Negative Pressure Wound Therapy in Free Flap Reconstruction: A Systematic Review and Meta-Analysis

Despite extensive research on negative pressure wound therapy (NPWT), its impact on immediate post-operative application in free flap reconstruction remains underexplored. The objective of this systematic review and meta-analysis is to evaluate the efficacy of NPWT compared with conventional wound therapy (CWT) in post-operative management of free flap, focusing on flap survival, complication rates, and flap size.

Searches were carried out in CENTRAL, Medline, and Embase. All prospective or retrospective clinical studies examining the effect of immediate post-operative application of NPWT after free flap reconstruction were considered for the review. No restrictions were placed on the date of publication but only papers written in English were included.

13 studies were included in the review, with 6 studies eligible for the meta-analysis. A total of 321 free flaps were included in the pooled analysis. NPWT reduced overall complication rates compared with CWT (OR 0.34, 95% CI 0.13 to 0.88, p = 0.03, n = 240) and also resulted in a statistically significant reduction in flap size (SMD -1.54, 95% CI ‒2.48 to -0.54, p = 0.002, n = 43). However, there was no significant difference in flap survival rates (OR 2.34, 95% CI 0.77 to 7.09, p = 0.13, n = 252).

NPWT appears to offer benefits over CWT in reducing complications and flap size, but precautions should be taken in interpreting these results. Further high-quality randomized controlled trials are required to validate these findings.