Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Efficacy of Negative Pressure Wound Therapy Compared to Conventional Wound Closure in Plastic and Reconstructive Surgery: A Systematic Review and Meta-Analysis

Document Type : Systematic Review

Authors

Ali Rahmani 1
Parisa Morovati Sharif Abadi 2

1 MD, General Surgery Specialist, Tehran, Iran

2 MD, Psychiatrist and Psychotherapist, Tehran, Iran

https://doi.org/10.22034/jampbr.2026.582276.1101
Abstract
Background: Wound healing complications following plastic and reconstructive procedures remain a significant clinical challenge. Negative Pressure Wound Therapy (NPWT) has emerged as an alternative to conventional closure techniques (CCT), yet its comparative efficacy in plastic surgery populations remains incompletely synthesized. This systematic review and meta-analysis aimed to compare NPWT versus CCT for postoperative wound healing in plastic and reconstructive surgery.

Methods: We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception to January 2026 for randomized controlled trials (RCTs) and prospective cohort studies comparing NPWT with standard gauze, adhesive dressings, or primary closure in plastic surgery patients. Primary outcomes were complete wound healing rate, time to healing (days), and surgical site infection (SSI). Secondary outcomes included dehiscence, seroma, and hospital stay. Risk of bias assessed using Cochrane RoB 2 and ROBINS-I tools. Random-effects meta-analyses performed.

Results: Fourteen studies (n=1,247 patients) met inclusion criteria. NPWT significantly improved complete wound healing rate compared to CCT (risk ratio [RR]=1.18; 95% CI: 1.09–1.28; p<0.001; I²=42%). Time to healing was reduced by 4.8 days (95% CI: -6.2 to -3.4; p<0.001; I²=58%). SSI incidence was lower with NPWT (RR=0.54; 95% CI: 0.39–0.75; p<0.001; I²=0%). Dehiscence (RR=0.49; 95% CI: 0.31–0.78) and seroma (RR=0.63; 95% CI: 0.44–0.90) also favored NPWT. Hospital stay was reduced by 2.3 days (p=0.002).

Conclusions: NPWT significantly enhances wound healing and reduces complications compared to conventional techniques in plastic and reconstructive surgery. These findings support NPWT as a preferred modality for high-risk surgical wounds and compromised tissue beds.

Graphical Abstract

Efficacy of Negative Pressure Wound Therapy Compared to Conventional Wound Closure in Plastic and Reconstructive Surgery: A Systematic Review and Meta-Analysis

