Effects of Negative-Pressure Wound Therapy With Instillation versus Standard of Care in Multiple Wound Types: Systematic Literature Review and Meta-Analysis

Plast Reconstr Surg. 2021 Jan 1;147(1S-1):68S-76S. doi: 10.1097/PRS.0000000000007614.


Background: Large randomized controlled trials that evaluate the effects of negative-pressure wound therapy with instillation of a topical solution and dwell time (NPWTi-d) are lacking. There is a need to synthesize existing data across multiple studies to provide a more precise estimate of the clinical effects of NPWTi-d.

Methods: A systematic literature review and a meta-analysis of comparative studies were performed to determine the effects of NPWTi-d versus control therapy in the adjunctive management of complex wounds. Weighted standardized mean difference or odds ratios and 95% confidence intervals were calculated to pool study and control group results in each publication for analysis.

Results: Thirteen studies comprising 720 patients were included in the analysis. Significantly fewer surgical debridements were performed in NPWTi-d patients versus control patients (P = 0.01). Wounds in the NPWTi-d group were ready for closure faster than control wounds (P = 0.03). The odds of reducing bacterial count from baseline in the NPWTi-d group was 4.4 times greater than control group wounds (P = 0.003), and percent reduction of bacterial count in NPWTi-d wounds was evident in all studies that captured that endpoint. There was a significantly shorter length of therapy in NPWTi-d patients versus control patients (P = 0.03). Wounds in NPWTi-d group were 2.39 times more likely to close than control group wounds (P = 0.01). Length of hospital stay was not significantly reduced for NPWTi-d patients compared with that for control patients (P = 0.06).

Conclusion: Results of this meta-analysis show a positive effect with use of NPWTi-d in various wound types.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Bacteria / isolation & purification
  • Bacterial Load
  • Bandages
  • Debridement / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data
  • Multiple Trauma / complications
  • Multiple Trauma / microbiology
  • Multiple Trauma / therapy*
  • Negative-Pressure Wound Therapy / instrumentation
  • Negative-Pressure Wound Therapy / methods*
  • Standard of Care*
  • Therapeutic Irrigation / instrumentation
  • Therapeutic Irrigation / methods*
  • Time Factors
  • Treatment Outcome
  • Wound Healing
  • Wound Infection / microbiology
  • Wound Infection / prevention & control*