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

Incisional Negative Pressure Wound Therapy for Deep Inferior Epigastric Perforator (DIEP) Flap Donor Site in Breast Reconstruction: Does It Impact Wound Healing? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incisional Negative Pressure Wound Therapy for Deep Inferior Epigastric Perforator (DIEP) Flap Donor Site in Breast Reconstruction: Does It Impact Wound Healing? Nishant Kumar, Solene Nooli, Muhammad S. Mazroua, Samyd S. Bustos, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7521588/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Apr, 2026 Read the published version in European Journal of Plastic Surgery → Version 1 posted 7 You are reading this latest preprint version Abstract 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 Negative Pressure Wound Therapy DIEP Flap Donor Site Complications Breast Reconstruction Wound Healing Figures Figure 1 Introduction The World Health Organization's Surgical Site Infection (SSI) Guidelines recommend prophylactic incisional negative pressure wound therapy (iNPWT) for high-risk surgical wounds. 1 However, these guidelines do not offer specific recommendations regarding its utilization in specific surgical procedures such as autologous flap-based breast reconstruction. Autologous flap-based breast reconstruction is generally regarded as a surgical procedure with a relatively low occurrence and less severe consequences of surgical site complications. 2 More particularly, the deep inferior epigastric perforator (DIEP) flap, renowned for its favorable aesthetic and functional outcomes, is widely regarded as the gold standard in post-mastectomy breast reconstruction. 3 According to previous studies, the overall donor site complication rate ranges between 15 to 23.5%. 4–6 Also, a significant number of complications occur beyond the standard 30-day post-operative period. 7 Studies have demonstrated the efficacy of iNPWT in reducing superficial surgical site infections in closed abdominal incisions; however, these studies were mainly conducted on patients undergoing laparotomy or Caesarean sections. 8 For patients undergoing abdominoplasty, iNPWT use decreases post-operative fluid accumulation and results in earlier drain removal. 9 Moreover, the use of iNPWT has demonstrated a substantial reduction in post-surgical complications at the breast in comparison to standard dressings (SD) among patients undergoing reduction mammaplasty as well as in oncological breast surgery; iNPWT use led to a 41% reduction in overall complication rate following oncological breast surgery and a 38% relative reduction in wound dehiscence following reduction mammaplasty as compared to SD. 10 , 11 However, there is limited published literature with only a few studies with small sample sizes investigating the efficacy of incisional negative pressure wound therapy (iNPWT) in reducing wound-related complications at the donor site in patients undergoing abdominal-based autologous breast reconstruction. 12 – 14 Therefore, in this retrospective study, we sought to evaluate the effectiveness of iNPWT compared to SD in promoting wound healing and reducing complications at the abdominal donor site following DIEP flap breast reconstruction. Patients and Methods A retrospective review of DIEP flaps performed from January 1st 2017 to December 31st 2022 at our institution was conducted, comparing cases utilizing iNPWT with those using SD. All patients who underwent autologous breast reconstruction with a DIEP flap were included. We excluded patients with missing data or if patients underwent conversion to a TRAM flap reconstruction. Both unilateral and bilateral procedures were included. Donor sites were dressed either with SD or with the iNPWT system (PREVENA PLUS™ Incisional Management System,3M Company, St. Paul, MN, USA), with the choice determined surgeon preference. The umbilicus was covered with Xeroform and Primapore for patients receiving standard dressings only. The iNPWT dressing was set at a continuous pressure mode of 125 mmHgand was programmed to operate for 7 days.SD involved used of Dermabond Prineo (Ethicon, Bridgewater, NJ,USA) and brown tape to abdominal incision site. Follow up visit was scheduled one week after discharge where the incisional wounds were assessed and iNPWT was removed. For patients on SD, removal typically occurred 10–14 days after discharge, often coinciding with their first postoperative clinic visit. If the wound did not appear well-healed, additional dressings using steri-strips or xeroform were done for as long as deemed necessary by the healthcare team. Data collection Patient data were retrospectively reviewed for all cases having a minimum follow-up period of three months after surgery. Pre-operative assessment documentation were screened to identify age, race, body mass index (BMI), and comorbidities such as diabetes, smoking history, prior chemotherapy, the presence of abdominal scars from previous surgeries, and chronic systemic steroid use. Data regarding donor site complications was extracted from post-operative clinical documentation. Primary outcomes were defined as any complications occurring within 30 days of surgery involving the abdominal donor site harvested for DIEP flap. Secondary outcomes included complications between 30–90 days, length of stay, duration of drain in site, readmissions, number of in-person visits, and video consults within 90 of surgery. Outcomes were subdivided into those occurring within 30 days and 30–90 days after surgery, to distinguish between early and late complications. Major complications were defined as any complication occurring at the abdominal donor site requiring surgical intervention, it included abdominal wall seroma, hematoma, necrosis, surgical site infection, wound dehiscence and unplanned revision in the operating room. Minor complications were defined as any complication involving the abdominal donor site, which was managed without surgical intervention, it included abdominal wall seroma, hematoma, wound necrosis, surgical site infection, wound dehiscence and use of antibiotics for more than a week. Wound necrosis was defined as any necrosis of the donor site wound including fat necrosis associated with infection or ischemia. The presence of an abdominal bulge or mass at the donor site within 30–90 days of surgery was also recorded. Surgical details including indication of surgery, side of harvested DIEP flap, and usage of mesh during abdominal closure were obtained from the operative notes of the surgeon. Data regarding post-operative antibiotic usage and number of days of antibiotic usage were also recorded. Readmissions to the hospital included all patients returning to the hospital for reasons pertaining to donor site complications only, within both the 0–30 day and 31–90 day postoperative periods. Length of stay was recorded from discharge summaries. Furthermore, we collected data on the duration of drain in site starting from the day of the procedure till it was removed only for cases where documented evidence was available. Drains were removed if the output was less than 30 ml over 24 hours for two consecutive days. Imaging Data Collection Preoperative imaging data obtained through computed tomography (CT) angiography were utilized to measure subcutaneous thickness at three specific locations including at the level of the umbilicus, and 2cm and 3cm above the symphysis pubis. These measurements were included to assess their potential association with postoperative complications as done in a previous study. 15 Measurements were taken from the skin surface to the anterior rectus fascia, ensuring a 90-degree angle with the anterior rectus fascia. At the umbilicus, measurement was done on the right and left side 2.5 cm from the midline. (Fig. 1 –4). Data Collection instrument and Statistical analysis Study data were collected and managed using REDCap (Research Electronic Data Capture) hosted at The Mayo Clinic, Rochester, MN. 16 , 17 . Data was summarized using desriptive statistics including counts with percentages for categorical and ordinal data and means with SD or medians with IQR for continuous data. We compared the differences using Pearson’s Chi-squared test for categorical variables and the Kruskal-Wallis rank sum test for continuous data. Univariable and multivariable logistic regression models were used to identify the odds ratio (OR) and 95% confidence intervals (CI) for independent clinical variables in predicting donor site complications. All variables with a p value < 0.35 on univariable logistic regression were selected for multiple logistic regression analysis. Akaike information criterion (AIC) was used to assess goodness of fit. Multicollinearity was identified using correlation analysis and only one of the variables were selected for regression if the correlation between them was above 0.6. All analyses were carried out with the BlueSky Statistics software package (Version 10.3.4, BlueSky Statistics LLC, Chicago, IL, USA) with p-value less than 0.05 indicating statistical significance. Results A total of 320 female patients were included in our study. A total of 165 (51.6%) patients received iNPWT and 155 (48.4%) patients received standard dressing (SD) after surgery. Table 1 shows the baseline demographic characteristics along with comorbidities and CT abdominal wall thicknesses. The mean age of patients in each group was 50 years and 51 years respectively (p = 0.315). There was no statistically significant difference between the two groups in terms of age, race, BMI, smoking status, diabetes, prior chemotherapy, chronic steroid use and previous abdominal scars (all p > 0.05). CT Abdominal wall thickness measured at four distinct anatomical locations did not show any statistically significant difference between the two groups (p > 0.05 at all 4 locations). Table 1 Patient Demographics and Comorbidities Characteristic DIEP with iNPWT n(%) Standard Dressing n(%) P value Demographics Age, years, mean ± SD, 50.0 ± 9.7 51.1 ± 10.2 0.315(1) Race 0.072(2) White 153 (92.7) 138 (89.0%) Asian 3 (1.8) 1 (0.6%) Native American 1 (0.6) 0 (0.0%) African-American 4 (2.4) 5 (3.2%) Hispanic 4 (2.4) 1 (0.6%) Asian Indian 0 (0.0) 3 (1.9%) Middle Eastern 0 (0.0) 1(0.6%) Choose not to disclose 0 (0.0) 1(0.6%) Unknown 0 (0.0) 5 (3.2%) Comorbidities BMI, kg/m2, mean ± SD, 29.7 ± 4.8 29.5 ± 4.0 0.816(1) Smoking 0.732(2) Current 0 (0.0) 1 (0.6) Former 46 (27.9) 41 (26.5) Second Hand/Passive 3 (1.8) 2 (1.3) Diabetes 6 (3.6) 4 (2.6) 0.588(2) Prior Chemotherapy 84 (50.9) 84 (54.2) 0.557(2) Duration between last chemotherapy and Surgery, Days, Median(25th Quartile-75th Quartile) 336(232–485) 310(169–473) 0.565(1) Chronic Systemic Steroid use 7 (4.2) 7 (4.5) 0.905(2) Previous Abdominal Scars 111 (67.3) 101 (65.2) 0.690(2) CT Abdominal Wall Thickness, mm, Mean ± SD At Umbilicus-Right 36.8 ± 9.9 36.1 ± 8.0 0.755(1) At Umbilicus -Left 35.9 ± 9.8 35.8 ± 8.4 0.852(1) At 2 cm above Symphysis Pubis 34.3 ± 10.8 33.6 ± 9.2 0.799(1) At 3 cm above Symphysis Pubis 31.7 ± 11.3 31.2 ± 10.0 0.868(1) Majority (> 90%) of the patients in each group underwent surgery due to breast cancer and the rest underwent surgery for risk-reducing purposes (Table 2 ). There was no significant difference between the groups based on side of harvested DIEP flap (p = 0.059); majority (> 60%) of the patients underwent bilateral abdominal flap harvesting. Similarly, there was no statistically significant difference between the two groups when characteristics like usage of mesh during abdominal closure (p = 0.183), post-operative antibiotic usage (p = 0.995) and