Benefits of negative pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomised controlled trials

Abstract

Background: Negative pressure wound therapy (NPWT) is a widely used adjunct for wound healing and an alternative to conventional dressings for skin grafts. This meta-analysis aimed to quantify the effectiveness of NPWT versus conventional dressings in this population through randomised control trials (RCTs).

Methods: A literature search in several databases was conducted from inception to October 2023. Eligible studies were RCTs reporting the efficacy and post-operative outcomes of NPWT and non-NPWT (control) in patients ≥18 years with skin grafts. Pooled proportions were analysed using a random-effects model. This review was registered prospectively with PROSPERO (CRD42023471105).

Results: Overall, 16 RCTs met the criteria for inclusion in the meta-analysis. This included 411 patients and 401 controls. Compared to conventional dressings, NPWT demonstrated 8.3% higher overall graft take (95% CI: 2.97, 13.63, I² = 85%), 10.0% higher graft take at -80 mmHg (95% CI: 5.69, 14.34, I² = 0%), higher graft success rates (OR = 1.86, 95% CI: 1.05, 3.30, I² = 0%), lower graft loss rates (OR = 0.44, 95% CI: 0.23, 0.85, I² = 0%), lower complication rates (OR = 0.36, 95% CI: 0.13, 0.99, I² = 76%) and lower reoperation rates (OR = 0.31, 95% CI: 0.13, 0.72, I² = 0%).

Conclusion: NPWT is a safe and effective approach for dressing skin grafts in adult patients compared to conventional wound dressings. NPWT improved graft take and graft success while reducing graft failure, reoperations and overall complications.

Keywords: Graft take; NPWT; Negative pressure wound therapy; Skin grafts; VAC; Wound dressings.