Single-use Negative Pressure Wound Therapy Research Articles

Precision in Prevention: Tailoring Single-Use Negative Pressure Wound Therapy Utilization Through Artificial Intelligence-Based Surgical Site Complications Risk and Cost Modeling.

Background: Surgical site complications (SSCs) are common, yet preventable hospital-acquired conditions. Single-use negative pressure wound therapy (sNPWT) has been shown to be effective in reducing rates of these complications. In the era of value-based care, strategic allocation of sNPWT is needed to optimize both clinical and financial outcomes. Materials and Methods: We conducted a retrospective analysis using data from the Premier Healthcare Database (2017-2021) for 10 representative open procedures in orthopedic, abdominal, cardiovascular, cesarean delivery, and breast surgery. After separating data into training and validation sets, various machine learning algorithms were used to develop pre-operative SSC risk prediction models. Model performance was assessed using standard metrics and predictors of SSCs were identified through feature importance evaluation. Highest-performing models were used to simulate the cost-effectiveness of sNPWT at both the patient and population level. Results: The prediction models demonstrated good performance, with an average area under the curve of 76%. Prominent predictors across subspecialities included age, obesity, and the level of procedure urgency. Prediction models enabled a simulation analysis to assess the population-level cost-effectiveness of sNPWT, incorporating patient and surgery-specific factors, along with the established efficacy of sNPWT for each surgical procedure. The simulation models uncovered significant variability in sNPWT's cost-effectiveness across different procedural categories. Conclusions: This study demonstrates that machine learning models can effectively predict a patient's risk of SSC and guide strategic utilization of sNPWT. This data-driven approach allows for optimization of clinical and financial outcomes by strategically allocating sNPWT based on personalized risk assessments.

Improvement in community wound management: why simple changes in clinical practice matter

Background/Aims Wounds continue to be an increasing burden to society, healthcare systems and patients. Wound care is an urgent challenge that requires new management strategies to help facilitate wound healing. This study aimed to evaluate an early intervention wound project facilitated by the COMPASS programme in a Swedish community setting in terms of treatment outcomes and health economic benefits. Methods An evaluation of wound care practice was completed using data collected on all wounds treated in 1 week in March 2021 (n=97). Single-use negative pressure wound therapy (sNPWT) was then introduced, alongside specialist education for all nurses. A post-intervention evaluation was carried out the following year with data on all wounds treated in 1 week in October 2022 (n=36). The samples were compared in terms of proportion of static and deteriorating wounds, wound characteristics, average number of dressing changes per wound and proportion of wounds requiring the patient to be admitted to hospital or referred to a specialist. Costs of care were calculated and compared for the two samples. Results Wounds in the post-intervention dataset were in a better overall condition (size and depth), with a lower proportion being classified as static or deteriorating (58.8% vs 44.4%). There was a non-significant difference in the average number of dressing changes required per week, with post-intervention wounds requiring fewer changes. A significantly lower proportion of patients required a referral to a specialist in the post-intervention sample compared to the pre-intervention sample (43.3% vs 16.7%; P<0.01). Conclusions Implementing a sNPWT pathway, alongside nurse education and increased involvement of nurses with specialist knowledge, can help to improve wound care outcomes and reduce the burden of wounds on nursing time and healthcare resources.

Single-use negative pressure wound therapy to prevent surgical site complications in high-risk patients undergoing caesarean sections: a real-world study

Abstract Surgical site complications (SSCs), including surgical site infection (SSI), are common following C-sections. Management of the post-operative incision with single-use negative pressure wound therapy (sNPWT) has been shown to reduce the risk of SSC in high-risk individuals. This study explored the outcomes of routine, real-world use of sNPWT in high-risk patients undergoing C-sections. An observational, retrospective in-service evaluation was conducted across eight obstetric centres in the Republic and Northern Ireland. Patients undergoing C-sections were stratified for their risk of developing SSC using commonly known risk factors, including BMI ≥30, smoking, diabetes, and whether the patients had undergone previous C-sections or had a previous history of wound dehiscence. Those at high-risk were treated with sNPWT post-operatively. Data relating to any SSC that developed post-operatively, for up to 30 days, were captured. Data were compared with original research previously published by Wloch et al. (2012). Of 1111 women considered high-risk, 106 (9.5%) went on to develop SSCs, predominantly superficial SSIs. SSCs were associated with extra visits with their general practitioner (GP), outpatient visits, or inpatient hospital stays in 5.7%, 2.4%, and 1.7% of the entire cohort, representing 59.4%, 25.5%, and 17.9% of the 106 patients with SSC. Patients needed on average 1.8 extra GP visits and 0.7 extra outpatient visits. Patients who needed to be readmitted to hospital had an average length of stay of 4 days. In comparison with a previously published cohort, in which sNPWT was not used, we observed a significant reduction in the incidence of SSCs across BMI groups 18.5–24.9 (P = 0.02), 25–29.9 (P = 0.003), and ≥35 kg/m2 (P = 0.04). In those patients who had undergone at least one previous C-section, the rates of complications also reduced (P = 0.006). This analysis provides further justification for using sNPWT to manage surgical incisions in patients considered at high risk of developing post-procedural SSCs, particularly those with a BMI ≥30 or a history of more than one C-section.