no of days of antibiotic usage (p = 0.768) were evaluated. The median time to drain removal was 13 days (IQR 13) with iNPWT as compared to 17 days (IQR 10.5) with SD; the difference was found to be statistically significant (p = 0.004). Similarly, patients with iNPWT had a shorter duration of hospital stay as compared to those with SD with the difference being statistically significant (3.5 days vs 3.9 days, p = 0.002). Table 2 Surgical and Operative Details Characteristic DIEP with iNPWT n(%) Standard Dressing n(%) P value Indication for Surgery 0.644 (1) Oncologic 151 (91.5) 144 (92.9) Risk reducing 14 (8.5) 11 (7.1) Side of Harvested DIEP flap 0.059 (1) Right 33 (20.0) 25 (16.1) Left 20 (12.1) 34 (21.9) Bilateral 112 (67.9) 96 (61.9) Usage of mesh during abdominal closure 24 (14.5) 15 (9.7) 0.183 (1) Length of stay, days, mean (± SD) $ 3.5 (± 1.1) 3.9 (± 1.6) 0.002 (2) Duration of Drain in site, days, mean (± SD)* 17.9 (± 11.8) 20.4 (± 12.8) 0.004 (2) Post-operative antibiotics usage 148 (89.7) 139 (89.7) 0.995 (1) No of days of antibiotic usage, mean (± SD) # 14.7 (± 11.9) 13.3 (± 8.8) 0.768 (2) Donor site complications occurring within 30 days of the primary surgery are summarized in Table 3 . In the group receiving iNPWT, the major and minor complication rates were 6.1% and 18.8% respectively. For the group receiving SD, complication rates were slightly higher with 7.1% having major complications requiring surgical intervention and 22.6% having minor complications that were managed non-surgically. However, the difference was not statistically significant, (p = 0.708 for major complications and p = 0.402 for minor complications). The most common major complication was wound necrosis in the group with iNPWT and seroma in those with SD.The most common minor complication was wound dehiscence in both groups. The readmission rates within 30 days of surgery were 1.8% and 2.6% for those with and without iNPWT respectively, there was no statistically significant difference in the readmission rates(p = 0.641). Similarly, there was no statistically significant difference in number of in-person visits(p = 0.176) and video consults (p = 0.694) within 30 days after surgery between the two groups. Majority of the patients had two in-person visits and no video visits in either group. Table 3 Donor site Complications within 30 days after surgery Characteristic DIEP with iNPWT n(%) Standard Dressing n(%) P value Overall Complications 38(23.0) 42(27.1) 0.401 (1) Major Complications 10 (6.1) 11 (7.1) 0.708 (1) Seroma 3(1.8) 5(3.2) 0.466 (1) Hematoma 1(0.6) 2(1.3) 0.593 (1) Surgical Site Infection 2(1.2) 2(1.3) 0.916 (1) Wound dehiscence 2(1.2) 1(0.6) 0.476 (1) Wound necrosis 4(2.4) 3(1.9) 0.537 (1) Revision in OR 3(1.8) 4(2.6) 0.757 (1) Minor Complications 31 (18.8) 35 (22.6) 0.402 (1) Seroma 4(2.4) 4(2.6) 0.855 (1) Hematoma 1(0.6) 3(1.9) 0.364 (1) Surgical Site Infection 1(0.6) 5(3.2) 0.119 (1) Wound dehiscence 22(13.3) 27(17.4) 0.567 (1) Wound Necrosis 5(3.0) 4(2.6) 0.579 (1) Use of Antibiotics for more than a week 5(3.0) 5(3.2) 0.874 (1) Readmission within first 30 days 3 (1.8) 4 (2.6) 0.641 (1) No of in person visits within 30 days 0.176 (2) 0 2 (1.2) 5 (3.2) 1 56 (33.9) 40 (25.8) 2 77 (46.7) 73 (47.1) 3 23 (13.9) 26 (16.8) 4 3 (1.8) 8 (5.2) ≥ 5 4 (2.4) 3 (1.9) No of in Video consults within 30 days 0.694 (2) 0 157 (95.2) 146 (94.2) 1 8 (4.8) 8 (5.2) 2 0 (0.0) 1 (0.6) Donor site complications occurring within 30 to 90 days after primary surgery are listed in Table 4 . There was no statistically significant difference between the two groups in terms of major and minor complication rates (p = 0.765 and p = 0.792 respectively). Most patients in each group had one in-person visit and no video consult within 30–90 days of surgery. Patients with iNPWT had a higher readmission rate of 3% as compared to 0.6% in those with SD, the difference however was statistically not significant(p = 0.116). Table 4 Donor site complications 30–90 days after surgery Characteristic DIEP with iNPWT n(%) Standard Dressing n(%) P value Overall Complications 32(19.4) 30(19.4) 0.993 (1) Major Complications 4 (2.4) 3 (1.9) 0.765 (1) Seroma 2(1.2) 1(0.6) 0.599 (1) Hematoma 0(0.0) 0(0.0) Surgical Site Infection 1(0.6) 0(0.0) 0.350 (1) Wound Dehiscence 3(1.8) 2(1.3) 0.809 (1) Wound Necrosis 2(1.2) 1(0.6) 0.659 (1) Revision in OR 1(0.6) 2(1.3) 0.270 (1) Minor Complications 29 (17.6) 29 (18.7) 0.792 (1) Seroma 10(6.1) 10(6.5) 1.000 (1) Hematoma 1(0.6) 0(0.0) 0.313 (1) Surgical Site Infection 2(1.2) 1(0.6) 0.553 (1) Wound dehiscence 18(10.9) 19(12.3) 0.788 (1 Wound Necrosis 4(2.4) 5(3.2) 0.717 (1) Use of Antibiotics for more than a week 4(2.4) 3(1.9) 0.687 (1) Abdominal Bulge or mass 1(0.6) 1(0.6) 0.965 (1) Readmission within 30–90 days 5 (3.0) 1 (0.6) 0.116(1) No of in-person visits 30–90 days 0.914 (2) 0 39 (23.6) 43 (27.7) 1 76 (46.1) 62 (40.0) 2 33 (20.0) 31 (20.0) 3 12 (7.3) 9 (5.8) 4 4 (2.4) 7 (4.5) ≥ 5 1 (0.6) 3 (1.9) No of in Video consults 30–90 days 0.782 (2) 0 146 (88.5) 139 (89.7) 1 16 (9.7) 10 (6.5) 2 1 (0.6) 5 (3.2) 3 2 (1.2) 1 (0.6) Overall complication rates between the two groups were similar; 62 (37.6%) patients with iNPWT and 58 (37.4%) patients with SD had any complication within 90 days of surgery (p = 0.977). No statistically significant difference was observed between the two groups in terms of overall complications within 30 days (p = 0.401) and 30–90 days of surgery (p = 0.993) When the CT abdominal wall thickness was compared between those with complications and those without complications at all four anatomical locations, no statistically significant difference was observed in each group (all p > 0.05). Table 5 summarizes the results of the comparison. Table 5 Relation between CT Abdominal Wall thickness and Complications Characteristic DIEP with iNPWT Mean(SD) Standard Dressing Mean(SD) CT Abdominal Wall Thickness(mm) With Complications No Complications P value With Complications No Complications P value At Umbilicus-Right 37.846 (11.156) 36.091 (9.010) 0.389(1) 36.962(8.172) 35.651 (7.951) 0.351 (1) At Umbilicus -Left 36.687 (11.046) 35.421 (9.069) 0.621(1) 36.792(8.495) 35.132 (8.268) 0.227 (1) At 2 cm above SP 34.819 (11.164) 33.932(10.687) 0.596(1) 34.652(9.691) 33.011 (8.910) 0.296 (1) At 3 cm above SP 31.599 (10.536) 31.713(11.773) 0.810(1) 31.776 (10.752) 30.794 (9.629) 0.574 (1) SP : Symphysis Pubis Note :(1) Kruskal-Wallis rank sum test Table 6 summarizes donor site complications stratified by BMI. Among patients with BMI < 25 kg/m2, use of iNPWT led to a statistically significant reduction in minor complication rate within 30 days of surgery(p = 0.039). However, no such difference was observed in complication rates for patients with BMI > 25 kg m2. Overall complication rates were similar in both BMI groups with or without the use of iNPWT (all p > 0.05). Table 6 Donor Site Complication Rate stratified by BMI Note : (1) Pearson's Chi-squared test Characteristic DIEP With iNPWT (%) Standard Dressing (%) P value Patients with BMI ≤ 25 kg/m2 (n = 51) Overall Complication Rates within 30 days 5(9.8) 7(13.7) 0.167(1) Major complication Rates within 30 days 4(7.8) 2(3.9) 0.678(1) Minor complication Rates within 30 days 3(5.9) 7(13.7) 0.039 (1) Overall Complication Rates within 30–90 days 4(7.8) 0(0) 0.081(1) Major complication Rates within 30–90 days 0(0) 0(0) Minor complication Rates within 30–90 days 4(7.8) 0(0) 0.081(1) Overall complication rates within 0–90 days 9(17.6) 7(13.7) 0.801(1) Patients with BMI > 25 kg/m 2 (n = 269) Overall Complication Rates within 30 days 33(12.3) 35(13) 0.752(1) Major complication Rates within 30 days 6(2.2) 9(3.3) 0.417(1) Minor complication Rates within 30 days 28(10.4) 28(10.4) 0.975(1) Overall Complication Rates within 30–90 days 28(10.4) 30(11.2) 0.743(1) Major complication Rates within 30–90 days 4(1.5) 3(1.1) 0.709(1) Minor complication Rates within 30–90 days 25(9.3) 29(10.8) 0.523(1) Overall complication rates within 90 days 53(19.7) 51(19) 0.840(1) Table 7 and Table 8 summarizes the results of logistic regression analysis. Correlation analysis revealed a significant correlation (> 0.6) between BMI and abdominal wall thickness at all four anatomical locations. Hence only BMI was used for logistic regression analysis to remove the effect of multicollinearity. Table 7 Logistic Regression analysis for overall donor site complications 0–90 days after surgery. Univariable Multivariable Risk Factor OR(95% CI) p-value aOR(95%CI) p-value Race-White 1.37(0.62–3.26) 0.452 Body Mass Index (BMI) 1.03(0.97–1.08) 0.334 1.02(0.97–1.08) 0.424 Current or past smoking exposure 1.68(1.02–2.74) 0.040 1.74(1.05–2.86) 0.030 Diabetes 1.11(0.28–3.98) 0.868 Chronic Systemic Steroid use 1.71(0.57–5.11) 0.328 1.91(0.63–5.80) 0.244 Previous abdominal scars 1.40(0.86–2.29) 0.180 1.43(0.88–2.40) 0.145 Use of iNPWT 1.00(0.64–1.58) 0.977 Use of mesh for abdominal closure 0.92(0.45–1.83) 0.825 Duration of Drain in site 1.04(1.02–1.07) 0.0002 Duration of hospital stay 1.15(0.98–1.38) 0.107 Table 8 Univariable analysis using logistic regression stratified by BMI Overall Complications 0–30 days Minor Complications 0–30 days Risk Factor OR(95% CI) p-value OR(95%CI) p-value Patients with BMI ≤ 25 kg/m2 (n = 51) Body Mass Index (BMI) 1.19(0.72–2.09) 0.511 1.30(0.75–2.43) 0.377 Current or past smoking exposure 4.86(1.09–22.44) 0.037 3.89(0.80-18.41) 0.082 Diabetes* NA NA Chronic Systemic Steroid use 1.68(0.07–19.24) 0.683 2.17(0.09–25.17) 0.546 Previous abdominal scars 1.00(0.26–4.31) 1.000 1.21(0.29–6.28) 0.803 Use of iNPWT 0.40(0.10–1.48) 0.174 0.22(0.04–0.93) 0.049 Duration of Drain in site 1.08(0.99–1.24) 0.150 1.10(1.00-1.29) 0.117 Duration of hospital stay 1.57(0.88–2.98) 0.130 1.66(0.91–3.22) 0.102 Patients with BMI > 25 kg/m2(n = 269) Body Mass Index (BMI) 1.02(0.95–1.09) 0.640 1.02(0.94–1.10) 0.706 Current or past smoking exposure 1.31(0.73–2.34) 0.360 1.61(0.87–2.96) 0.127 Diabetes 1.28(0.27–4.75) 0.727 1.67(0.35–6.21) 0.470 Chronic Systemic Steroid use 2.58(0.72–8.85) 0.128 1.45(0.31–5.21) 0.592 Previous abdominal scars 1.75(0.96–3.32) 0.077 1.91(0.99–3.90) 0.062 Use of iNPWT 0.92(0.53–1.59) 0.752 0.99(0.55–1.79) 0.975 Duration of Drain in site 1.03(1.005–1.05) 0.018 1.02(1.00-1.05) 0.050 Duration of hospital stay 1.20(0.998–1.46) 0.060 1.02(0.81–1.23) 0.827 * None of the patients with BMI ≤ 25 kg/m2 had diabetes. Table 7 describes the results of logistic regression analysis performed on the overall study population. Patients who were current smokers or had any history of smoking including passive exposure was classified as having current or past smoking exposure. On univariable analysis, it was found to be a significant factor in increasing odds of overall donor site complications 0–90 days after surgery (OR 1.68, CI 1.02–2.74, p = 0.040). Duration of drain in site was also significantly associated with overall complications within 90 days, (OR 1.04, CI 1.02–1.07, p = 0.0002), however since it cannot be used to predict complications pre-operatively, it was excluded from multiple regression analysis. All variables which had a p-value < 0.35 on univariable analysis were used for multiple regression analysis yielding an AIC = 425. The only significant factor predicting donor-site complications was current or past smoking exposure based on multivariable logistic regression (OR 1.74, CI 1.05–2.86, p = 0.030). Interestingly, use of iNPWT did not reduce odds of overall donor site complications (OR 1.00, CI 0.64–1.58, p = 0.977). However, upon stratification of the study population into BMI ≤ 25 and BMI > 25 kg/m 2 , the use of iNPWT led to reduction in minor complications within 30 days of surgery (OR 0.22, CI 0.04–0.93, p = 0.049) among women with BMI ≤ 25 kg/m 2 (Table 8 ). In the same subgroup of patients, current or past smoking exposure was associated with more than 4-fold increase in odds of Overall 30-day complications (OR 4.86, CI 1.09–22.44, p = 0.037). No variables were found to be significant in predicting 30-days complications in the subgroup of patients with BMI > 25 kg/m 2 , although there was significant association with duration of drain in site (OR 1.03, CI 1.005–1.05, p = 0.018). In our cohort, iNPWT-related issues occurred in 14 of 166 cases, including dressing leakage (6 cases), tubing issues (2 cases), device drops (2 cases), water ingress (1 case), battery failure (1 case), and contact dermatitis (2). These were resolved through remote troubleshooting (4 cases) or in-person visits (10 cases), including repatching and device resets, ensuring the device functioned for the full 7-day duration. Discussion To the best of our knowledge, this retrospective study involving 320 patients represents the largest study to date assessing differences in donor site complication rates associated with the use of iNPWT. Despite the larger sample size, this study did not demonstrate any significant reduction in overall complication rates with the use of iNPWT. Consistent findings were reported in two earlier studies with sample sizes of 56 and 42 patients, respectively. 