Negative-pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomized controlled trials

Introduction: Although skin grafts are widely used in reconstruction of large skin defect and complex wounds, many factors lead to suboptimal graft take. Negative-pressure wound therapy (NPWT) reportedly increases the graft take rates when added to skin grafting, but a summary analysis of the data of randomized controlled trials has yet to be performed. We conducted this systematic review and meta-analysis of randomized controlled trials to compare the effectiveness and safety of NPWT and non-NPWT for patients with skin grafts. Methods: We searched PubMed, Embase, Cochrane Library, and CNKI for relevant trials based on predetermined eligibility criteria from database establishment to February 2020. Two reviewers screened citations and extracted data independently. The quality of the included studies was evaluated according to the Cochrane Handbook, whereas statistical heteroge-neity was assessed using chi-square tests and I2 statistics. Review Manager 5.3 was used for statistical analysis. Results: Ten randomized controlled trials with 488 patients who underwent NPWT or non-NPWT were included. Compared with non-NPWT, NPWT yielded an improved the percentage of graft take, a reduction in days from grafting to discharge, with lower relative risk of re-operation, and no increased relative risk of adverse event. Further, the subgroup analysis showed an improved the percentage of graft take in negative pressure of 80 mmHg, and no improved the percentage of graft take in negative pressure of 125 mmHg. Conclusion: NPWT is more effective than non-NPWT for the integration of skin grafts, and the negative pressure of 80 mmHg can be recommended. Data on adverse events and negative pressure are, however, limited. A better understanding of complications after NPWT and the ideal negative pressure for the integration of skin grafts is imperative. (c) 2021 Elsevier Ltd and ISBI. All rights reserved.

Automated summary

Through analysis of data from 10 randomized controlled trials, it was found that compared with non-NPWT, NPWT can increase the success rate of graft take, shorten the days from grafting to discharge, reduce the relative risk of re-operation, and not increase the relative risk of adverse events. Negative pressure of 80 mmHg is beneficial for improving graft take rate, but no significant effect was observed with negative pressure of 125 mmHg.