A robotic venous leg ulcer system reveals the benefits of negative pressure wound therapy in effective fluid handling.

We applied a market-leading, single-use negative pressure wound therapy device to a robotic venous leg ulcer system and compared its fluid handling performance with that of standard of care, superabsorbent and foam dressings and compression therapy. For each tested product, we determined a metrics of retained, residual, evaporated and (potential) leaked fluid shares, for three exudate flow regimes representing different possible clinically relevant scenarios. The single-use negative pressure wound therapy system under investigation emerged as the leading treatment option in the aspects of adequate fluid handling and consistent delivery of therapeutic-level wound-bed pressures. The superabsorbent dressing performed reasonably in fluid handling (resulting in some pooling but no leakage), however, it quickly caused excessive wound-bed pressures due to swelling, after less than a day of simulated use. The foam dressing exhibited the poorest fluid handling performance, that is, pooling in the wound-bed as well as occasional leakage, indicating potential inflammation and peri-wound skin maceration risks under real-world clinical use conditions. These laboratory findings highlight the importance of advanced robotic technology as contemporary means to simulate patient and wound behaviours and inform selection of wound care technologies and products, in ways that are impossible to achieve if relying solely on clinical trials and experience.

A Systematic Review and Meta-analysis of Two Negative Pressure Wound Therapy Devices to Manage Cesarean Section Incisions.

This paper aims to evaluate whether there is a device-dependent effect on the reduction of surgical site complications in obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing cesarean section (C-section). PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for the period, January 2011 to September 2021. English language articles describing a randomized controlled trial (RCT) that compared either a -80 or -125 mm Hg single-use negative pressure wound therapy (sNPWT) device to standard dressings in obese (BMI ≥ 30 kg/m2) patients undergoing C-section were included. Conference abstracts and "terminated" RCTs with published results were deemed eligible for inclusion. The primary outcome of interest was surgical site infection (SSI), classified as composite, superficial, or deep. Secondary outcomes assessed included seroma, dehiscence, hematoma, bleeding, reoperation, readmission, blistering, and (composite) wound complications. A total of 223 titles were identified, of which 129 were screened by full-text review. Eleven RCTs encompassing 5,847 patients met the inclusion criteria and were considered eligible for further analysis (-80 mm Hg: six studies; -125 mm Hg: five studies). A statistically significant improvement in the composite SSI (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.54-0.89) and superficial SSI (OR: 0.66; 95% CI: 0.50-0.86) outcomes was observed with the -80 mm Hg device, compared with standard dressings. The same effect on SSI outcomes was not observed with the -125 mm Hg device (composite SSI-OR: 0.91; 95% CI: 0.64-1.28; superficial SSI-OR: 1.12; 95% CI: 0.70-1.78). There were no statistically significant differences in any of the other assessed outcomes. sNPWT devices may differ in their ability to reduce composite or superficial SSI after C-section. KEY POINTS: · Negative pressure benefits obese patients undergoing C-section.. · Negative pressure devices may differ in performance.. · A head-to-head clinical trial is needed..

Healing Peristomal Wounds Around Retracted Stomas with Negative-Pressure Wound Therapy: A Case Series.