12 , 13 In contrast, a prospective clinical trial involving 75 women undergoing DIEP flap breast reconstruction found a significant reduction in wound dehiscence with iNPWT, although no meaningful differences were observed in other outcomes such as seroma, hematoma, or surgical site infection. 14 This study confirmed smoking as a significant predictor of donor-site complications, a finding that aligns with established evidence in the literature. 18 The only measurable benefit of iNPWT shown in the current study was a modest reduction in drain duration by a few days. At best, this may alleviate patient inconvenience without increasing donor-site complications. Comparable reductions in drain removal time have been reported in abdominoplasty patients. 9 However, iNPWT use can be cumbersome, as illustrated by occasional device-related issues encountered by some patients. Although infrequent, these problems highlight practical challenges that sometimes necessitate phone support or additional clinic visits. Such findings emphasize the importance of patient education and support systems to ensure uninterrupted therapy and optimize postoperative outcomes. It is also important to consider the financial aspects of using iNPWT, particularly in the context of surgical site outcomes. An economic analysis study done on patients undergoing surgery involving abdominal incisions including breast reconstruction, described savings of about $ 667 per patient due to reduced incidence of surgical site complications. 19 The cost savings increase for patients at higher risk of complications such as those with BMI > 30 or diabetes. 19 Usage of iNPWT costs about $ 3000 per patient at our institution. A previous study has demonstrated significant improvement in cost-benefit attributed to reduced complications outweighing the increase in cost attributed to the usage of iNPWT at the donor site in patients undergoing DIEP flap-based reconstruction. 20 Patient-reported outcomes could help us understand if the benefits listed above actually translate to reduced financial burden. A financial survey of such patients could validate the above-mentioned hypothesis. We also found that CT abdominal thickness played no role in determining the complication rate. Although patients with complications had a slightly higher mean abdominal wall thickness as compared to those without complications for both groups of patients with and without iNPWT the difference was not statistically significant. This aligns with previous work reporting no clear association between abdominal fat thickness and donor-site morbidity. 21 Nevertheless, other investigators have reported contrary findings, suggesting that increased abdominal wall thickness may predispose patients to delayed wound healing, surgical site infection, and flap necrosis in abdominally based breast reconstruction. 15 Taken together, these observations highlight ongoing uncertainty regarding the role of abdominal wall thickness, suggesting that its impact may be context-specific or confounded by additional patient- or procedure-related variables. One such variable is BMI which correlates positively with abdominal wall fat thickness. 22 Higher BMI is a known risk factor for increased donor site complications after DIEP-based breast reconstruction. 5 , 23 In our study, patients with BMI < 25 kg/m² showed a statistically significant reduction in 30-day minor complications with iNPWT, while no such benefit was seen in those with BMI ≥ 25 kg/m². At 90 days, complication rates did not differ significantly between BMI groups regardless of iNPWT use (Table 6 ). These findings suggest that the benefits of iNPWT may diminish over time and with increasing BMI. Similar results have been reported in obese women undergoing cesarean section, where iNPWT did not reduce complication rates compared to standard dressings. 24 , 25 This study has several important limitations. Its retrospective design limits causal inference, and the predominance of a single racial group (~ 90%, Table 1 ) affects generalizability. Patients from minority communities have been shown to experience higher complication rates. 26 Future randomized controlled studies with more diverse and high-risk populations are needed to better assess the benefits of iNPWT. Declarations Source of Funding: The authors declare that no funds, grants, or other support were received to support the research, authorship, or publication of this work. Clinical trial number : not applicable Human Ethics and Consent to Participate declarations: Not applicable Ethical Considerations: Ethics committee Name: Institutional Review Board (IRB)– Minimal Risk Committee IRB Approval Number: 22-010241 Waiver of Informed Consent under HIPAA regulations : As this study involved a retrospective chart review with no direct interaction or intervention with human subjects, informed consent was not obtained. A Waiver of Informed Consent and HIPAA Authorization was granted by the Institutional Review Board – Minimal Risk Committee, consistent with federal guidelines under 45 CFR 164.512(i)(2)(ii). The waiver was approved because the research involved no more than minimal risk to subjects, could not practicably be conducted without the waiver, and involved adequate measures to protect the privacy and confidentiality of patient information. All data were de-identified prior to analysis . Author Contribution N.K. and S.N. contributed equally as first co-authors. N.K., S.N., M.S.M., and S.S.B. performed data collection and investigation. N.K. and S.S.B. conducted the formal analysis. M.S.M., S.S.B., and A.V. contributed to study methodology. S.N., M.S.M., S.S.B., C.H., V.F., J.M.J., and A.V. provided supervision. N.K. drafted the original manuscript, and all authors (N.K., S.N., M.S.M., S.S.B., C.H., V.F., J.M.J., and A.V.) contributed to review and editing. All authors approved the final manuscript. Acknowledgement We acknowledge the contribution of Ross A. Dierkhising, M.S, Principal Biostatistician at the Mayo Clinic, Rochester, Minnesota for helping with statistical analyses. Data Availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. References Leaper DJ, Edmiston CE (2017) World Health Organization: global guidelines for the prevention of surgical site infection. J Hosp Infect Feb 95(2):135–136. 10.1016/j.jhin.2016.12.016 von Glinski M, Holler N, Kümmel S et al (2022) Autologous vs. implant-based breast reconstruction after skin- and nipple-sparing mastectomy-A deeper insight considering surgical and patient-reported outcomes. Front Surg 9:903734. 10.3389/fsurg.2022.903734 Sorotos M, Firmani G, Schiavone L, Ricci A, Santanelli di Pompeo F (2023) Effects of DIEP flap-based breast reconstruction on respiratory function. J Plast Reconstr Aesthet Surg Jun 81:99–104. 10.1016/j.bjps.2023.02.025 Paik JM, Lee KT, Jeon BJ et al (2015) Donor site morbidity following DIEP flap for breast reconstruction in Asian patients: Is it different? Microsurgery Nov 35(8):596–602. 10.1002/micr.22495 Grünherz L, Keijzer W, Uyulmaz S et al (2020) Donor site aesthetics and morbidity after DIEP flap breast reconstruction-A retrospective multicenter study. Breast J Oct 26(10):1980–1986. 10.1111/tbj.14003 Huang H, Lu Wang M, Chen Y, Chadab TM, Vernice NA, Otterburn DM (2024) A Machine Learning Approach to Predicting Donor Site Complications Following DIEP Flap Harvest. J Reconstr Microsurg Jan 40(1):70–77. 10.1055/a-2071-3368 Duraes EF, Schwarz G, Durand P et al (2015) Complications Following Abdominal-Based Free Flap Breast Reconstruction: Is a 30 days Complication Rate Representative? Aesthetic Plast Surg Oct 39(5):694–699. 10.1007/s00266-015-0534-4 Wells CI, Ratnayake CBB, Perrin J, Pandanaboyana S (2019) Prophylactic Negative Pressure Wound Therapy in Closed Abdominal Incisions: A Meta-analysis of Randomised Controlled Trials. World J Surg Nov 43(11):2779–2788. 10.1007/s00268-019-05116-6 Abesamis GM, Chopra S, Vickery K, Deva AK (2019) A Comparative Trial of Incisional Negative-Pressure Wound Therapy in Abdominoplasty. Plast Reconstr Surg Glob Open May 7(5):e2141. 10.1097/gox.0000000000002141 Ferrando PM, Ala A, Bussone R, Bergamasco L, Actis Perinetti F, Malan F (2018) Closed Incision Negative Pressure Therapy in Oncological Breast Surgery: Comparison with Standard Care Dressings. Plast Reconstr Surg Glob Open Jun 6(6):e1732. 10.1097/gox.0000000000001732 Galiano RD, Hudson D, Shin J et al (2018) Incisional Negative Pressure Wound Therapy for Prevention of Wound Healing Complications Following Reduction Mammaplasty. Plast Reconstr Surg Glob Open Jan 6(1):e1560. 10.1097/gox.0000000000001560 Kang S, Okumura S, Maruyama Y et al (2022) Effect of Incision Negative Pressure Wound Therapy on Donor Site Morbidity in Breast Reconstruction with Deep Inferior Epigastric Artery Perforator Flap. JPRAS Open Dec 34:73–81. 10.1016/j.jpra.2022.08.002 Doval AF, Chegireddy V, Beal L et al (2021) Efficacy of Closed Incision Negative Pressure Wound Therapy on Abdominal Donor Site After Free Flap Breast Reconstruction. Wounds Apr 33(4):81–85 Muller-Sloof E, de Laat E, Kenç O et al (2022) Closed-Incision Negative-Pressure Therapy Reduces Donor-Site Surgical Wound Dehiscence in DIEP Flap Breast Reconstructions: A Randomized Clinical Trial. Plast Reconstr Surg Oct 1:150:38s–47s. 10.1097/prs.0000000000009541 Boehm LM, Hettinger P, LoGiudice J, Doren EL (2020) Increasing abdominal wall thickness predicts complications in abdominally based breast reconstruction: A review of 106 consecutive patients. J Plast Reconstr Aesthet Surg Jul 73(7):1277–1284. 10.1016/j.bjps.2019.11.012 Harris PA, Taylor R, Minor BL et al (2019) The REDCap consortium: Building an international community of software platform partners. J Biomed Inform Jul 95:103208. 10.1016/j.jbi.2019.103208 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform Apr 42(2):377–381. 10.1016/j.jbi.2008.08.010 Chang DW, Reece GP, Wang B et al (2000) Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg Jun 105(7):2374–2380. 10.1097/00006534-200006000-00010 Nherera LM, Saunders C, Verma S, Trueman P, Fatoye F (2021) Single-use negative pressure wound therapy reduces costs in closed surgical incisions: UK and US economic evaluation. J Wound Care May 1(Sup5):S23–s31. 