Re: The Use of Negative Pressure Wound Therapy for Breast Surgeries: A Systematic Review and Meta-Analysis.

Background: Negative pressure wound therapy (NPWT) following breast surgery has emerged as a promising intervention theorized to reduce complication rates, improve patient-important outcomes, and enhance cost-effectiveness. This systematic review and meta-analysis aims to determine outcomes of NPWT following breast surgery. Methods: MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL were searched to include all English-language, peer-reviewed observational and randomized controlled trials (RCTs) investigating NPWT on the breast or donor site among patients undergoing breast surgery. Studies evaluated at least one of the following outcomes: wound dehiscence, surgical site infection (SSI), implant loss, re-operation, re-admission, hematoma, seroma, and skin/wound necrosis. Quality of evidence was assessed with GRADE methodology. Results: This review includes 31 studies (eight RCTs, 23 observational) analyzing 3320 patients (4326 breasts). High certainty of evidence indicates decreased risk of wound dehiscence among NPWT patients in RCTs for all NPWT application sites (donor: 0.40; 95%CI 0.21, 0.79; breast: 0.59; 95%CI 0.41, 0.84) and observational trials where NPWT was placed on donor sites (0.64; 95%CI 0.42, 0.98). Some evidence indicates NPWT may reduce SSI, hematoma, seroma, and skin/wound necrosis incidence, however results are uncertain and varied in statistical significance. No effect was identified on rates of breast implant loss, re-operation, and re-admission, although this certainty of evidence is very low. Conclusions: Our findings suggest NPWT following breast surgery reduces the risk of wound dehiscence, may have some effect on SSIs, hematoma, seroma, and skin/wound necrosis; and does not demonstrate an effect on rates of implant loss, re-operation or re-admission.

A Commentary on “Prophylactic negative pressure wound therapy for closed laparotomy incision after ventral hernia repair: A systematic review and meta-analysis” (Int J Surg 2022; 97:106216)

<p>This guide presents recommendations for midwives and obstetricians on the subject of wound healing; in relation to surgical site infections (SSI) post-caesarean section (CS) using negative pressure wound therapy (NPWT) for at-risk groups. Background It is well documented that there has been a steady growth in CS rates since the 1980s (Betrán et al, 2016), despite the World Health Organization's ([WHO], 2015) reiteration in 1985 of an 'ideal' CS rate globally of 10%–15%. Bragg et al (2010) asserts a CS increase in England from 9% in 1980 to 24.6% by 2008–2009. The National Maternity and Perinatal Audit ([NMPA], 2019) Project Team reports a birth rate of 700 000 during 2016–2017 in the NHS across England, Wales and Scotland, of which approximately 1 in 4 women were delivered by CS (Bhatia et al, 2021); a statistic reiterated within the National Institute for Health and Care Excellence ([NICE], (2021) caesarean birth guidance. The WHO (2015) affirms that when medically necessary, CS prevents maternal and newborn mortality (Boerma et al, 2018; Sandall et al, 2018). There are many speculated reasons for this increase, such as rising maternal age at first.</p>

Diabetes mellitus (DM), which affects millions globally, is rising exponentially. Diabetic foot ulcers (DFUs) are a major health and economic concern in patients with uncontrolled DM. Complex factors such as neuropathy, ischemia, and susceptibility to infection contribute to the development of DFUs, which can lead to amputations and significant mortality. Traditional DFU therapies often struggle to address the diversity and complexity of ulcers. Current guidelines for DFU care recommend Negative Pressure Wound Therapy (NPWT) as a potential treatment option. NPWT applies controlled negative pressure to optimize wound healing. Despite its promise, limited evidence, varying methodologies, and restricted data accessibility necessitate a comprehensive evaluation.Our study adhered to PRISMA standards and conducted an extensive search across multiple databases, including PubMed, Embase, and the Cochrane Library, to identify randomized controlled trials (RCTs) published after 2008. The search included targeted keywords related to diabetic foot complications and NPWT to evaluate the safety and efficacy of this approach compared with conventional wound treatments.In the meta-analysis comprising 11 studies and a total of 1,135 participants, significant outcomes favored NPWT for DFUs. NPWT demonstrated a substantial impact on complete wound closure, with an OR of 2.193 (95% CI: 1.562-3.079; p < 0.0001). Ulcer healing also showed a statistically significant improvement, with an OR of 2.771 (95% CI: 1.511-5.082; p = 0.0010). Granulation tissue development improved markedly, as indicated by a standardized mean difference of -1.3384 (95% CI: -1.5577 to -1.1192; p < 0.0001). NPWT notably reduced amputation rates by 63%, with an OR of 0.368 (95% CI: 0.182-0.746). Although there was a trend toward fewer adverse events with NPWT, the effect did not reach statistical significance (log OR: 0.1548; 95% CI: -0.4364 to 0.7460).These findings underscore the clinical efficacy of NPWT in the management of DFUs. In conclusion, this systematic review and meta-analysis confirm the effectiveness of NPWT in improving wound closure, accelerating recovery, and reducing amputation rates in patients with DFUs.