One method for treating a retracted stoma is a vacuum dressing that cleans the wound and protects against intestinal leakage. This case series describes the use of an integrated, single-use negative-pressure wound therapy (NPWT) dressing to treat retracted stomas as an alternative to other noninvasive remedies. The report includes seven patients who were hospitalized in the authors' surgical department from 2019 to 2020. All patients developed severe peristomal infection that failed to respond to local treatment with proper ostomy appliances or specialist dressings. After cleaning each wound and removing necrotic lesions, the authors applied a single-use hydrofiber NPWT dressing to each patient. The dressing was changed every 2 to 5 days, depending on the effects of the therapy. The stoma orifice was covered with a bag with two-piece ostomy systems. The peristomal wound healed in all cases, and leakage was eliminated. The mean time of treatment was 14 days (range, 10-21 days), and the vacuum dressings were changed an average of four times (range, 3-7 times). None of the patients required a stoma translocation or other additional surgery. Three patients received systemic IV antibiotic therapy to treat general infection. Single-use NPWT dressings protect peristomal wounds from bowel leakage and do not hinder the application of stoma bags. This system, similar to standard NPWT devices, effectively protects infected stomas from retraction.

Single-Use Negative Pressure Wound Therapy Applied on Various Wound Types: An Interventional Case Series.

The purpose of this study was to determine whether a single-use negative pressure wound therapy (NPWT) system achieves individualized goals of therapy when used to treat patients with a variety of wound types. Multiple case series. The same comprised 25 participants; their mean age was 51.2 years (SD: 18.2; range: 19-79 years); 14 were male (56%) and 11 were female (44%). Seven study participants withdrew from study participation. Wound etiologies vary; 4 had diabetic foot ulcers; 1 had a full-thickness pressure injury; 7 were treated for management of an abscess or cyst; 4 had necrotizing fasciitis, 5 had nonhealing postsurgical wounds, and 4 had wounds of other etiologies. Data were collected at 2 ambulatory wound care clinics located in the Southeastern United States (Augusta and Austell, Georgia). A single-outcome measure was selected for each participant by his or her attending physician at a baseline visit. Selected end points were (1) decrease in wound volume, (2) decrease in size of the tunneling area, (3) decrease in size of the undermining, (4) decrease in the amount of slough, (5) increase in granulation tissue formation, (6) decrease in periwound swelling, and (7) wound bed progression toward transition to another treatment modality (such as standard dressing, surgical closure, flap, or graft). Progress toward the individualized goal was monitored until the goal was achieved (study end point) or a maximum of 4 weeks following initiation of treatment. The most common primary treatment goal was to achieve a decrease in wound volume (22 of 25 study participants), and the goal to increase granulation tissue was chosen for the remaining 3 study participants. A majority of participants (18 of 23, 78.3%) reached their individualized treatment outcome. The remaining 5 participants (21.7%) were withdrawn during the study (for reasons not related to the therapy). The median (interquartile range [IQR]) duration of NPWT therapy was 19 days (IQR: 14-21 days). Between baseline and the final assessment, median reductions in wound area and volume were 42.7% (IQR: 25.7-71.5) and 87.5% (IQR: 30.7-94.6). The single-use NPWT system achieved multiple individualized treatment objectives in a variety of wound types. Individually selected goals of therapy were met by all study participants who completed the study.

Letter to the editor regarding the article by Elhage et al.: "Closed-incision negative pressure therapy at -125 mmHg significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta-analysis of randomized controlled trials".

Letter to the editor regarding the article by Elhage et al.: "Closed-incision negative pressure therapy at -125 mmHg significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta-analysis of randomized controlled trials".

The local physiological effects of a single-use topical negative pressure device in healthy volunteers: the PICO-1 study.

This study aimed to investigate the effects of a single-use negative pressure wound therapy (sNPWT) device on tissue perfusion, oxygenation and pressure in the intact skin of healthy volunteers. Healthy volunteers wore a PICO sNPWT device (Smith+Nephew, UK) on their right medial calf for one week. Perfusion, tissue oxygenation and tissue pressure were recorded in superficial and deep tissues over a period of seven days. At the baseline visit, measurements were recorded before and after dressing application without activation. Macrovascular flow and transduced needle pressure measures were recorded at 0 minutes, 30 minutes and 60 minutes after device activation. Superficial tissue perfusion and both oxygenation measures were recorded continuously over the hour following activation. All outcome measures were repeated at 24 hours and again after seven days, both with the dressing and following dressing removal. The device was associated with a measurable increase in perfusion of the limb in 12 healthy volunteers. Superficial tissue oxygenation adjacent to the dressing was reduced during wear, while deeper tissue demonstrated an increase in oxygenation levels. Superficial skin perfusion was observed to differ between skin overlying muscle and that overlying bone. Pressure in tissue underneath the dressing pad was increased throughout dressing wear and returned to baseline levels on dressing removal. sNPWT produced measurable changes in local physiology in healthy volunteers with intact skin, despite the absence of a wound. Effects may differ according to anatomical site and the composition of underlying tissues. Other factors that promote healing were not explored in this study. This study was funded by Smith+Nephew investigator-initiated grant IIS 684. The funder had no input into study design, conduct, analysis, manuscript preparation or dissemination. The authors have no conflicts of interest to declare.

