Background Indications for the use of negative pressure wound therapy (NPWT) are broadening with a range of systems now available on the market, including those designed for use on clean, closed incisions and skin grafts. Reviews have concluded that the evidence for the effectiveness of NPWT remains uncertain, however, it is a rapidly evolving therapy. Consequently, an updated systematic review of the evidence for the effects of NPWT on postoperative wounds expected to heal by primary intention is required. Objectives To assess the effects of NPWT on surgical wounds (primary closure, skin grafting or flap closure) that are expected to heal by primary intention. Search methods We searched the following electronic databases to identify reports of relevant randomised clinical trials: the Cochrane Wounds Group Specialised Register (searched 28 January 2014); the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, issue 12); Database of Abstracts of Reviews of Effects (2013, issue 12); Ovid MEDLINE (2011 to January 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 24 January 2014); Ovid EMBASE (2011 to January 2014 Week 44); and EBSCO CINAHL (2011 to January 2014). We conducted a separate search to identify economic evaluations. Selection criteria We included trials if they allocated patients to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with a different type of NPWT. Data collection and analysis We assessed trials for their appropriateness for inclusion and for their quality. This was done by three review authors working independently, using pre-determined inclusion and quality criteria. Main results In this first update, we included an additional four trials, taking the total number of trials included to nine (785 participants). Three trials involved skin grafts, four included orthopaedic patients and two included general surgery and trauma surgery patients; all the included trials had unclear or high risk of bias for one or more of the quality indicators we assessed. Seven trials compared NPWT with a standard dressing (two of these were 'home-made'NPWT devices), one trial compared one 'home-made'NPWT with a commercially available device. In trials where the individual was the unit of randomisation, there were no differences in the incidence of surgical site infections (SSI); wound dehiscence, re-operation (in incisional wounds); seroma/haematoma; or failed skin grafts. Lower re-operation rates were observed among skin graft patients in the ' home-made' NPWT group (7/65; 10.8%) compared to the standard dressing group (17/66; 25.8%) (risk ratio (RR) 0.42; 95% CI 0.19 to 0.92). The mean cost to supply equipment for VAC (R) therapy was USD 96.51/day compared to USD4.22/day for one of the ' home-made' devices (P value 0.01); labour costs for dressing changes were similar for both treatments. Pain intensity score was also reported to be lower in the ' home-made' group when compared with the VAC (R) group (P value 0.02). One of the trials in orthopaedic patients was stopped early because of a high incidence of fracture blisters in the NPWT group (15/24; 62.5%) compared with the standard dressing group (3/36; 8.3%) (RR 7.50; 95% CI 2.43 to 23.14). Authors' conclusions Evidence for the effects of negative pressure wound therapy (NPWT) for reducing SSI and wound dehiscence remains unclear, as does the effect of NPWT on time to complete healing. Rates of graft loss may be lower when NPWT is used, but hospital-designed and built products are as effective in this area as commercial applications. There are clear cost benefits when non-commercial systems are used to create the negative pressure required for wound therapy, with no evidence of a negative effect on clinical outcome. In one study, pain levels were also rated lower when a ' home-made' system was compared with a commercial counterpart. The high incidence of blisters occurring when NPWT is used following orthopaedic surgery suggests that the therapy should be limited until safety in this population is established. Given the cost and widespread use of NPWT, there is an urgent need for suitably powered, high-quality trials to evaluate the effects of the newer NPWT products that are designed for use on clean, closed surgical incisions. Such trials should focus initially on wounds that may be difficult to heal, such as sternal wounds or incisions on obese patients.
机构:
Univ York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Fairhurst, C.
Corbacho-Martin, B.
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Univ York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Corbacho-Martin, B.
Buckley, H.
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Univ York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Buckley, H.
Clarke, E.
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Hull & East Yorkshire Hosp NHS Trust, Acad Vasc Surg Unit, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Clarke, E.
Cullum, N.
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Univ Manchester, Fac Biol Med & Hlth, Sch Hlth Sci, Div Nursing Midwifery & Social Work, Manchester, Lancs, England
Cent Manchester Univ Hosp NHS Fdn Trust, Manchester Acad Hlth Sci Ctr, Res & Innovat Div, Manchester, Lancs, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Cullum, N.
Dixon, S.
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Patient & Publ Involvement Grp, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Dixon, S.
Dumville, J.
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Univ Manchester, Fac Biol Med & Hlth, Sch Hlth Sci, Div Nursing Midwifery & Social Work, Manchester, Lancs, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Dumville, J.
Firth, A.
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Hull & East Yorkshire Hosp NHS Trust, Acad Vasc Surg Unit, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Firth, A.
Hendetson, E.
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Hull & East Yorkshire Hosp NHS Trust, Outpatient Serv, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Hendetson, E.
Lamb, K.
