Systematic Review and Meta-analysis of Prophylactic Negative Pressure Wound Therapy Devices for Major Lower Extremity...

Area of Science:

• Wound healing and reconstructive surgery
• Infection control in surgical procedures
• Vascular surgery outcomes

Background:

• Major lower extremity amputations are frequently performed for critical limb ischemia and severe infections.
• Patients undergoing these amputations, particularly those with dysvascular conditions and diabetes, face elevated risks of post-operative wound complications.
• Surgical site infections (SSI) are a significant concern in this patient population.

Purpose of the Study:

• To systematically review and analyze the impact of prophylactic incisional negative pressure wound therapy (NPWT) on outcomes following major lower extremity amputations.
• To evaluate the efficacy of NPWT in reducing wound complications and SSIs compared to standard care.

Main Methods:

• A systematic literature search was conducted across major databases including PubMed, Scopus, and Embase, supplemented by conference abstracts and trial registries.
• Included studies compared NPWT applied to closed incisions with traditional dry dressings in patients undergoing major amputations.
• Meta-analyses assessed the relative risk of overall wound complications and SSIs, with risk of bias and outcome certainty evaluated using established criteria (MINORS, Cochrane, GRADE).

Main Results:

• Nine studies (3 RCTs, 6 cohort studies) involving 749 patients were analyzed; overall study quality was moderate to poor with very low outcome certainty.
• Prophylactic NPWT demonstrated a significantly lower pooled rate of wound complications (16.0%) compared to standard care (44.6%).
• NPWT was associated with a statistically significant reduction in both composite wound complication rates (RR 0.42) and SSI rates (RR 0.45) versus standard care.

Conclusions:

• Despite variable study quality, prophylactic NPWT appears to reduce wound complications after major amputations.
• Further high-quality, adequately powered randomized controlled trials (RCTs) are necessary to confirm these benefits and assess cost-effectiveness.
• Future research should clarify whether NPWT should be implemented routinely or selectively for patients undergoing major amputations.