Current Incisional Negative Pressure Wound Therapy Systems: Technical Characteristics and a Decision Framework for...

Incisional negative pressure wound therapy has expanded from a niche adjunct to a widely adopted strategy for the prevention and management of wound complications in selected surgical settings. However, available systems differ in pressure profile, fluid handling, dressing interface, and suitability for fragile skin or anatomically challenging incisions, while practical guidance for device selection remains limited. Whether iNPWT should be used selectively is an established question; which system characteristics are relevant once its use has been judged appropriate is not. We conducted a structured narrative review of the literature on incisional negative pressure wound therapy published between January 2013 and September 2026, based on a targeted PubMed/MEDLINE search. Clinical studies addressing primarily closed surgical incisions were reviewed across elective, emergency, and reconstructive settings; conventional negative pressure wound therapy for open wounds was considered only in order to define the boundary between the two indications. Device technical characteristics were extracted separately from manufacturers' instructions for use and clinician guidelines. Evidence was synthesised in relation to clinical indication, incision and patient characteristics, device features, reported outcomes, and treatment-related adverse events. On this basis, a clinical-requirement-first decision framework for bedside device selection was developed, with each component labelled as direct clinical evidence, indirect clinical evidence, documented technical characteristic, or expert clinical consideration. The available evidence supports a selective rather than routine use of incisional negative pressure wound therapy. The greatest clinical value appears in high-risk incisions and in settings where oedema, superficial fluid accumulation, or limited soft-tissue protection are likely to contribute to wound morbidity. Reported benefits vary according to procedure type, baseline risk, endpoint definition, and device configuration. Published studies evaluate complete proprietary systems rather than isolated technical variables. The only randomised comparison between two commercial systems identified was small and found no difference between them. Adverse events remain relevant and may limit treatment in fragile skin or when drainage exceeds the fluid-handling capacity declared for the selected dressing. Incisional negative pressure wound therapy should be considered an adjunct to standard preventive measures, not a universal solution. A structured approach integrating anticipated fluid-handling requirements, perilesional skin tolerance, seal feasibility over the relevant anatomy, and intended therapy duration may support more rational and transparent device selection once iNPWT has been judged appropriate. Current evidence does not establish a hierarchy among commercially available incisional systems, and the framework should be regarded as structured decision support rather than as a validated algorithm.