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Leeds Community Healthcare NHS Trust, Leeds Wound Res Unit, Leeds, W Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Lamb, K.
McGinnis, E.
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Leeds Teaching Hosp NHS Trust, Dept Tissue Viabil, Leeds, W Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
McGinnis, E.
Oswald, A.
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Hull & East Yorkshire Hosp NHS Trust, Acad Vasc Surg Unit, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Oswald, A.
Goncalves, P. Saramago
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Univ York, Ctr Hlth Econ, York, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Goncalves, P. Saramago
Soares, M. O.
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Univ York, Ctr Hlth Econ, York, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Soares, M. O.
Stubbs, N.
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Leeds Community Healthcare NHS Trust, Leeds Wound Res Unit, Leeds, W Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Stubbs, N.
Chetter, I
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Univ York, Ctr Hlth Econ, York, N Yorkshire, England
Hull York Med Sch, Res Off, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
机构:
Univ York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Buckley, Hannah
Clarke, Emma
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Hull & East Yorkshire Hosp NHS Trust, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Clarke, Emma
Cullum, Nicky
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机构:
Univ Manchester, Sch Nursing Midwifery & Social Work, Manchester, Lancs, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Cullum, Nicky
Dixon, Stephen
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Patient & Publ Involvement Grp Representat, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Dixon, Stephen
Dumville, Jo
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Univ Manchester, Sch Nursing Midwifery & Social Work, Manchester, Lancs, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Dumville, Jo
Fairhurst, Caroline
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Univ York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Fairhurst, Caroline
Firth, Anna
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Hull & East Yorkshire Hosp NHS Trust, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Firth, Anna
Henderson, Eileen
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Hull & East Yorkshire Hosp NHS Trust, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Henderson, Eileen
Lamb, Karen
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Leeds Community Healthcare NHS Trust, Leeds, W Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Lamb, Karen
McGinnis, Elizabeth
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机构:
Leeds Teaching Hosp NHS Trust, Leeds, W Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
McGinnis, Elizabeth
Oswald, Angela
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Hull & East Yorkshire Hosp NHS Trust, Kingston Upon Hull, N Humberside, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Oswald, Angela
Goncalves, Pedro Saramago
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Univ York, Ctr Hlth Econ, York, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Goncalves, Pedro Saramago
Soares, Marta
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Univ York, Ctr Hlth Econ, York, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Soares, Marta
Stubbs, Nikki
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Leeds Community Healthcare NHS Trust, Leeds, W Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Stubbs, Nikki
Torgerson, David
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Univ York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
Torgerson, David
Chetter, Ian
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Hull & East Yorkshire Hosp NHS Trust, Kingston Upon Hull, N Humberside, England
Hull York Med Sch, York, N Yorkshire, EnglandUniv York, Dept Hlth Sci, York Trials Unit, York YO10 5DD, N Yorkshire, England
机构:
Christian Med Coll & Hosp, Dept Plast & Reconstruct Surg, Vellore 632004, Tamil Nadu, IndiaChristian Med Coll & Hosp, Dept Plast & Reconstruct Surg, Vellore 632004, Tamil Nadu, India
Sreekar, Harinatha
Lambda, Shashank
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Christian Med Coll & Hosp, Dept Plast & Reconstruct Surg, Vellore 632004, Tamil Nadu, IndiaChristian Med Coll & Hosp, Dept Plast & Reconstruct Surg, Vellore 632004, Tamil Nadu, India
Lambda, Shashank
Gupta, Ashish K.
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Christian Med Coll & Hosp, Dept Plast & Reconstruct Surg, Vellore 632004, Tamil Nadu, IndiaChristian Med Coll & Hosp, Dept Plast & Reconstruct Surg, Vellore 632004, Tamil Nadu, India
机构:
Natl Cheng Kung Univ, Inst Biomed Engn, Tainan 701, Taiwan
China Med Univ, China Med Univ Hosp, Dept Surg, Div Plast Surg, Taichung, TaiwanNatl Cheng Kung Univ, Inst Biomed Engn, Tainan 701, Taiwan
Li, Tzong Shiun
Choong, Mun Yau
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China Med Univ, China Med Univ Hosp, Dept Surg, Div Plast Surg, Taichung, TaiwanNatl Cheng Kung Univ, Inst Biomed Engn, Tainan 701, Taiwan
Choong, Mun Yau
Wu, Hsu Fu
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Natl Cheng Kung Univ, Inst Biomed Engn, Tainan 701, TaiwanNatl Cheng Kung Univ, Inst Biomed Engn, Tainan 701, Taiwan
Wu, Hsu Fu
Chung, Kao-Chi
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Natl Cheng Kung Univ, Inst Biomed Engn, Tainan 701, TaiwanNatl Cheng Kung Univ, Inst Biomed Engn, Tainan 701, Taiwan