaction and corroborate the efficacy of our technique in yielding a notably low incidence of wound complications. Incorporating the Avance Solo NPWT system in postoperative care incurs a total cost of £215.50. This includes the Avance Solo “Pump Kit” (£154.00), and two sizes of Avance Solo border dressings with tubing (£28.50 and £34.00). We feel that the effectiveness and patient outcomes achieved with this system are commensurate with its cost, offering an effective solution for wound management postabdominoplasty.

DISCLOSURES

S.R.A. is funded by the Welsh Clinical Academic Training Fellowship. I.S.W. is the surgical Specialty Lead for Health and Care Research Wales, and reports active grants from the American Association of Plastic Surgeons and the European Association of Plastic Surgeons; is an associate editor for the Annals of Plastic Surgery, editorial board of BMC Medicine and numerous other editorial board roles. S.R.A. received a grant from the British Association of Plastic, Reconstructive and Aesthetic Surgeons specifically for this work. The other author has no financial interest to declare in relation to the content of this article. The Reconstructive Surgery & Regenerative Medicine Research Center is funded by The Scar Free Foundation and Health and Care Research Wales. The Scar Free Foundation is the only medical research charity focused on scarring with the mission to achieve scar free healing within a generation. The authors have no financial interest to declare in relation to the content of this article.

Supplementary Material

Published online 3 September 2024.

Disclosure statements are at the end of this article, following the correspondence information.

Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com.
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REFERENCES

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2. Abesamis GM Chopra S Vickery K . A comparative trial of incisional negative-pressure wound therapy in abdominoplasty. Plast Reconstr Surg Glob Open. 2019;7 :e2141.31333924
3. Gallo L Gallo M Chin B . Closed incision negative pressure therapy versus traditional dressings for low transverse abdominal incisions healing by primary closure: a systematic review and meta-analysis. Plast Surg. 2022;31 :390–400.
