Closed incision management with negative pressure wound therapy: a systematic review and meta-analysis of orthopedic trauma outcomes

We conducted a systematic review and meta-analysis to evaluate the effectiveness of negative pressure wound therapy (NPWT) compared to traditional wound care for closed incisions following orthopedic trauma surgery. Wound complications, including surgical site infections (SSIs) and wound dehiscence, are common in orthopedic trauma surgery, affecting a significant portion of patients. To address this, we analyzed data from 3994 participants across 15 trials, with 2045 patients receiving NPWT and 1949 receiving conventional wound dressings. Our results show that NPWT was associated with reduced deep surgical site infection (OR, 0.60; 95% CI, 0.45–0.81, P = 0.0005), superficial surgical site infection (OR, 0.34; 95% CI, 0.19–0.61, P = 0.003), and wound dehiscence (OR, 0.41; 95% CI, 0.21–0.80, P = 0.009) compared to traditional dressings. Additionally, NPWT was associated with a reduction in hospital stays (MD, 0.89; 95% CI, 0.49–1.30, P = 0.0001). However, the clinical significance of this modest reduction should be interpreted cautiously given the high heterogeneity (I2 = 92%) observed in this outcome. Despite these positive outcomes, the study's limitations, such as the lack of long-term follow-up, the potential for publication bias, moderate to high heterogeneity in some outcomes, and the inclusion of both randomized and non-randomized studies, suggest that additional high-quality randomized controlled trials are necessary to fully validate the long-term effectiveness and safety of NPWT in this context.