10.12968/jowc.2021.30.Sup5.S23 Munro SP, Dearden A, Joseph M, O'Donoghue JM (2023) Reducing donor-site complications in DIEP flap breast reconstruction with closed incisional negative pressure therapy: A cost-benefit analysis. J Plast Reconstr Aesthet Surg Mar 78:13–18. 10.1016/j.bjps.2022.08.003 Modarressi A, Müller CT, Montet X, Rüegg EM, Pittet-Cuénod B (2017) DIEP flap for breast reconstruction: Is abdominal fat thickness associated with post-operative complications? J Plast Reconstr Aesthet Surg Aug 70(8):1068–1075. 10.1016/j.bjps.2017.05.002 Kim J, Lim H, Lee SI, Kim YJ (2012) Thickness of rectus abdominis muscle and abdominal subcutaneous fat tissue in adult women: correlation with age, pregnancy, laparotomy, and body mass index. Arch Plast Surg Sep 39(5):528–533. 10.5999/aps.2012.39.5.528 Fisher MH, Ohmes LB, Yang JH et al (2024) Abdominal donor-site complications following autologous breast reconstruction: A multi-institutional multisurgeon study. J Plast Reconstr Aesthet Surg Mar 90:88–94. 10.1016/j.bjps.2024.01.033 Kawakita T, Iqbal SN, Overcash RT (Feb 2021) Negative pressure wound therapy system in extremely obese women after cesarean delivery compared with standard dressing. J Matern Fetal Neonatal Med 34(4):634–638. 10.1080/14767058.2019.1611774 Wihbey KA, Joyce EM, Spalding ZT et al (2018) Prophylactic Negative Pressure Wound Therapy and Wound Complication After Cesarean Delivery in Women With Class II or III Obesity: A Randomized Controlled Trial. Obstet Gynecol . Aug ;132(2):377–384. 10.1097/aog.0000000000002744 Mets EJ, Chouairi FK, Gabrick KS, Avraham T, Alperovich M (2019) Persistent disparities in breast cancer surgical outcomes among hispanic and African American patients. Eur J Surg Oncol Apr 45(4):584–590. 10.1016/j.ejso.2019.01.016 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Apr, 2026 Read the published version in European Journal of Plastic Surgery → Version 1 posted Editorial decision: Revision requested 14 Sep, 2025 Reviews received at journal 12 Sep, 2025 Reviewers agreed at journal 09 Sep, 2025 Reviewers invited by journal 09 Sep, 2025 Editor assigned by journal 09 Sep, 2025 Submission checks completed at journal 09 Sep, 2025 First submitted to journal 02 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7521588","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":514815724,"identity":"a35b8b94-182f-4a3e-8f4a-ad57cd02dee2","order_by":0,"name":"Nishant Kumar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYBACgwNg6jAPgwSIroAK8+DRYtgAph5DtBw4Q4QWYwj1mQGs5WAbEVrMJLITP1cwfJaRn9387PHHedvkDY43MD5424Zbi41E7mbJMwy3eQzuHDM3OLjttuGGMweYDefi17JBsgGkRSLBTAKohXHDjQQ2aV48WsyAtvxsYDjPIz8j/ZvEwTm37YFa2H/j02IskbsNaMtxHoYbOUBbGm4ngmxhxqfFsOftNssGg+M8BjdyyiTOHLudPPPMwWbJOedwazE4nrv5ZkPFYXugw7ZJVNTctu073nzww5sy3FqgGpHYCgcYGwipRwPypGoYBaNgFIyCYQ8A7LFb0a/ElRcAAAAASUVORK5CYII=","orcid":"","institution":"Mayo Clinic","correspondingAuthor":true,"prefix":"","firstName":"Nishant","middleName":"","lastName":"Kumar","suffix":""},{"id":514815725,"identity":"4c823ea9-309e-441b-90b4-b533c5695043","order_by":1,"name":"Solene Nooli","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Solene","middleName":"","lastName":"Nooli","suffix":""},{"id":514815726,"identity":"e0d6c917-8015-45fd-b62b-8282b8cb8cb9","order_by":2,"name":"Muhammad S. Mazroua","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"S.","lastName":"Mazroua","suffix":""},{"id":514815727,"identity":"6af9ca47-ff6a-4e88-98e7-e33adefbce24","order_by":3,"name":"Samyd S. Bustos","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Samyd","middleName":"S.","lastName":"Bustos","suffix":""},{"id":514815728,"identity":"73e5fda7-d10d-4682-b0bc-e4bb20ea7a0a","order_by":4,"name":"Christin Harless","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Christin","middleName":"","lastName":"Harless","suffix":""},{"id":514815729,"identity":"a5efaff3-0376-487c-85fc-36b55bd2c473","order_by":5,"name":"Vahe Fahradyan","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Vahe","middleName":"","lastName":"Fahradyan","suffix":""},{"id":514815730,"identity":"1fa6c9a2-2b51-4cb2-b209-ad58bfdc9bc8","order_by":6,"name":"Jorys Martinez-Jorge","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Jorys","middleName":"","lastName":"Martinez-Jorge","suffix":""},{"id":514815731,"identity":"eb988255-5f4b-4a9b-9a79-c11cd5c66762","order_by":7,"name":"Aparna Vijayasekaran","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Aparna","middleName":"","lastName":"Vijayasekaran","suffix":""}],"badges":[],"createdAt":"2025-09-03 00:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7521588/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7521588/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00238-026-02452-4","type":"published","date":"2026-04-30T15:58:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91560485,"identity":"e7abfcd0-5fac-4977-ba0e-bfcff36f8521","added_by":"auto","created_at":"2025-09-17 18:42:43","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":974576,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of abdominal wall thickness using CT angiogram images\u003c/p\u003e\n\u003cp\u003eA\u003cstrong\u003e: \u003c/strong\u003eAt the umbilicus-left side- 2.5 cm from midline B\u003cstrong\u003e: \u003c/strong\u003eAt the umbilicus-right side-2.5 cm from midline\u003c/p\u003e\n\u003cp\u003eC\u003cstrong\u003e:\u003c/strong\u003e 2 cm above the symphysis pubis D\u003cstrong\u003e: \u003c/strong\u003e3 cm above the symphysis pubis\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7521588/v1/0a09ae9d630e30a0d2ab5ddb.jpeg"},{"id":108437731,"identity":"a98c7b11-0c8d-463a-a1f9-74961cb331d7","added_by":"auto","created_at":"2026-05-04 16:02:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1586450,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7521588/v1/b223d253-3c7f-46aa-9f9d-6f1420eb8439.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Incisional Negative Pressure Wound Therapy for Deep Inferior Epigastric Perforator (DIEP) Flap Donor Site in Breast Reconstruction: Does It Impact Wound Healing?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe World Health Organization's Surgical Site Infection (SSI) Guidelines recommend prophylactic incisional negative pressure wound therapy (iNPWT) for high-risk surgical wounds.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e However, these guidelines do not offer specific recommendations regarding its utilization in specific surgical procedures such as autologous flap-based breast reconstruction.\u003c/p\u003e\u003cp\u003eAutologous flap-based breast reconstruction is generally regarded as a surgical procedure with a relatively low occurrence and less severe consequences of surgical site complications.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e More particularly, the deep inferior epigastric perforator (DIEP) flap, renowned for its favorable aesthetic and functional outcomes, is widely regarded as the gold standard in post-mastectomy breast reconstruction.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e According to previous studies, the overall donor site complication rate ranges between 15 to 23.5%.\u003csup\u003e4\u0026ndash;6\u003c/sup\u003e Also, a significant number of complications occur beyond the standard 30-day post-operative period.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eStudies have demonstrated the efficacy of iNPWT in reducing superficial surgical site infections in closed abdominal incisions; however, these studies were mainly conducted on patients undergoing laparotomy or Caesarean sections.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e For patients undergoing abdominoplasty, iNPWT use decreases post-operative fluid accumulation and results in earlier drain removal.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eMoreover, the use of iNPWT has demonstrated a substantial reduction in post-surgical complications at the breast in comparison to standard dressings (SD) among patients undergoing reduction mammaplasty as well as in oncological breast surgery; iNPWT use led to a 41% reduction in overall complication rate following oncological breast surgery and a 38% relative reduction in wound dehiscence following reduction mammaplasty as compared to SD.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e However, there is limited published literature with only a few studies with small sample sizes investigating the efficacy of incisional negative pressure wound therapy (iNPWT) in reducing wound-related complications at the donor site in patients undergoing abdominal-based autologous breast reconstruction.\u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTherefore, in this retrospective study, we sought to evaluate the effectiveness of iNPWT compared to SD in promoting wound healing and reducing complications at the abdominal donor site following DIEP flap breast reconstruction.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003e A retrospective review of DIEP flaps performed from January 1st 2017 to December 31st 2022 at our institution was conducted, comparing cases utilizing iNPWT with those using SD. All patients who underwent autologous breast reconstruction with a DIEP flap were included. We excluded patients with missing data or if patients underwent conversion to a TRAM flap reconstruction. Both unilateral and bilateral procedures were included. Donor sites were dressed either with SD or with the iNPWT system (PREVENA PLUS\u0026trade; Incisional Management System,3M Company, St. Paul, MN, USA), with the choice determined surgeon preference. The umbilicus was covered with Xeroform and Primapore for patients receiving standard dressings only. The iNPWT dressing was set at a continuous pressure mode of 125 mmHgand was programmed to operate for 7 days.SD involved used of Dermabond Prineo (Ethicon, Bridgewater, NJ,USA) and brown tape to abdominal incision site.\u003c/p\u003e\u003cp\u003eFollow up visit was scheduled one week after discharge where the incisional wounds were assessed and iNPWT was removed. For patients on SD, removal typically occurred 10\u0026ndash;14 days after discharge, often coinciding with their first postoperative clinic visit. If the wound did not appear well-healed, additional dressings using steri-strips or xeroform were done for as long as deemed necessary by the healthcare team.\u003c/p\u003e\u003cp\u003eData collection\u003c/p\u003e\u003cp\u003ePatient data were retrospectively reviewed for all cases having a minimum follow-up period of three months after surgery. Pre-operative assessment documentation were screened to identify age, race, body mass index (BMI), and comorbidities such as diabetes, smoking history, prior chemotherapy, the presence of abdominal scars from previous surgeries, and chronic systemic steroid use. Data regarding donor site complications was extracted from post-operative clinical documentation. Primary outcomes were defined as any complications occurring within 30 days of surgery involving the abdominal donor site harvested for DIEP flap. Secondary outcomes included complications between 30\u0026ndash;90 days, length of stay, duration of drain in site, readmissions, number of in-person visits, and video consults within 90 of surgery. Outcomes were subdivided into those occurring within 30 days and 30\u0026ndash;90 days after surgery, to distinguish between early and late complications. Major complications were defined as any complication occurring at the abdominal donor site requiring surgical intervention, it included abdominal wall seroma, hematoma, necrosis, surgical site infection, wound dehiscence and unplanned revision in the operating room. Minor complications were defined as any complication involving the abdominal donor site, which was managed without surgical intervention, it included abdominal wall seroma, hematoma, wound necrosis, surgical site infection, wound dehiscence and use of antibiotics for more than a week. Wound necrosis was defined as any necrosis of the donor site wound including fat necrosis associated with infection or ischemia. The presence of an abdominal bulge or mass at the donor site within 30\u0026ndash;90 days of surgery was also recorded.