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Peer-reviewedCC BY 4.0Journal of Clinical Orthopaedics and Trauma

Negative pressure wound therapy versus standard wound dressings for open fractures of the extremities: A systematic review and meta-analysis

  • Daniel Powell1
  • Kamal Alchaghouri2
  • Vinuki Tilakaratne3
  • Riyad Nechat4
  • Damini Jha5
  • Mazen Kafienah4
  • Parmis Vafapour6
  • Saad Azam7
7 affiliations
  1. 1Newcastle University, Newcastle upon Tyne, United Kingdom
  2. 2University of Manchester, Manchester, United Kingdom
  3. 3Hull York Medical School, York, United Kingdom
  4. 4King's College London, London, United Kingdom
  5. 5Trakia University, Stara Zagora, Bulgaria
  6. 6Ashford and St Peters NHS Trust, United Kingdom
  7. 7Shaikh Khalifa Bin Zayed Al-Nahyan Medical & Dental College, Lahore, Pakistan
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Abstract

Background: In recent years, negative pressure wound therapy (NPWT) has become increasingly employed in clinical practice for managing open extremity fractures, despite limited evidence, highlighting the need for an updated synthesis of evidence on this topic. This meta-analysis aims to assess the effectiveness of NPWT compared to standard wound dressings for open fracture wounds of the extremities.

Methods: The meta-analysis was registered with PROSPERO (ID: CRD420251148559). PubMed, EMBASE, Scopus, Cochrane, and Google Scholar were searched on April 12, 2025 for randomized controlled trials (RCTs) comparing NPWT with standard dressings in open fractures of the extremities. Primary outcomes were overall infection rates, deep infection rates, acute infection rates and length of hospital stay. Secondary outcomes included positive wound culture rate, and further interventions defined as graft repair, flap repair, or delayed wound closure. Data was pooled using random-effects models. The Cochrane Risk of Bias-2 Tool was implemented to assess risk of bias.

Results: 10 RCTs involving 1171 patients were included. NPWT demonstrated no statistical reduction in overall or acute infection rate, length of hospital stay, or need for further interventions. NPWT significantly reduced deep infection rates (OR = 0.39, 95% CI 0.17–0.88) and positive wound culture rates (OR = 0.35, 95% CI 0.14–0.89), although these findings should be interpreted cautiously given the limited sample size and clinical heterogeneity. Overall risk of bias was low across most domains.

Conclusion: Compared to standard dressings, NPWT did not reduce overall or acute infection rates, length of hospital stay, and the need for further interventions. Heterogeneity was high for several outcomes and the certainty of evidence was very low for the majority of outcomes, highlighting the need for further high-quality studies. The current evidence does not demonstrate consistent superiority of either approach.

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Cite

BibTeXRIS
BibTeX
@article{powell2026negative,
  title = {{Negative pressure wound therapy versus standard wound dressings for open fractures of the extremities: A systematic review and meta-analysis}},
  author = {Daniel Powell and Kamal Alchaghouri and Vinuki Tilakaratne and Riyad Nechat and Damini Jha and Mazen Kafienah and Parmis Vafapour and Saad Azam},
  journal = {Journal of Clinical Orthopaedics and Trauma},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jcot.2026.103645},
  url = {https://doi.org/10.1016/j.jcot.2026.103645},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Negative pressure wound therapy versus standard wound dressings for open fractures of the extremities: A systematic review and meta-analysis
AU  - Daniel Powell
AU  - Kamal Alchaghouri
AU  - Vinuki Tilakaratne
AU  - Riyad Nechat
AU  - Damini Jha
AU  - Mazen Kafienah
AU  - Parmis Vafapour
AU  - Saad Azam
PY  - 2026
DA  - 2026/10/22
JO  - Journal of Clinical Orthopaedics and Trauma
DO  - 10.1016/j.jcot.2026.103645
UR  - https://doi.org/10.1016/j.jcot.2026.103645
AB  - Background: In recent years, negative pressure wound therapy (NPWT) has become increasingly employed in clinical practice for managing open extremity fractures, despite limited evidence, highlighting the need for an updated synthesis of evidence on this topic. This meta-analysis aims to assess the effectiveness of NPWT compared to standard wound dressings for open fracture wounds of the extremities.  Methods: The meta-analysis was registered with PROSPERO (ID: CRD420251148559). PubMed, EMBASE, Scopus, Cochrane, and Google Scholar were searched on April 12, 2025 for randomized controlled trials (RCTs) comparing NPWT with standard dressings in open fractures of the extremities. Primary outcomes were overall infection rates, deep infection rates, acute infection rates and length of hospital stay. Secondary outcomes included positive wound culture rate, and further interventions defined as graft repair, flap repair, or delayed wound closure. Data was pooled using random-effects models. The Cochrane Risk of Bias-2 Tool was implemented to assess risk of bias.  Results: 10 RCTs involving 1171 patients were included. NPWT demonstrated no statistical reduction in overall or acute infection rate, length of hospital stay, or need for further interventions. NPWT significantly reduced deep infection rates (OR = 0.39, 95% CI 0.17–0.88) and positive wound culture rates (OR = 0.35, 95% CI 0.14–0.89), although these findings should be interpreted cautiously given the limited sample size and clinical heterogeneity. Overall risk of bias was low across most domains.  Conclusion: Compared to standard dressings, NPWT did not reduce overall or acute infection rates, length of hospital stay, and the need for further interventions. Heterogeneity was high for several outcomes and the certainty of evidence was very low for the majority of outcomes, highlighting the need for further high-quality studies. The current evidence does not demonstrate consistent superiority of either approach.
SN  - 0976-5662
SN  - 2213-3445
ER  -