The Use of Negative Pressure Wound Therapy as an Adjunct Treatment in Patients Undergoing Sternal Wound Reconstruction With Pectoralis Major Flaps

BACKGROUND: Deep sternal wound infection and dehiscence following median sternotomy remain challenging clinical problems with high morbidity. Negative pressure wound therapy (NPWT) has been reported to improve wound healing outcomes in various types of wounds. However, the reported efficacy of NPWT in sternal wound reconstruction varies widely in the literature. There are few large-scale single-institution studies examining the preoperative factors associated with NPWT and associated postoperative outcomes. METHODS: Records of 584 sternal wound reconstructions with pectoralis major flaps from 1995 to 2024 were included. Patients were divided into those receiving (group 1) and not receiving (group 2) preoperative NPWT before flap reconstruction. Demographic variables and perioperative and intraoperative characteristics were initially analyzed using univariate analyses. The primary outcome was the occurrence of at least one postoperative complication within 30-days of flap reconstruction. Other secondary outcomes included 30-day reoperation and mortality. A multivariable logistic regression model was used to assess for factors associated with NPWT utilization (P<0.05), and propensity-matched analysis was used to account for the influence of baseline preoperative characteristics on postoperative outcomes. RESULTS: The median [IQR] interval between index cardiac procedure and reconstruction was significantly longer in group 1 than group 2 (51 [36 to 84] d vs. 27 [14 to 49] d; P<0.001). In a multivariable logistic regression model (Table 6), chronic kidney disease (OR: 2.30, P=0.0050), peripheral vascular disease (OR: 1.55, P=0.028), male sex (OR: 1.82, P=0.015), and prior cardiac surgery (OR: 1.97, P=0.011) predicted higher odds of NPWT utilization. On univariate analysis, the overall unadjusted complication rate was significantly higher in group 1 than in group 2 (50.4% vs. 40.1%, P=0.046). However, propensity-matched analysis revealed no differences in overall 30-day postoperative complication rates, reoperation, or mortality between groups. CONCLUSIONS: NPWT utilization before bilateral pectoralis major flap reconstruction was predicted by a higher comorbidity burden. Upon adjustment for baseline comorbidities between groups, our findings suggest no differences in postoperative outcomes from preoperative NPWT use before sternal reconstruction with vascularized soft tissue transfer. Therefore, we believe NPWT should not influence the timing of definitive soft tissue coverage whenever flap reconstruction is clinically and logistically feasible.