\u003c/p\u003e\u003cp\u003eSurgical details including indication of surgery, side of harvested DIEP flap, and usage of mesh during abdominal closure were obtained from the operative notes of the surgeon. Data regarding post-operative antibiotic usage and number of days of antibiotic usage were also recorded. Readmissions to the hospital included all patients returning to the hospital for reasons pertaining to donor site complications only, within both the 0\u0026ndash;30 day and 31\u0026ndash;90 day postoperative periods. Length of stay was recorded from discharge summaries. Furthermore, we collected data on the duration of drain in site starting from the day of the procedure till it was removed only for cases where documented evidence was available. Drains were removed if the output was less than 30 ml over 24 hours for two consecutive days.\u003c/p\u003e\u003cp\u003eImaging Data Collection\u003c/p\u003e\u003cp\u003ePreoperative imaging data obtained through computed tomography (CT) angiography were utilized to measure subcutaneous thickness at three specific locations including at the level of the umbilicus, and 2cm and 3cm above the symphysis pubis. These measurements were included to assess their potential association with postoperative complications as done in a previous study.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Measurements were taken from the skin surface to the anterior rectus fascia, ensuring a 90-degree angle with the anterior rectus fascia. At the umbilicus, measurement was done on the right and left side 2.5 cm from the midline. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;4).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eData Collection instrument and Statistical analysis\u003c/p\u003e\u003cp\u003eStudy data were collected and managed using REDCap (Research Electronic Data Capture) hosted at The Mayo Clinic, Rochester, MN.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Data was summarized using desriptive statistics including counts with percentages for categorical and ordinal data and means with SD or medians with IQR for continuous data. We compared the differences using Pearson\u0026rsquo;s Chi-squared test for categorical variables and the Kruskal-Wallis rank sum test for continuous data.\u003c/p\u003e\u003cp\u003eUnivariable and multivariable logistic regression models were used to identify the odds ratio (OR) and 95% confidence intervals (CI) for independent clinical variables in predicting donor site complications. All variables with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.35 on univariable logistic regression were selected for multiple logistic regression analysis. Akaike information criterion (AIC) was used to assess goodness of fit. Multicollinearity was identified using correlation analysis and only one of the variables were selected for regression if the correlation between them was above 0.6.\u003c/p\u003e\u003cp\u003eAll analyses were carried out with the BlueSky Statistics software package (Version 10.3.4, BlueSky Statistics LLC, Chicago, IL, USA) with p-value less than 0.05 indicating statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 320 female patients were included in our study. A total of 165 (51.6%) patients received iNPWT and 155 (48.4%) patients received standard dressing (SD) after surgery. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the baseline demographic characteristics along with comorbidities and CT abdominal wall thicknesses. The mean age of patients in each group was 50 years and 51 years respectively (p\u0026thinsp;=\u0026thinsp;0.315). There was no statistically significant difference between the two groups in terms of age, race, BMI, smoking status, diabetes, prior chemotherapy, chronic steroid use and previous abdominal scars (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). CT Abdominal wall thickness measured at four distinct anatomical locations did not show any statistically significant difference between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 at all 4 locations).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient Demographics and Comorbidities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDIEP with iNPWT\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Dressing\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.315(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.072(2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e153 (92.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e138 (89.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNative American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfrican-American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsian Indian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle Eastern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChoose not to disclose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, kg/m2, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.816(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.732(2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (27.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (26.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecond Hand/Passive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.588(2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior Chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (50.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 (54.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.557(2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration between last chemotherapy and Surgery, Days, Median(25th Quartile-75th Quartile)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e336(232\u0026ndash;485)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e310(169\u0026ndash;473)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.565(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic Systemic Steroid use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.905(2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious Abdominal Scars\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e111 (67.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101 (65.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.690(2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCT Abdominal Wall Thickness, mm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt Umbilicus-Right\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.755(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt Umbilicus -Left\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.852(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt 2 cm above Symphysis Pubis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.799(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt 3 cm above Symphysis Pubis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.868(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMajority (\u0026gt;\u0026thinsp;90%) of the patients in each group underwent surgery due to breast cancer and the rest underwent surgery for risk-reducing purposes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There was no significant difference between the groups based on side of harvested DIEP flap (p\u0026thinsp;=\u0026thinsp;0.059); majority (\u0026gt;\u0026thinsp;60%) of the patients underwent bilateral abdominal flap harvesting. Similarly, there was no statistically significant difference between the two groups when characteristics like usage of mesh during abdominal closure (p\u0026thinsp;=\u0026thinsp;0.183), post-operative antibiotic usage (p\u0026thinsp;=\u0026thinsp;0.995) and no of days of antibiotic usage (p\u0026thinsp;=\u0026thinsp;0.768) were evaluated. The median time to drain removal was 13 days (IQR 13) with iNPWT as compared to 17 days (IQR 10.5) with SD; the difference was found to be statistically significant (p\u0026thinsp;=\u0026thinsp;0.004). Similarly, patients with iNPWT had a shorter duration of hospital stay as compared to those with SD with the difference being statistically significant (3.5 days vs 3.9 days, p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSurgical and Operative Details\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDIEP with iNPWT\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Dressing\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndication for Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.644 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOncologic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e151 (91.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e144 (92.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk reducing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSide of Harvested DIEP flap\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.059 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25 (16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34 (21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e112 (67.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e96 (61.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUsage of mesh during abdominal closure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24 (14.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.183 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of stay, days, mean (\u0026plusmn;\u0026thinsp;SD)\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.5 (\u0026plusmn;\u0026thinsp;1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.9 (\u0026plusmn;\u0026thinsp;1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.002 (2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Drain in site, days, mean (\u0026plusmn;\u0026thinsp;SD)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.9 (\u0026plusmn;\u0026thinsp;11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.4 (\u0026plusmn;\u0026thinsp;12.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.004 (2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost-operative antibiotics usage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e148 (89.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e139 (89.