Background/Objectives: Surgical site infections (SSIs) following pancreaticoduodenectomy contribute to significant morbidity and healthcare costs. Negative pressure wound therapy (NPWT) has emerged as a potential preventive intervention; however, evidence regarding its efficacy in pancreatic surgery remains limited. This systematic review and meta-analysis aimed to evaluate the efficacy of NPWT compared to conventional dressings in preventing SSI following pancreaticoduodenectomy. Methods: PubMed, Scopus, BASE, Cochrane CENTRAL, and ClinicalTrials.gov were systematically searched from their inception to 2 April 2025. Randomized clinical trials and observational studies comparing NPWT with conventional dressings in patients undergoing pancreaticoduodenectomy were included. Two independent reviewers extracted the data and assessed the methodological quality. Random-effects meta-analysis was performed to calculate the pooled relative risks (RRs) with 95% CIs. The primary outcome was the incidence of SSI. The secondary outcomes included pancreatic fistula, seroma formation, incisional hernia, and readmission rates. Results: Nine studies (three randomized clinical trials and six observational studies) comprising 1247 patients were included. NPWT was associated with a significant reduction in SSI compared with conventional dressings (RR, 0.61; 95% CI, 0.41–0.90). Subgroup analysis revealed varying effects by study design: retrospective cohort studies showed a nonsignificant trend toward SSI reduction (RR, 0.53; 95% CI, 0.19–1.48), randomized clinical trials demonstrated a nonsignificant trend favoring NPWT (RR, 0.67; 95% CI, 0.37–1.23), and the single prospective cohort study showed significant SSI reduction (RR, 0.48; 95% CI, 0.28–0.84). No significant differences were observed in pancreatic fistula rates between the NPWT and conventional dressing groups. Prophylactic NPWT application, longer duration (≥5 days), and higher negative pressure settings (−125 mmHg) appeared more effective than therapeutic application, shorter duration, and lower-pressure settings, respectively. Conclusions: This systematic review and meta-analysis suggests that NPWT is associated with a reduced SSI risk following pancreaticoduodenectomy. The greatest benefit may be achieved with prophylactic application in high-risk patients, longer therapy duration, and higher negative pressure settings. These findings support the consideration of NPWT as part of SSI prevention strategies in pancreatic surgery, particularly for patients with identified risk factors.

NPWT combined with porcine ADM dressing can effectively remove wound bacteria, reduce wound exudation, and promote wound healing in repairing deep partial-thickness burn wounds and full-thickness burn wounds. Its clinical effect is better than NPWT or porcine ADM dressing alone, and this method may be suitable for patients with non-surgical treatment.

Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery. This systematic review was reported according to PRISMA guidelines. The protocol was published in PROSPERO (CRD42018114625). Medline, Embase, CINAHL and Cochrane Library databases were searched for studies which compare the efficacy of NPWT versus non-NPWT dressings for closed incisions in breast surgery. Specific outcomes of interest were total wound complications, surgical site infection (SSI), seroma, haematoma, wound dehiscence and necrosis. Seven studies (1500 breast incisions in 904 patients) met the inclusion criteria. NPWT was associated with a significantly lower rate of total wound complications [odds ratio (OR) 0.36; 95% CI 0.19-069; P = 0.002], SSI (OR 0.45; 95% CI 0.24-0.86; P = 0.015), seroma (OR 0.28; 95% CI 0.13-0.59; P = 0.001), wound dehiscence (OR 0.49; 95% CI 0.32-0.72; P < 0.001) and wound necrosis (OR 0.38; 95% CI 0.19-0.78; P = 0.008). There was no significant difference in haematoma rate (OR 0.8; 95% CI 0.19-3.2; P = 0.75). Statistically significant heterogeneity existed for total wound complications, but no other outcomes. Compared with conventional non-NPWT dressings, prophylactic application of NPWT is associated with significantly fewer surgical site complications including SSI, seroma, wound dehiscence and wound necrosis for closed breast incisions.

