The impact of closed-incision negative-pressure therapy on donor-site outcomes in drainless abdominal free flap breast reconstruction.

Abstract

Concerns regarding donor-site healing persist in abdominal-based free flap breast reconstruction. Although closed-incision negative-pressure therapy (CINPT) has demonstrated wound-related benefits, its efficacy without the use of drains remains unexplored. We evaluated the impact of CINPT compared with those of standard dressings on abdominal donor-site outcomes in drainless closure. We retrospectively reviewed patients with breast cancer who underwent abdominal-based free flap breast reconstruction without donor-site drains between January 2023 and April 2025. Patients received either CINPT (using the PICO system, Smith & Nephew) or the standard dressing (using Steri-Strips, 3M). Outcomes included fluid collections requiring aspiration, overall donor-site complications, and BREAST-Q abdomen scores. A total of 172 patients were included (CINPT group: 86 and standard group: 86). There were no significant differences in the incidence of donor-site fluid accumulation (26.7% vs. 22.1%, p = 0.478) or overall complications (4.7% vs. 5.8%, p = 1.000). CINPT showed higher early scar satisfaction at 2.6 months (2.3 ± 0.9 vs. 2.1 ± 0.8, p = 0.048); whereas other BREAST-Q subscales were comparable. In drainless abdominal-based free flap breast reconstruction, CINPT did not reduce fluid collections or other donor-site complications compared with standard dressings. Standard dressing may be a safe and sufficient option, whereas CINPT may offer benefits in early scar satisfaction.