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.995 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo of days of antibiotic usage, mean (\u0026plusmn;\u0026thinsp;SD)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.7 (\u0026plusmn;\u0026thinsp;11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.3 (\u0026plusmn;\u0026thinsp;8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.768 (2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDonor site complications occurring within 30 days of the primary surgery are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In the group receiving iNPWT, the major and minor complication rates were 6.1% and 18.8% respectively. For the group receiving SD, complication rates were slightly higher with 7.1% having major complications requiring surgical intervention and 22.6% having minor complications that were managed non-surgically. However, the difference was not statistically significant, (p\u0026thinsp;=\u0026thinsp;0.708 for major complications and p\u0026thinsp;=\u0026thinsp;0.402 for minor complications). The most common major complication was wound necrosis in the group with iNPWT and seroma in those with SD.The most common minor complication was wound dehiscence in both groups. The readmission rates within 30 days of surgery were 1.8% and 2.6% for those with and without iNPWT respectively, there was no statistically significant difference in the readmission rates(p\u0026thinsp;=\u0026thinsp;0.641). Similarly, there was no statistically significant difference in number of in-person visits(p\u0026thinsp;=\u0026thinsp;0.176) and video consults (p\u0026thinsp;=\u0026thinsp;0.694) within 30 days after surgery between the two groups. Majority of the patients had two in-person visits and no video visits in either group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDonor site Complications within 30 days after surgery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDIEP with iNPWT\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Dressing\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38(23.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42(27.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.401 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMajor Complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.708 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeroma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3(1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.466 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.593 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Site Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.916 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound dehiscence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.476 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound necrosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3(1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.537 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRevision in OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3(1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.757 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor Complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35 (22.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.402 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeroma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.855 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3(1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.364 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Site Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.119 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound dehiscence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22(13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27(17.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.567 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound Necrosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.579 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of Antibiotics for more than a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.874 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReadmission within first 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.641 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo of in person visits within 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.176 (2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56 (33.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40 (25.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e77 (46.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73 (47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (13.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26 (16.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo of in Video consults within 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.694 (2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e157 (95.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e146 (94.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDonor site complications occurring within 30 to 90 days after primary surgery are listed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. There was no statistically significant difference between the two groups in terms of major and minor complication rates (p\u0026thinsp;=\u0026thinsp;0.765 and p\u0026thinsp;=\u0026thinsp;0.792 respectively). Most patients in each group had one in-person visit and no video consult within 30\u0026ndash;90 days of surgery. Patients with iNPWT had a higher readmission rate of 3% as compared to 0.6% in those with SD, the difference however was statistically not significant(p\u0026thinsp;=\u0026thinsp;0.116).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDonor site complications 30\u0026ndash;90 days after surgery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDIEP with iNPWT\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Dressing\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32(19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30(19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.993 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMajor Complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.765 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeroma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.599 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Site Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.350 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound Dehiscence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3(1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.809 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound Necrosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.659 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRevision in OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.270 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor Complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29 (18.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.792 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeroma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10(6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10(6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.000 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.313 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Site Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.553 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound dehiscence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18(10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19(12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.788 (1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound Necrosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.717 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of Antibiotics for more than a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3(1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.687 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal Bulge or mass\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.965 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReadmission within 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.116(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo of in-person visits 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.914 (2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39 (23.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43 (27.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76 (46.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo of in Video consults 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.782 (2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e146 (88.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e139 (89.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOverall complication rates between the two groups were similar; 62 (37.6%) patients with iNPWT and 58 (37.4%) patients with SD had any complication within 90 days of surgery (p\u0026thinsp;=\u0026thinsp;0.977). No statistically significant difference was observed between the two groups in terms of overall complications within 30 days (p\u0026thinsp;=\u0026thinsp;0.401) and 30\u0026ndash;90 days of surgery (p\u0026thinsp;=\u0026thinsp;0.993)\u003c/p\u003e\u003cp\u003eWhen the CT abdominal wall thickness was compared between those with complications and those without complications at all four anatomical locations, no statistically significant difference was observed in each group (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarizes the results of the comparison.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelation between CT Abdominal Wall thickness and Complications\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eDIEP with iNPWT Mean(SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eStandard Dressing Mean(SD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCT Abdominal Wall\u003c/p\u003e\u003cp\u003eThickness(mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eWith\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eNo Complications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eWith\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eNo Complications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt Umbilicus-Right\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.846 (11.156)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.091 (9.010)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.389(1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.962(8.172)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35.651 (7.951)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.351 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt Umbilicus -Left\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.687 (11.046)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.421 (9.069)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.621(1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.792(8.495)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35.132 (8.268)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.227 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt 2 cm above SP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.819 (11.164)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.932(10.687)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.596(1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34.652(9.691)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33.011 (8.910)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.296 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt 3 cm above SP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.599 (10.536)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.713(11.773)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.810(1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31.776 (10.752)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30.794 (9.629)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.574 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eSP\u003c/b\u003e: Symphysis Pubis \u003cb\u003eNote\u003c/b\u003e:(1) Kruskal-Wallis rank sum test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e summarizes donor site complications stratified by BMI. Among patients with BMI\u0026thinsp;\u0026lt;\u0026thinsp;25 kg/m2, use of iNPWT led to a statistically significant reduction in minor complication rate within 30 days of surgery(p\u0026thinsp;=\u0026thinsp;0.039). However, no