Negative-pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomized controlled trials

Background &amp; Aim: This study aims to assess the surgical site infection (SSI) rate in obese women undergoing C-sections, comparing negative pressure wound therapy (NPWT) and standard dressings. Methods &amp; Materials: In this systematic review and meta-analysis, databases including Science Direct, Medline/PubMed, Web of Science, Scopus, and Cochrane Library were searched for articles published up to January 2024. The selection criteria included randomized controlled trials and cohort studies comparing the effect of (NPWT) with standard dressings on wound complications in women with obesity undergoing C-sections. Data collection and analysis Pooled effect sizes were calculated using random effects models based on heterogeneity. Results: Out of 20 included studies, 18 reported SSI rates, which included 9243 cases and showed that NPWT reduces the rate of SSIs in obese women undergoing C-section (RR: 0.8, 95% CI: 0.66–0.96, I2= 24.5%, P= 0.01). An in-depth examination of 13 high-quality studies, in which NPWT devices were used, reveals a pooled Mantel-Haenszel (M-H) Risk Ratio (RR) of 0.92 for Prevention- Reduction - Epithelialization- Vacuum- Environment- Negative pressure- Advanced (PREVENA) (95% CI: 0.67–1.26, I2= 0%, P= 0.6) and 0.76 for Pressure- Incision- Closed- Optimization (PICO) (95% CI: 0.44–1.33, I2= 15%, P= 0.05), with a significant difference among devices (P=0.05). Conclusion: NPWT reduces the SSI rate in obese women undergoing C-sections, regardless of the type or device used. Economic evaluations are crucial to justify NPWT device costs against expenses for treating surgical infections, supporting its widespread use in infection prevention.

Numerous studies have demonstrated that negative pressure wound therapy (NPWT) can enhance wound healing; however, its use following skin grafting remains a subject of debate. Given the high rate of graft failure in extremities and the critical role these areas play in human mobility, this study aimed to evaluate whether NPWT improves skin grafts take rates after extremity skin grafting. A comprehensive literature search was conducted across multiple databases, and 18 studies involved 1098 patients met the inclusion criteria and were included in the analysis. The effectiveness of NPWT versus conventional therapy after extremity skin grafting was compared. The primary outcome was the graft take rate, while secondary outcomes included postoperative complications and length of hospital stay. Additionally, we evaluated the influence of graft position, graft thickness, and negative pressure on graft take rates. Compared to conventional therapy, NPWT significantly improved the graft take rates (MD = 11.04, 95 % CI [5.57, 16.51], p < 0.0001), reduced the incidence of postoperative infection, seroma, and reoperation, and shortened the length of hospital stay. However, no significant differences were observed in tendon exposure and delayed healing. Subgroup analyses revealed improved skin graft take rates when skin graft thickness was ≤0.2 mm and negative pressure was ≤100 mmHg. These findings suggest that NPWT is an adjunctive therapy for skin grafting in the extremities. Furthermore, we observed that the application of NPWT on the upper extremities and the optimal negative pressure value require further investigation.

