Negative Pressure Wound Therapy Versus Conventional Dressing in the Management of Diabetic Foot Ulcers: A Comparative...

Diabetic foot ulcers (DFUs) are an important complication of diabetes mellitus and are a major risk factor for amputation. The use of negative pressure wound therapy (NPWT) is suggested as an alternative to traditional wound dressings, but there is limited evidence to support its effectiveness. This systematic review and meta-analysis aimed to assess the effectiveness and safety of NPWT for the treatment of DFU against traditional dressings. Eight randomized controlled trials (RCTs) involving 1,099 participants were found after systematic searches in PubMed, Cochrane CENTRAL, Web of Science, and Scopus databases up to April 2025. Complete healing, amputation rates, time to healing, and hospital length of stay were all outcomes. When heterogeneity was present (I² statistic), the pooled risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated using a fixed-effect or random-effects model. The risk of bias was estimated with RoB 2. NPWT demonstrated reduced amputation rates, but the pooled effect did not reach statistical significance (RR 0.72; 95% CI 0.18 to 1.27; I² = 0%; five studies) and time to healing (MD -14.80 days; 95% CI -23.48 to -6.12; I² = 95.29%; six studies). Complete healing favored NPWT but with imprecision (RR 2.02 (95% CI 0.98 to 4.18); I² = 93.18%; three studies). Hospital stay showed a non-significant pooled estimate (MD -8.88 days; 95% CI -19.05 to 1.30; I² = 96.68%; three studies). Subgroup analyses indicated consistent short-term benefits and inconsistent long-term benefits, as the largest pragmatic trial demonstrated no benefit at 16 weeks. Reported benefits of NPWT in DFUs included decreased risk of amputation and improved early wound healing; there was considerable heterogeneity and inconsistent long-term benefits, to reduce the certainty of evidence. The use of NPWT should be considered in appropriate patients, especially those who are at high risk for amputation or have large wounds.