such difference was observed in complication rates for patients with BMI\u0026thinsp;\u0026gt;\u0026thinsp;25 kg m2. Overall complication rates were similar in both BMI groups with or without the use of iNPWT (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDonor Site Complication Rate stratified by BMI \u003cb\u003eNote\u003c/b\u003e: (1) Pearson's Chi-squared test\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDIEP With iNPWT (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Dressing (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePatients with BMI\u0026thinsp;\u0026le;\u0026thinsp;25 kg/m2 (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Complication Rates within 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.167(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMajor complication Rates within 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.678(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor complication Rates within 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Complication Rates within 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.081(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMajor complication Rates within 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor complication Rates within 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.081(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall complication rates within 0\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.801(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatients with BMI\u0026thinsp;\u0026gt;\u0026thinsp;25 kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;269)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Complication Rates within 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.752(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMajor complication Rates within 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.417(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor complication Rates within 30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.975(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Complication Rates within 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(11.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.743(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMajor complication Rates within 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.709(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor complication Rates within 30\u0026ndash;90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25(9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.523(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall complication rates within 90 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53(19.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51(19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.840(1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e summarizes the results of logistic regression analysis. Correlation analysis revealed a significant correlation (\u0026gt;\u0026thinsp;0.6) between BMI and abdominal wall thickness at all four anatomical locations. Hence only BMI was used for logistic regression analysis to remove the effect of multicollinearity.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic Regression analysis for overall donor site complications 0\u0026ndash;90 days after surgery.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMultivariable\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk Factor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace-White\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.37(0.62\u0026ndash;3.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.452\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody Mass Index (BMI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.03(0.97\u0026ndash;1.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.334\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.02(0.97\u0026ndash;1.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.424\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent or past smoking exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.68(1.02\u0026ndash;2.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.74(1.05\u0026ndash;2.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.11(0.28\u0026ndash;3.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.868\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic Systemic Steroid use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.71(0.57\u0026ndash;5.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.91(0.63\u0026ndash;5.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.244\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious abdominal scars\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.40(0.86\u0026ndash;2.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.43(0.88\u0026ndash;2.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of iNPWT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.00(0.64\u0026ndash;1.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.977\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of mesh for abdominal closure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.92(0.45\u0026ndash;1.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.825\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Drain in site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.04(1.02\u0026ndash;1.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.0002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of hospital stay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.15(0.98\u0026ndash;1.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariable analysis using logistic regression stratified by BMI\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eOverall Complications 0\u0026ndash;30 days\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMinor Complications 0\u0026ndash;30 days\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk Factor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003ePatients with BMI\u0026thinsp;\u0026le;\u0026thinsp;25 kg/m2 (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody Mass Index (BMI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.19(0.72\u0026ndash;2.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.511\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.30(0.75\u0026ndash;2.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.377\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent or past smoking exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.86(1.09\u0026ndash;22.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.89(0.80-18.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.082\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic Systemic Steroid use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.68(0.07\u0026ndash;19.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.683\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.17(0.09\u0026ndash;25.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.546\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious abdominal scars\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00(0.26\u0026ndash;4.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.21(0.29\u0026ndash;6.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.803\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of iNPWT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.40(0.10\u0026ndash;1.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.22(0.04\u0026ndash;0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Drain in site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.08(0.99\u0026ndash;1.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.10(1.00-1.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of hospital stay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.57(0.88\u0026ndash;2.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.66(0.91\u0026ndash;3.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatients with BMI\u0026thinsp;\u0026gt;\u0026thinsp;25 kg/m2(n\u0026thinsp;=\u0026thinsp;269)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody Mass Index (BMI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.02(0.95\u0026ndash;1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.640\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.02(0.94\u0026ndash;1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent or past smoking exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.31(0.73\u0026ndash;2.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.61(0.87\u0026ndash;2.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.127\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.28(0.27\u0026ndash;4.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.727\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.67(0.35\u0026ndash;6.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.470\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic Systemic Steroid use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.58(0.72\u0026ndash;8.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.45(0.31\u0026ndash;5.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.592\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious abdominal scars\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.75(0.96\u0026ndash;3.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.91(0.99\u0026ndash;3.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of iNPWT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.92(0.53\u0026ndash;1.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.99(0.55\u0026ndash;1.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.975\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Drain in site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.03(1.005\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.02(1.00-1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of hospital stay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.20(0.998\u0026ndash;1.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.02(0.81\u0026ndash;1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*\u003c/b\u003e None of the patients with BMI\u0026thinsp;\u0026le;\u0026thinsp;25 kg/m2 had diabetes.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e describes the results of logistic regression analysis performed on the overall study population. Patients who were current smokers or had any history of smoking including passive exposure was classified as having current or past smoking exposure. On univariable analysis, it was found to be a significant factor in increasing odds of overall donor site complications 0\u0026ndash;90 days after surgery (OR 1.68, CI 1.02\u0026ndash;2.74, p\u0026thinsp;=\u0026thinsp;0.040). Duration of drain in site was also significantly associated with overall complications within 90 days, (OR 1.04, CI 1.02\u0026ndash;1.07, p\u0026thinsp;=\u0026thinsp;0.0002), however since it cannot be used to predict complications pre-operatively, it was excluded from multiple regression analysis. All variables which had a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.35 on univariable analysis were used for multiple regression analysis yielding an AIC\u0026thinsp;=\u0026thinsp;425. The only significant factor predicting donor-site complications was current or past smoking exposure based on multivariable logistic regression (OR 1.74, CI 1.05\u0026ndash;2.86, p\u0026thinsp;=\u0026thinsp;0.030).