Prophylactic Negative Pressure Wound Therapy Versus Standard Wound Care Among Lower Extremity Amputations: A Meta-Analysis

Prophylactic closed incisional negative pressure wound therapy (NPWT) has emerged as a promising strategy to reduce postoperative wound complications following lower extremity amputation in patients with peripheral arterial disease (PAD). We conducted a meta-analysis to evaluate whether closed incisional NPWT reduces wound complications compared with standard wound care (SWC) in this high-risk vasculopathic population. A systematic search was performed to identify studies comparing closed incisional NPWT and SWC among patients with PAD undergoing lower extremity amputation. PubMed, Embase, Web of Science, and CINAHL were searched from inception to January 2025 using predefined search strings. Six studies met eligibility criteria and were included in the analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using random-effects models as the primary analysis to account for anticipated clinical and methodological heterogeneity across studies. Leave-one-out analyses and an analysis excluding the study in which NPWT was delivered as part of a multifaceted care bundle were performed to assess robustness. A total of 893 patients were included, including 408 in the closed incisional NPWT group and 485 in the SWC group. Closed incisional NPWT was associated with lower odds of postoperative surgical site infection (SSI) (OR = 0.370; 95% CI = 0.143-0.957; P = .044) and wound dehiscence (OR = 0.224; 95% CI = 0.125-0.401; P = .008). Closed incisional NPWT was associated with lower odds of postoperative SSI and wound dehiscence following lower extremity amputation in patients with PAD. Because the evidence is predominantly observational and prediction intervals included the null value, these findings should be interpreted cautiously and confirmed in adequately powered randomized trials.