Incisional Negative Pressure Wound Therapy for Deep Inferior Epigastric Perforator (DIEP) Flap Donor Site in Breast Reconstruction: Does It Impact Wound Healing?

Introduction The deep inferior epigastric artery perforator (DIEP) flap is widely used for breast reconstruction, with donor site complications influenced by various factors. This study assessed the impact of incisional negative pressure wound therapy (iNPWT) on donor site healing compared to standard dressings (SD). Methods A retrospective review of DIEP flap reconstructions performed between 2017 and 2022 was conducted. Donor sites were managed with either SD or iNPWT (PREVENA PLUS™, 3M). Outcomes assessed included donor-site complications, drain duration, length of stay, and readmissions. Predictors of complications were analyzed using univariable and multivariable logistic regression. Results A total of 320 patients were included; iNPWT was applied in 165 (51.6%) and SD in 155 (48.4%). Baseline demographics and comorbidities were comparable between groups. Complication rates within 30 days were 23.0% for iNPWT and 27.1% for SD (p = 0.401); iNPWT use was associated with significantly earlier drain removal (median 13 vs. 17 days, p = 0.004). Multivariable analysis identified smoking as an independent predictor of donor-site complications (aOR 1.74, 95% CI 1.05–2.86, p = 0.030); iNPWT was not significantly associated with reduced complication rates (OR 1.00, 95% CI 0.64–1.58, p = 0.977). Conclusions Smoking was confirmed as a significant predictor of donor-site morbidity. While iNPWT did not lower overall complication rates, it modestly reduced drain duration. Further prospective studies are warranted to define its role in DIEP flap reconstruction. Level of Evidence Level III, therapeutic study