Effective negative pressure wound therapy for open wounds: The importance of consistent pressure delivery.

Two distinct design concepts exist for single-use negative pressure wound therapy systems: Canister-based versus canisterless. The canister-based technology provides intrinsic stable delivery of the intended negative pressure, because exudate is constantly transferred from the wound into a canister, thereby preventing dressing saturation. In contrast, with a canisterless system, where delivery of the negative pressure depends on continuous evaporation of wound fluids from its dressing, loss of the intended wound-bed pressure may occur due to dressing saturation. To investigate whether these two designs differ in their mechanobiological effect with respect to magnitudes and distributions of tissue strain fields under the absorptive dressing, termed the influence zone, we integrated computational modelling with an animal study. This influence zone must be of biologically influential strain levels and extend sufficiently into the peri-wound for stimulating fibroblasts to migrate and progress the healing. We found that an effective influence zone requires continuous delivery of the intended pressure to the wound-bed. Loss of negative pressure at the wound-bed below 40 mmHg adversely lowered the peri-wound stimulation around a 120 × 70 mm sized wound to less than one-third of the baseline stimulation, and further pressure decreases to 20 mmHg or lower resulted in complete lack of peri-wound mechano-stimulation.

Single-Use Negative Pressure Wound Therapy for Chronic Wounds


 Limited clinical effectiveness data suggest that single-use negative pressure wound therapy may reduce the frequency of dressing changes when compared with standard wound therapy (evidence from 1 single-arm study).
 No clinical evidence was identified describing the impact of single-use negative pressure wound therapy on functionality, pain, mortality, length of hospital stay, quality of life, and safety.
 It is unknown whether single-use or disposable negative pressure wound therapy is cost-effective for the management of chronic wounds (no eligible studies found).
 One guideline provides recommendations relevant to single-use negative pressure wound therapy with chronic wounds; however, there is no clear link to a robust evidence review reported by the guideline developers.

A guide to caesarean wound healing

A guide to caesarean wound healing

Single-use negative pressure wound therapy reduces costs in closed surgical incisions: UK and US economic evaluation.

Single-use negative pressure wound therapy (sNPWT) following closed surgical incisions has a demonstrable effect in reducing surgical site complications (SSC). However, there is little health economic evidence to support its widespread use. We sought to evaluate the cost-effectiveness of sNPWT compared with standard care in reducing SSCs following closed surgical incisions. A decision analytic model was developed to explore the total costs and health outcomes associated with the use of the interventions in patients following vascular, colorectal, cardiothoracic, orthopaedic, C-section and breast surgery from the UK National Health Service (NHS) and US payer perspective over a 12-week time horizon. We modelled complications avoided (surgical site infection (SSI) and dehiscence) using data from a recently published meta-analysis. Cost data were sourced from published literature, NHS reference costs and Centers for Medicare and Medicaid Services. We conducted subgroup analysis of patients with diabetes, an American Society of Anesthesiologists (ASA) score ≥3 and body mass index (BMI) ≥30kg/m2. A sensitivity analysis was also conducted. sNPWT resulted in better clinical outcomes and overall savings of £105 per patient from the UK perspective and $637 per patient from the US perspective. There were more savings when higher-risk patients with diabetes, or a BMI ≥30kg/m2 or an ASA≥3 were considered. We conducted both one-way and probabilistic sensitivity analysis, and the results suggested that this conclusion is robust. Our findings suggest that the use of sNPWT following closed surgical incisions saves cost when compared with standard care because of reduced incidence of SSC. Patients at higher risk should be targeted first as they benefit more from sNPWT. This analysis is underpinned by strong and robust clinical evidence from both randomised and observational studies.

Single-Use Negative Pressure Wound Therapy Devices: A Technologic Analysis.