\u003c/p\u003e\u003cp\u003eInterestingly, use of iNPWT did not reduce odds of overall donor site complications (OR 1.00, CI 0.64\u0026ndash;1.58, p\u0026thinsp;=\u0026thinsp;0.977). However, upon stratification of the study population into BMI\u0026thinsp;\u0026le;\u0026thinsp;25 and BMI\u0026thinsp;\u0026gt;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e, the use of iNPWT led to reduction in minor complications within 30 days of surgery (OR 0.22, CI 0.04\u0026ndash;0.93, p\u0026thinsp;=\u0026thinsp;0.049) among women with BMI\u0026thinsp;\u0026le;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). In the same subgroup of patients, current or past smoking exposure was associated with more than 4-fold increase in odds of Overall 30-day complications (OR 4.86, CI 1.09\u0026ndash;22.44, p\u0026thinsp;=\u0026thinsp;0.037). No variables were found to be significant in predicting 30-days complications in the subgroup of patients with BMI\u0026thinsp;\u0026gt;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e, although there was significant association with duration of drain in site (OR 1.03, CI 1.005\u0026ndash;1.05, p\u0026thinsp;=\u0026thinsp;0.018).\u003c/p\u003e\u003cp\u003eIn our cohort, iNPWT-related issues occurred in 14 of 166 cases, including dressing leakage (6 cases), tubing issues (2 cases), device drops (2 cases), water ingress (1 case), battery failure (1 case), and contact dermatitis (2). These were resolved through remote troubleshooting (4 cases) or in-person visits (10 cases), including repatching and device resets, ensuring the device functioned for the full 7-day duration.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this retrospective study involving 320 patients represents the largest study to date assessing differences in donor site complication rates associated with the use of iNPWT. Despite the larger sample size, this study did not demonstrate any significant reduction in overall complication rates with the use of iNPWT. Consistent findings were reported in two earlier studies with sample sizes of 56 and 42 patients, respectively.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e In contrast, a prospective clinical trial involving 75 women undergoing DIEP flap breast reconstruction found a significant reduction in wound dehiscence with iNPWT, although no meaningful differences were observed in other outcomes such as seroma, hematoma, or surgical site infection.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e This study confirmed smoking as a significant predictor of donor-site complications, a finding that aligns with established evidence in the literature.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe only measurable benefit of iNPWT shown in the current study was a modest reduction in drain duration by a few days. At best, this may alleviate patient inconvenience without increasing donor-site complications. Comparable reductions in drain removal time have been reported in abdominoplasty patients.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e However, iNPWT use can be cumbersome, as illustrated by occasional device-related issues encountered by some patients. Although infrequent, these problems highlight practical challenges that sometimes necessitate phone support or additional clinic visits. Such findings emphasize the importance of patient education and support systems to ensure uninterrupted therapy and optimize postoperative outcomes.\u003c/p\u003e\u003cp\u003eIt is also important to consider the financial aspects of using iNPWT, particularly in the context of surgical site outcomes. An economic analysis study done on patients undergoing surgery involving abdominal incisions including breast reconstruction, described savings of about \u003cspan\u003e$\u003c/span\u003e667 per patient due to reduced incidence of surgical site complications.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e The cost savings increase for patients at higher risk of complications such as those with BMI\u0026thinsp;\u0026gt;\u0026thinsp;30 or diabetes.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Usage of iNPWT costs about \u003cspan\u003e$\u003c/span\u003e3000 per patient at our institution. A previous study has demonstrated significant improvement in cost-benefit attributed to reduced complications outweighing the increase in cost attributed to the usage of iNPWT at the donor site in patients undergoing DIEP flap-based reconstruction.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Patient-reported outcomes could help us understand if the benefits listed above actually translate to reduced financial burden. A financial survey of such patients could validate the above-mentioned hypothesis.\u003c/p\u003e\u003cp\u003eWe also found that CT abdominal thickness played no role in determining the complication rate. Although patients with complications had a slightly higher mean abdominal wall thickness as compared to those without complications for both groups of patients with and without iNPWT the difference was not statistically significant. This aligns with previous work reporting no clear association between abdominal fat thickness and donor-site morbidity.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Nevertheless, other investigators have reported contrary findings, suggesting that increased abdominal wall thickness may predispose patients to delayed wound healing, surgical site infection, and flap necrosis in abdominally based breast reconstruction.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Taken together, these observations highlight ongoing uncertainty regarding the role of abdominal wall thickness, suggesting that its impact may be context-specific or confounded by additional patient- or procedure-related variables.\u003c/p\u003e\u003cp\u003eOne such variable is BMI which correlates positively with abdominal wall fat thickness.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Higher BMI is a known risk factor for increased donor site complications after DIEP-based breast reconstruction.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e In our study, patients with BMI\u0026thinsp;\u0026lt;\u0026thinsp;25 kg/m\u0026sup2; showed a statistically significant reduction in 30-day minor complications with iNPWT, while no such benefit was seen in those with BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2;. At 90 days, complication rates did not differ significantly between BMI groups regardless of iNPWT use (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). These findings suggest that the benefits of iNPWT may diminish over time and with increasing BMI. Similar results have been reported in obese women undergoing cesarean section, where iNPWT did not reduce complication rates compared to standard dressings.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis study has several important limitations. Its retrospective design limits causal inference, and the predominance of a single racial group (~\u0026thinsp;90%, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) affects generalizability. Patients from minority communities have been shown to experience higher complication rates. \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Future randomized controlled studies with more diverse and high-risk populations are needed to better assess the benefits of iNPWT.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSource of Funding:\u003c/strong\u003e The authors declare that no funds, grants, or other support were received to support the research, authorship, or publication of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics committee Name: \u0026nbsp;Institutional Review Board (IRB)– Minimal Risk Committee\u003c/p\u003e\n\u003cp\u003eIRB Approval Number: 22-010241\u003c/p\u003e\n\u003cp\u003eWaiver of Informed Consent under HIPAA regulations\u003cstrong\u003e\u0026nbsp;: \u0026nbsp;\u003c/strong\u003eAs this study involved a retrospective chart review with no direct interaction or intervention with human subjects, informed consent was not obtained. A Waiver of Informed Consent and HIPAA Authorization\u0026nbsp;was granted by the Institutional Review Board – Minimal Risk Committee, consistent with federal guidelines under 45 CFR 164.512(i)(2)(ii). The waiver was approved because the research involved no more than minimal risk to subjects, could not practicably be conducted without the waiver, and involved adequate measures to protect the privacy and confidentiality of patient information. All data were de-identified prior to analysis\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eN.K. and S.N. contributed equally as first co-authors. N.K., S.N., M.S.M., and S.S.B. performed data collection and investigation. N.K. and S.S.B. conducted the formal analysis. M.S.M., S.S.B., and A.V. contributed to study methodology. S.N., M.S.M., S.S.B., C.H., V.F., J.M.J., and A.V. provided supervision. N.K. drafted the original manuscript, and all authors (N.K., S.N., M.S.M., S.S.B., C.H., V.F., J.M.J., and A.V.) contributed to review and editing. All authors approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe acknowledge the contribution of Ross A. Dierkhising, M.S, Principal Biostatistician at the Mayo Clinic, Rochester, Minnesota for helping with statistical analyses.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLeaper DJ, Edmiston CE (2017) World Health Organization: global guidelines for the prevention of surgical site infection. 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Eur J Surg Oncol Apr 45(4):584\u0026ndash;590. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejso.2019.01.016\u003c/span\u003e\u003cspan address=\"10.1016/j.ejso.2019.01.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Negative Pressure Wound Therapy, DIEP Flap, Donor Site Complications, Breast Reconstruction, Wound Healing","lastPublishedDoi":"10.21203/rs.3.rs-7521588/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7521588/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSmoking 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLevel III, therapeutic study\u003c/p\u003e","manuscriptTitle":"Incisional Negative Pressure Wound Therapy for Deep Inferior Epigastric Perforator (DIEP) Flap Donor Site in Breast Reconstruction: Does It Impact Wound Healing?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 18:42:38","doi":"10.21203/rs.3.rs-7521588/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-14T12:38:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-12T19:04:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134811588890681202670129871211201859559","date":"2025-09-09T19:28:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-09T15:31:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-09T09:45:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T09:44:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Plastic Surgery","date":"2025-09-03T00:40:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dac873a9-9692-4455-95b0-5d82cf03bde8","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:01:36+00:00","versionOfRecord":{"articleIdentity":"rs-7521588","link":"https://doi.org/10.1007/s00238-026-02452-4","journal":{"identity":"european-journal-of-plastic-surgery","isVorOnly":false,"title":"European Journal of Plastic Surgery"},"publishedOn":"2026-04-30 15:58:24","publishedOnDateReadable":"April 30th, 2026"},"versionCreatedAt":"2025-09-17 18:42:38","video":"","vorDoi":"10.1007/s00238-026-02452-4","vorDoiUrl":"https://doi.org/10.1007/s00238-026-02452-4","workflowStages":[]},"version":"v1","identity":"rs-7521588","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7521588","identity":"rs-7521588","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}