The open abdomen technique may be used in critically ill patients to manage abdominal injury, reduce the septic complications, and prevent the abdominal compartment syndrome. Many different techniques have been proposed and multiple studies have been conducted, but the best method of temporary abdominal closure has not been determined yet. Recently, new randomized and nonrandomized controlled trials have been published on this topic. We aimed to perform an up-to-date systematic review on the management of open abdomen, including the most recent published randomized and nonrandomized controlled trials, to compare negative pressure wound therapy (NPWT) with no NPWT and define if one technique has better outcomes than the other with regard to primary fascial closure, postoperative 30-day mortality and morbidity, enteroatmospheric fistulae, abdominal abscess, bleeding, and length of stay. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions, an online literature research (until July 1, 2015) was performed on MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Library databases. The MeSH terms and free words used "vacuum assisted closure" "vac;", "open abdomen", "damage control surgery", and "temporary abdominal closure". No language restriction was made. The initial systematic literature search yielded 452 studies. After a careful assessment of the titles and of the full text was obtained, eight articles fulfilled inclusion criteria. We analyzed 1,225 patients, of whom 723 (59%) underwent NPWT and 502 (41%) did not undergo NPWT, and performed four subgroups: VAC versus Bogota bag technique (two studies, 106 participants), VAC versus mesh-foil laparostomy (two studies, 159 participants), VAC versus laparostomy (adhesive impermeable with midline zip) (one study, 106 participants), and NPWT versus no NPWT techniques (three studies, 854 participants) in which it is not possible to perform an analysis of the different types of treatment. Comparing the NPWT group and the group without NPWT, there was no statistically significant difference in fascial closure (63.5% vs 69.5%; odds ratio [OR], 0.74; 95% confidence interval [CI], 0.27-2.06; p = 0.57), postoperative 30-day overall morbidity (p = 0.19), postoperative enteroatmospheric fistulae rate (2.1% vs 5.8%; OR, 0.63; 95% CIs, 0.12-3.15; p = 0.57), in the postoperative bleeding rate (5.7% vs 14.9%; OR, 0.58; 95% CIs, 0.05-6.84; p = 0.87), and postoperative abdominal abscess rate (2.4% vs 5.6%; OR, 0.42; 95% CI, 0.13-1.34; p = 0.14). On the other hand, statistical significance was found between the NPWT group and the group without NPWT in the postoperative mortality rate (28.5% vs 41.4%; OR, 0.46; 95% CI, 0.23-0.91; p = 0.03) and in the length of stay in the intensive care unit (mean difference, -4.53; 95% CI, -5.46 to 3.60; p < 0.00001). The limitations of the present analysis might be related to the lack of randomized controlled trials, so there is a risk of selection bias favoring NPWT. For several outcomes, there were few studies, confidence intervals were wide, and inconsistency was high, suggesting that although there were no statistically significant differences between the groups, there was insufficient evidence to show that the outcomes were similar. We can conclude from the current available data that NPWT seems to be associated with a trend toward better outcomes compared to the use of no NPWT. It does reflect the evidence presented in the current systematic review; however, the data should be interpreted with substantial caution given a number of weaknesses (in particular, the lack of statistical significance and heterogeneity between studies, i.e., small sample size of the included studies, high variability between studies). We highlight the need for randomized controlled trials having homogeneous inclusion criteria to assess the use of NPWT for the management of open abdomen. Systemic review/meta-analysis, level III.

Background: The use of Negative Pressure Wound Dressing has been found to promote the wound healing process, therefore, reducing the risk of surgical site complications. The use of this technique amongst breast cancer patients, who have often encountered a distressing journey, may prove beneficial in making the post-operative process less eventful. Many of these patients have a limited time window to start adjuvant treatment. The use of a negative pressure device is recommended in both prophylactic and therapeutic scenarios. NPWT may also be used in patients who have undergone cosmetic breast surgery. We have evaluated the use of NPWT in breast surgery with an updated and systematic review of the available literature.&#x0D; Methods: The authors systematically searched the PubMed, Science Direct, and Wiley Online databases using the phrases “Negative Pressure Wound Therapy in Breast surgery” and “Vacuum-Assisted Closure in Breast Wound” and all publications, including relevant data were considered eligible for inclusion in the review.&#x0D; Results: We have found reports of 7 studies, 3 retrospective, 2 prospective, one randomized trial, and one case series. The complication rate in the NPWT group versus conventional dressing group has been reported in 5 papers. A statistically significant effect in favor of NPWT was documented in three trials.&#x0D; Conclusion: The current evidence supports the notion that NPWT systems are beneficial in enhancing the healing of complicated breast wounds. However, larger studies exploring the effectiveness of this technique would be of interest to breast surgeons.

