Incisional Negative Pressure Wound Therapy: a Systematic Review and Meta-analysis

Aim: Postoperative wound complications make many surgical procedures unnecessarily complex, particularly in high-risk patients. Negative Pressure Wound Therapy is well recognized in the management of open wounds. In recent years, it has been introduced as well in the management of closed surgical incisions to reduce postoperative wound complications, though the evidence base to support this intervention is limited. The aim of this study was to assess if Negative Pressure Wound Therapy (NPWT) reduces postoperative complications when applied on closed surgical incisions.
Method: A systematic review and meta-analysis of randomized controlled trials of NPWT compared to standard postoperative dressings on closed incisions.
Results: Ten studies met the inclusion criteria, reporting on 1344 incisions (1121 patients). NPWT was associated with a significant reduction of wound infection (46%), and seroma formation (52%) compared to standard care. The reduction in wound dehiscence was not statistically significant. The numbers needed to treat were 3 (seroma), 17 (dehiscence), and 25 (infection). Methodical heterogeneity across studies led to downgrading quality of evidence to moderate for infection and seroma, and low for dehiscence.
Conclusion: Compared with standard postoperative dressings, NPWT significantly reduces the rate of wound infection and seroma when applied to closed surgical wounds, but diversity in clinical and methodological aspects of the included studies means that no absolute or general recommendations can be made.