Negative pressure wound therapy: a vacuum of evidence?

• Published in: Archives of surgery (Chicago. 1960) Vol. 143; no. 2; p. 189
• Main Authors: Gregor, Sven, Maegele, Marc, Sauerland, Stefan, Krahn, Jan F, Peinemann, Frank, Lange, Stefan
• Format: Journal Article
• Language: English
• Published: United States 01-02-2008
• Subjects: Anti-Infective Agents - therapeutic use; Debridement - methods; Diabetic Foot - diagnosis; Diabetic Foot - therapy; Female; Humans; Male; Negative-Pressure Wound Therapy - methods; Pressure Ulcer - diagnosis; Pressure Ulcer - therapy; Randomized Controlled Trials as Topic; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Skin Transplantation - methods; Treatment Outcome; Wound Healing - physiology; Wounds and Injuries - diagnosis; Wounds and Injuries - therapy
• ISSN: 1538-3644
• DOI: 10.1001/archsurg.2007.54

To systematically examine the clinical effectiveness and safety of negative pressure wound therapy (NPWT) compared with conventional wound therapy.
MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched. Manufacturers were contacted, and trial registries were screened.
Randomized controlled trials (RCTs) and non-RCTs comparing NPWT and conventional therapy for acute or chronic wounds were included in this review. The main outcomes of interest were wound-healing variables. After screening 255 full-text articles, 17 studies remained. In addition, 19 unpublished trials were found, of which 5 had been prematurely terminated.
Two reviewers independently extracted data and assessed methodologic quality in a standardized manner.
Seven RCTs (n = 324) and 10 non-RCTs (n = 278) met the inclusion criteria. The overall methodologic quality of the trials was poor. Significant differences in favor of NPWT for time to wound closure or incidence of wound closure were shown in 2 of 5 RCTs and 2 of 4 non-RCTs. A meta-analysis of changes in wound size that included 4 RCTs and 2 non-RCTs favored NPWT (standardized mean difference: RCTs, -0.57; non-RCTs, -1.30).
Although there is some indication that NPWT may improve wound healing, the body of evidence available is insufficient to clearly prove an additional clinical benefit of NPWT. The large number of prematurely terminated and unpublished trials is reason for concern.