Would you recommend a wound vac for recovery after a tummy tuck?

Question

Vacuum-assisted closure of a wound is a type of therapy to help wounds heal. It's also known as wound VAC. I had a wound vac after my cesarean and it helps heal the wound faster. Is the tummy tuck incision similar to the bikini cesarean incision and would you recommend the same wound vac application?

Robert M. Lowen, MD · Answer

A wound vac is a negative pressure foam pad placed over a wound or incision, connected to a vacuum of -50-200 mm Hg, and covered by an occlusive adherent membrane. It's purpose is to remove fluid secreted by a wound or incision, decrease swelling, increase blood flow and decrease tension on the wound or incision. There are no randomized controlled studies of its use in aesthetic surgery, but there are many for other specialties where it has been found beneficial in decreasing the frequency of surgical site infections (SSI's), particularly for high risk patients where the consequences of a wound infection can be very serious, e.g. cardiac surgery median sternotomies, orthopedic total knee and hip, vascular surgery groin incisions over grafts.
Studies of its us for C sections showed no clear benefit, as there were both negative and positive results in five studies and more large randomized clinical trials are needed to clarify its use for C sections.
For patients who undergo bariatric surgery, abdominal wall reconstruction, hernia repairs it is beneficial as these patients have high risk factors for wound infections, which may include diabetes, obesity, and additively smoking if they are smokers as well.
There are no studies to suggest that the use of closed-incision negative pressure therapy  (ciNPT) for aesthetic surgery such as abdominoplasty confers a benefit, although there are intuitive reasons to suggest it might since it can reduce swelling, reduce drainage from an incision, and relieve some scar tension which theoretically could improve scar quality. But ciNPTis only put on for a week, and there are no longer term studies of scar quality.
Plastic and Reconstructive Surgery Journal published an in-depth supplement in the January 2019 PRS to bring this topic to the attention of the plastic surgery community.
Plastic and Reconstructive Surgery. January 2019 - Volume 143 - Management of Surgical Incisions Utilizing Closed-Incision Negative-Pressure Therapy 1S
To get the benefits of reduced swelling (edema) better effectiveness against bacteria and biofilm than gauze dressings, and reducing incisional tension, there are current technologies available and helpful surgical techniques.
From the surgical point of view, a deep layer closure in the superficial fascia as described by Lockwood brings the flaps together with high tension in the deep layer that relieves skin tension where the visible scar forms. This makes the surface appear as a little hill which gradually relaxes over the next weeks as the skin heals, relieving tension on the skin itself.
Technologies available which I use include Prineo Dermabond Tape. This is an flexible, bacteriostatic mesh which is rolled onto the incision and secured with a liquid polymer from a dispenser. It sticks to the wound, relieving tension further and protecting it better than gauze alone. It  adds about $150 to the cost. It is removed at three weeks at which time patients may use scar modifying silicone gel, or use a proprietary technology called Embrace. Embrace consists of an applicator that when opened sets tension on an adhesive silicone pad. When the pad is applied in line with the incision, it pulls the skin toward the incision, thus unloading the tension and potentially resulting in better scar quality. The device is used for seven weeks while scar is maturing, changed every ten days.
For edema control I use a foam pad, e.g., Epifoam, over the abdomen, and if lipo has been done, over the flanks as well. The foam pads stay on at least 3 days and up to 2 weeks. They minimize bruising also.
So a long answer to your question, no, I would not apply a wound vac, ciNPT, to a tummy tuck incision. Research over the next few years may give a more definitive answer to its benefit in aesthetic cosmetic surgery. Some surgeons are using it in reconstructive breast surgery after mastectomy and like the results.
Economic Analysis Based on the Use of Closed-Incision Negative-Pressure Therapy after Postoperative Breast Reconstruction
Gabriel, Allen; Maxwell, G. Patrick
Plastic and Reconstructive Surgery. 143(1S):36S-40S, January 2019.
For  more information copy this:
 Management of Surgical Incisions Utilizing Closed-Incision Negative-Pressure Therapy 1S 
into the Pubmed search bar accessed by the URL below.

Carlos Mata, MD, MBA, FACS · Answer

Hello, thank you for submitting your concernsA wound vac is not necessary for an incision following a tummy tuck. If post-op care instruction are followed and the tummy tuck is properly done by a board certified plastic surgeon you should not require one. Often times wound vacs are not covered by insurance for cosmetic purposes making it an additional expense. Best of luck

Finny George, MD · Answer

Hi, thank you for your question. 
Wound VACs have been around for decades and most of not all the plastic surgeons on the forum have used them for large open wounds that result in complex situations or patients with significant medical problems. 
Typically, elective cosmetic surgery in healthy patients does not require the use of a wound VAC. 
You may be alluding to the use of an incisional wound vac which can be placed over a closed incision to help with fluid egress and can sometimes speed the healing process. This machine and it’s associated supplies will not be covered by medical insurance, so you may want to consider that if you are planning on discussing this with your surgeon. 
The tummy tuck incision is usually placed low on the abdomen often in the bikini line so that it is hidden from view. 
Your board-Certified plastic surgeon will be able to discuss all of the options for your surgery and whether you would benefit from the wound VAC, but I believe most plastic surgeons would not encourage its prophylactic use. 
Good luck in achieving your aesthetic goals!

Austin Hayes, MD · Answer

Thank you for your question. A wound VAC should not be needed after a tummy tuck procedure. It would not help with healing unless there was an unforeseen complication. When considering a tummy tuck procedure make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if a tummy tuck is right for you.

Richard Baxter, MD · Answer

Wound vac devices are used when there are complications in healing, but have not been shown to benefit healing otherwise. Risk factors for complications of this type include smoking and BMI more than 30.

Anita Patel, MD, FACS · Answer

While each surgeon has her/his own preference on how to manage incisions, a wound vac is not necessary or customary after a tummy tuck. A lot of people don't realize plastic surgery is the field that manages complex wounds, and wound vacs are something all plastic surgeons typically have experience with. While the main use has been for open wounds, or wounds with drainage, the uses have expanded to some surgeons using them over intact incisions, with the thought of reducing tension at the skin edges, improving vascularity of skin edges, and draining any fluid. However, the surgeons using it tend to do so in specific circumstances where the risks of dehiscence (skin separation or opening) or drainage  are higher, like with abdominal laparotomy and C section. It would not be bad to use after tummy tuck, but would not necessarily improve your results either.

Daniel Barrett, MD · Answer

Dear ruralmama,every plastic surgeon has his own postoperative protocol which he recommends to his patients but most plastic surgeons don't use VAC for tummy tuck incisions. I would suggest you to discuss this with your plastic surgeon.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Kenneth Hughes, MD · Answer

Tummy tuck incision separation should be managed conservatively and should not require wound vac application.  Dressing changes until the wound is healed can be followed by scar revision in one year if needed.

Camille Cash, MD · Answer

For tummy tucks many surgeons use JP drains (Jackson-Pratt drains).  This type of drain collects fluid from the surgical site and is easily maintained and emptied.  It is a suction drain but it less complex and cumbersome compared to a wound vac.

Curtis Wong, MD · Answer

and a wound VAC is not needed for a clean incision to heal.  The manufacturers look for ways to expand their products uses and using it on intact incisions was one of them... but that never made sense to me.  Unless you have one in your possession, its not worth paying the extra money for the potential benefits touted by the company.

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