The purpose of this technologic analysis was to evaluate single-use negative pressure wound therapy (sNPWT) devices. Published literature regarding negative pressure wound therapy, particularly focusing on single-use or disposal devices, was reviewed. Varied features of devices currently available in the United States were drawn from use instructions published by individual manufacturers. Safety information regarding sNPWT was derived from the Manufacturer and User Facility Device Experience (MAUDE) Database. Single-use or disposable negative pressure wound therapy devices provide a safe and effective alternative to traditional negative pressure wound therapy. These devices promote healing of select open wounds and reduce complication rates in closed surgical incisions, when used in accordance with manufacturer guidelines. They may be used in any setting, but they are designed for use in home care and may be applied as a primary treatment option or following a course of traditional negative pressure wound therapy.

Treatment of Pediatric Sternotomy Wound Complications: A Minimally Invasive Approach.

Pediatric sternal wound complications (SWCs) include sterile wound dehiscence (SWD) and superficial/deep sternal wound infections (SSWI/DSWI), and are generally managed by repetitive debridement and surgical wound approximation. Here, we report a novel nonsurgical management strategy of pediatric sternotomy wound complications, using serial noninvasive wound approximation technique combined with single-use negative pressure wound therapy (PICO) device. Nine children with SWCs were managed by serial approximation with adhesive skin tapes and serial PICO device application. Thorough surgical debridement or surgical approximations were not performed. Three patients were clinically diagnosed as SWD, two patients as SSWI, and four patients as DSWI. None of the wounds demonstrated apparent mediastinitis or bone destructions. PICO device was applied at 16.1 days (range: 6-26 days) postoperatively, together with serial wound approximation by skin tapes. The average duration of PICO use was 16.9 days (range: 11-29 days) and the wound approximation was achieved in all patients. None of the patients underwent aggressive surgical debridement or invasive surgical approximation by sutures. We report our successful management of selected pediatric SWCs, using serial noninvasive wound approximation technique combined with PICO device.

Cellular benefits of single-use negative pressure wound therapy demonstrated in a novel ex vivo human skin wound model.

Negative pressure wound therapy is a widely used treatment for chronic, nonhealing wounds. Surprisingly, few studies have systematically evaluated the cellular and molecular effects of negative pressure treatment on human skin. In addition, no study to date has directly compared recently available single‐use negative pressure modalities to traditional negative pressure devices in a controlled setting. Here we developed a novel large‐scale ex vivo human skin culture system to effectively evaluate the efficacy of two different negative pressure wound therapy modalities. Single‐use and traditional negative pressure devices were applied to human ex vivo wounded skin sheets cultured over a period of 48 hours. Cellular tissue response to therapy was evaluated via a combination of histological analysis and transcriptional profiling, in samples collected from the wound edge, skin adjacent to the wound, and an extended skin region. Single‐use negative pressure wound therapy caused less damage to wound edge tissue than traditional application, demonstrated by improved skin barrier, reduced dermal‐epidermal junction disruption and a dampened damage response. Transcriptional profiling confirmed significantly less activation of multiple pro‐inflammatory markers in wound edge skin treated with single‐use vs traditional negative pressure therapy. These findings may help to explain the greater efficacy of sNPWT in the clinic, while offering a noninvasive system to develop improved NPWT‐based therapies.

PMD53 COMPARISON OF WOUND CLOSURE IN SURGICAL WOUNDS BETWEEN SINGLE-USE NEGATIVE PRESSURE WOUND THERAPY AND TRADITIONAL NEGATIVE PRESSURE WOUND THERAPY: A REAL WORLD ANALYSIS

Evidence for single-use Negative Pressure Wound Therapy (sNPWT) in managing surgical incisions is demonstrated across surgical indications. However, there is limited evidence of surgical wounds using large real world database. The aim of this study was to examine wound closure in sNPWT and tNPWT in surgical wounds patients from a real-world evidence perspective This retrospective cohort study was conducted by identifying surgical wounds from an outpatient wound clinic EMR from 2014 to 2018. The treatment period began with the first application of NPWT and continued until the LEU closed or the patient was lost to follow-up. Patients were excluded if they received both types of NPWT or had missing wound clinical information. Patients were matched on demographic characteristics, comorbidities and baseline wound surface area, wound depth, wound age using propensity score matching. Wound closure was reported descriptively and estimated using multiple logistic regression analysis. Number of wound closed and surface area was reported at monthly interval. One-to-one propensity score matching method matched 490 sNPWT to tNPWT patients with baseline surface area of 8.10 cm2 and 8.56 cm2, respectively. Descriptive analysis estimated that sNPWT improved wound closure (43.47% vs 39.39%; p-value=0.1946) while regression analysis estimated sNPWT wounds were 37% more likely to close (OR=1.37; 95% CI=1.01-1.87; p-value=0.0445). In addition, sNPWT patients had higher number of wound closed and higher surface area reduction at monthly follow-up period. Before matching, there were 568 sNPWT and 1,787 tNPWT patients with mean initial surface area of 7.36 cm2 and 17.76 cm2, respectively and descriptive analysis estimated that sNPWT had statistically significant higher wound closure rate (44.37% vs 37.88%; p-value=0.0059). Single-use Negative pressure wound therapy is associated with significantly higher wound closure rate compared to traditional negative pressure wound therapy in surgical wounds.