Deep sternal wound infection (DSWI) is a severe and life-threatening complication following cardiovascular surgery. Negative pressure wound therapy (NPWT) has emerged as a promising therapeutic bridging option for DSWI. In this systematic review and meta-analysis, the authors aimed to evaluate the impact of NPWT on clinical outcomes in patients with DSWI. A comprehensive literature search was conducted according to the PRISMA guideline in electronic databases, including PubMed, Embase, and Cochrane Library. Data extraction was performed independently by two reviewers, and risk of bias was assessed by ROBINS-I tool. The primary outcomes assessed were mortality rate and reinfection rate. The secondary outcomes assessed were length of hospital stay and ICU stay. In this systematic review identified a total of 36 studies, comprising 3681 patients with DSWI who received treatment. The meta-analysis revealed that NPWT was associated with a significant reduction in mortality rate (RR 0.46, 95% CI: 0.35-0.61, P<0.000001) and reinfection rate (RR 0.43, 95% CI: 0.25-0.74, P=0.002) compared to conventional wound management. Furthermore, pooling of these studies showed significant difference between the NPWT and conventional treatment groups in length of hospital stay (mean difference: -4.49, 95% CI: -8.14 to -0.83; P=0.02) and length of ICU stay (mean difference: -1.11, 95% CI: -2.18 to -0.04; P=0.04). This systematic review and meta-analysis provide evidence that NPWT is superior to conventional treatment for patients with DSWI following cardiovascular surgery.

Topical negative pressure (TNP) has become a common treatment of infected wounds. A systematic review and meta-analysis was performed to investigate TNP efficacy compared to conventional therapy in the treatment of deep surgical site infections (SSIs), particularly post-sternotomy infections. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials (RCTs) and observational studies comparing TNP to conventional treatment in deep SSIs published up to February 2012. Study quality was evaluated through the GRADE system and bias risk through the Newcastle-Ottawa scale (NOS). Primary outcome was infection cure/wound resolution rate. Secondary outcomes were adverse events, length of stay, mortality, and costs. The results are presented with 95% confidence intervals (95% CIs) and report estimates as odds ratios (ORs). Heterogeneity was determined through the I (2) test, with >50% being considered significant. Among 83 studies retrieved, 12 cohort studies including 873 patients were considered. All the studies were of low quality, 11/12 had a medium risk of bias, and none were RCTs. Wound resolution was obtained more frequently in TNP-treated patients as compared with continuous and closed drainage (OR 6.45, 95% CI 3.46-12.00). TNP use was associated with significant reduction of length of stay compared with standard of care (mean difference: 8.21, 95% CI -12.19, -4.23). High heterogeneity was detected between studies, explained by the TNP comparator type. The systematic review and meta-analysis suggest that TNP might be more effective than standard therapy in the cure of deep SSIs. However, multicenter RCTs are needed to confirm the potential value of this treatment.

To evaluate the clinical efficacy of negative pressure wound therapy (NPWT) combined with topical oxygen therapy (TOT) for chronic refractory wounds (CRWs), addressing potential hypoxia limitation of NPWT through oxygen supplementation, thereby offering an innovative therapeutic approach for CRWs. The study was performed according to the 2015 Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. A comprehensive search was conducted in PubMed, Cochrane, Embase, Web of Science, CNKI, VIP, and Wanfang databases for randomized controlled trials (RCTs) on the treatment of CRWs with NPWT combined with TOT (inception to October 2024). Studies were screened based on predefined criteria, and data were extracted and assessed using RevMan 5.4. Meta-analysis, sensitivity analysis, and publication bias assessment were performed using Stata 15.0. Eleven RCTs (844 patients) were included. Compared with NPWT, the combination therapy was associated with the following outcomes: increased healing rate (risk ratio [RR] = 1.51, 95% confidence interval [CI]: 1.36-1.69, I2 = 18.1%), reduced time from debridement to skin grafting (mean difference [MD] = -2.82 days, 95% CI: -3.15 to -2.50, I2 = 4%), shortened healing time (MD = -9.09 days, 95% CI: -11.98 to -6.20, I2 = 91.2%), enhanced granulation coverage (MD = 7.56%, 95% CI: 6.09-9.03, I2 = 0.0%), and decreased bacterial positivity (RR = 0.27, 95% CI: 0.18-0.41, I2 = 0.0%). This study provides evidence-based medical research supporting NPWT plus TOT as a synergistic strategy for CRWs. Combined therapy may offer benefits over NPWT alone in CRW treatment, suggesting a promising approach to improve healing outcomes.