PMD54 COMPARISON OF WOUND CLOSURE IN PRESSURE ULCERS BETWEEN SINGLE-USE NEGATIVE PRESSURE WOUND THERAPY AND TRADITIONAL NEGATIVE PRESSURE WOUND THERAPY: A REAL WORLD ANALYSIS

Evidence for single-use Negative Pressure Wound Therapy (sNPWT) in managing surgical incisions is demonstrated across chronic and surgical indications. However, there is limited evidence in chronic wounds. The aim of this study was to examine wound closure in sNPWT and tNPWT in Pressure Ulcers (PU) from a real-world evidence perspective

PMD45 COMPARISON OF WOUND CLOSURE IN CHRONIC LOWER EXTREMITY ULCERS BETWEEN SINGLE-USE NEGATIVE PRESSURE WOUND THERAPY AND TRADITIONAL NEGATIVE PRESSURE WOUND THERAPY: A REAL WORLD ANALYSIS

Evidence for single-use Negative Pressure Wound Therapy (sNPWT) in managing surgical incisions is demonstrated across surgical indications. However, there is limited evidence in chronic wounds. Recently, a randomized clinical trial demonstrated superior clinical outcomes for sNPWT compared to tNPWT in lower extremity ulcers (LEU). The aim of this study was to examine wound closure in sNPWT and tNPWT in chronic LEU patients from a real-world evidence perspective

Robert S. Kirsner Gary Delhougne Richard J. Searle

The purpose of this economic evaluation was to determine the cost-effectiveness of single-use negative pressure wound therapy (sNPWT) compared with traditional NPWT (tNPWT) for the treatment of VLUs and DFUs in the United States. A Markov decision-analytic model was used to compare the incremental cost and ulcer weeks avoided for a time horizon of 12 and 26 weeks using lower extremity ulcer closure rates from a published randomized controlled trial (N = 161) that compared sNPWT with tNPWT. Treatment costs were extracted from a retrospective cost-minimization study of sNPWT and tNPWT from the payer perspective using US national 2016 Medicare claims data inflated to 2018 costs and multiplied by 7 to estimate the weekly costs of treatment for sNPWT and tNPWT. Two (2) arms of the model, tNPWT and sNPWT, were calculated separately for a combination of both VLU and DFU ulcer types. In this model, a hypothetical cohort of patients began in the open ulcer health state, and at the end of each weekly cycle a proportion of the cohort moved into the closed ulcer health state according to a constant transition probability. The costs over the defined timescale were summed to give a total cost of treatment for each arm of the model, and then the difference between the arms was calculated. Effectiveness was calculated by noting the incidence of healing at 12 and 26 weeks and the total number of open ulcer weeks; the incremental effectiveness was calculated as sNPWT effectiveness minus tNPWT effectiveness. Data were extracted to Excel spreadsheets and subjected to one-way sensitivity, scenario (where patients with unhealed ulcers were changed to standard care at 4 or 12 weeks), probabilistic, and threshold analyses. sNPWT was found to provide an expected cost saving of $7756 per patient and an expected reduction of 1.67 open ulcer weeks per patient over 12 weeks and a cost reduction of $15 749 and 5.31 open ulcer weeks over 26 weeks. Probabilistic analysis at 26 weeks showed 99.8% of the simulations resulted in sNPWT dominating tNPWT. Scenario analyses showed that sNPWT remained dominant over tNPWT (cost reductions over 26 weeks of $2536 and $7976 per patient, respectively). Using sNPWT for VLUs and DFUs is likely to be more cost-effective than tNPWT from the US payer perspective and may provide an opportunity for policymakers to reduce the economic burden of lower extremity ulcers.