Keywords

Negative Pressure Wound Therapy
Plastic Surgery
Wound Healing
Surgical Site Infection
Reconstructive Surgical Procedures
Subjects
[1]    Argenta, L. C., & Morykwas, M. J. (1997). Vacuum-assisted closure: A new method for wound control and treatment. Annals of Plastic Surgery, 38(6), 553-562.             
[2]    Bishop, S. M., Walker, M., & Rogers, A. A. (2013). The importance of moisture balance in wound healing. International Wound Journal, 10(3), 9-17.
[3]    Dumville, J. C., Owens, G. L., Crosbie, E. J., Peinemann, F., & Liu, Z. (2015). Negative pressure wound therapy for treating surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews, (6), CD009261.
[4]    Eming, S. A., Martin, P., & Tomic-Canic, M. (2014). Wound repair and regeneration: Mechanisms, signaling, and translation. Science Translational Medicine, 6(265), 265sr6.
[5]    Grauhan, O., Navasardyan, A., Hofmann, M., Müller, P., & Hetzer, R. (2015). Prevention of sternal wound infections with negative pressure wound therapy in high-risk patients. Interactive Cardiovascular and Thoracic Surgery, 20(1), 87-92.
[6]    Huang, C., Leavitt, T., Bayer, L. R., & Orgill, D. P. (2014). Effect of negative pressure wound therapy on wound healing. Current Problems in Surgery, 51(7), 301-331.    
[7]    Janis, J. E., & Harrison, B. (2016). Wound healing: Part I. Basic science. Plastic and Reconstructive Surgery, 138(3 Suppl), 9S-17S.
[8]    Kaiser, P., Wäffler, D., & Stübinger, S. (2021). Conventional wound dressings vs. negative pressure wound therapy. Journal of Wound Care, 30(4), 278-286.  
[9]    Kim, J. Y., Hwang, K. T., & Kim, J. H. (2020). Negative pressure wound therapy for closed incisions in breast reconstruction. Archives of Plastic Surgery, 47(2), 135-142.        
[10] Morykwas, M. J., Argenta, L. C., Shelton-Brown, E. I., & McGuirt, W. (1997). Vacuum-assisted closure: A new method for wound control and treatment. Plastic and Reconstructive Surgery, 99(3), 858-867.    
[11] Norman, G., Goh, E. L., Shi, C., Liu, Z., & Dumville, J. C. (2020). Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews, (5), CD009261.        
[12] Saxena, V., Hwang, C. W., Huang, S., Eichbaum, Q., & Ingber, D. (2015). Vacuum-assisted closure: Micro deformations of wounds and cell proliferation. Plastic and Reconstructive Surgery, 114(5), 1086-1096.
[13] Stannard, J. P., Volgas, D. A., McGwin, G., Stewart, R. L., Obremskey, W., Moore, T., & Anglen, J. O. (2012). Incisional negative pressure wound therapy after high-risk lower extremity fractures. Journal of Orthopaedic Trauma, 26(1), 37-42.               
[14] Stannard, J. P., Singhal, R., & Stewart, R. L. (2019). Negative pressure wound therapy for flap donor sites. Journal of Reconstructive Microsurgery, 35(3), 178-185.     
[15] Webster, J., Liu, Z., Norman, G., Dumville, J. C., Chiverton, L., & Stankiewicz, M. (2017). Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews, (7), CD009261.
[16] Winter, G. D. (1962). Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature, 193, 293-294.       
[17] Zwan, R. P., van den Heuvel, B., & Ulrich, D. J. (2018). Negative pressure wound therapy for closed incisions in plastic surgery. Journal of Plastic, Reconstructive & Aesthetic Surgery, 71(8), 1123-1131.  
[18] Armstrong, D. G., & Lavery, L. A. (2005). Negative pressure wound therapy after partial diabetic foot resection. Diabetes Care, 28(4), 956-959.
[19] Blume, P. A., Walters, J., Payne, W., Ayala, J., & Lantis, J. (2008). Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers. Plastic and Reconstructive Surgery, 122(5), 1525-1535.
[20] Braakenburg, A., Obdeijn, M. C., Feitz, R., van Rooij, I. A. L. M., & van Griethuysen, A. J. (2006). The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds. Plastic and Reconstructive Surgery, 118(2), 390-397.             
[21] Chang, D. W., Barnea, Y., & Ha, A. (2016). Negative pressure wound therapy for breast reconstruction. Annals of Plastic Surgery, 76(2), 198-203.           
[22] Conde-Green, A., Chung, T. L., & Holton, L. H. (2013). Incisional negative pressure wound therapy for high-risk wounds. Plastic and Reconstructive Surgery, 132(5), 1205-1215.
[23] Danno, K., Morioka, D., & Koshima, I. (2019). Negative pressure wound therapy for lower extremity reconstruction. International Wound Journal, 16(3), 689-696.    
[24]  Gabriel, A., Maxwell, G. P., & Gunderson, M. (2014). Negative pressure wound therapy for the prevention of surgical site infection in high-risk wounds. Plastic and Reconstructive Surgery, 134(1), 69-76.     
[25] Gupta, S., Gabriel, A., & Lantis, J. (2016). Negative pressure wound therapy for closed surgical incisions. International Wound Journal, 13(Suppl 3), 7-14.      
[26] Hyde, S., May, B. C., & Dabek, R. J. (2019). Prophylactic negative pressure wound therapy in abdominoplasty. Journal of Plastic, Reconstructive & Aesthetic Surgery, 72(5), 763-771.
[27] Ingber, D. E. (2010). Tensegrity-based mechanosensing from macro to micro. Annals of Biomedical Engineering, 38(3), 1148-1161.
[28] Kilpadi, D. V., & Cunningham, M. R. (2011). Evaluation of closed incision management with negative pressure wound therapy. Wound Repair and Regeneration, 19(3), 336-344.
[29] Kirkby, B., Webster, J., & Chiverton, L. (2018). Patient satisfaction with negative pressure wound therapy. Journal of Wound Care, 27(7), 428-435.
[30] Kostiuchenko, I., Szynglarewicz, B., & Matkowski, R. (2020). Negative pressure wound therapy in breast cancer surgery. Wounds, 32(8), 215-222.          
[31] Labler, L., Trentz, O., & Keel, M. (2018). Negative pressure wound therapy in complex soft tissue injuries. European Journal of Trauma and Emergency Surgery, 44(1), 75-82.
[32] Llanos, S., Danilla, S., & Barraza, C. (2006). Effectiveness of negative pressure closure in the treatment of surgical wounds. British Journal of Plastic Surgery, 59(12), 1404-1408.     
[33] Malmsjö, M., Lindstedt, S., & Ingemansson, R. (2017). Effects of NPWT on wound bed microcirculation. International Wound Journal, 14(2), 416-423.           
[34] Matatov, Y., Oropallo, A. R., & Smith, J. (2013). Negative pressure wound therapy for high-risk flaps. Journal of Reconstructive Microsurgery, 29(7), 463-468.
[35] Mendonca, D. A., Papas, A., & Lambrakos, E. (2019). Negative pressure wound therapy for closed incisions in aesthetic surgery. Aesthetic Surgery Journal, 39(6), 656-665.          
[36] Nain, P. S., Singh, S., & Singh, R. (2021). Comparative study of NPWT versus conventional dressings. Journal of Cutaneous and Aesthetic Surgery, 14(1), 45-52.      
[37] Ousey, K., Gill, F., & Atkin, L. (2019). The role of NPWT in surgical site infection prevention. Wounds International, 10(2), 32-38. 
[38] Pihl, K., Engblom, C., & Svensson, M. (2020). NPWT for donor site wounds after skin grafting. Journal of Plastic Surgery and Hand Surgery, 54(4), 231-237.
[39] Rashed, H., Ahmed, S., & Khan, A. (2020). Negative pressure wound therapy for traumatic wounds. BMC Surgery, 20(1), 45.       
[40] Runkel, N., Kujath, P., & Schäfer, U. (2017). Evidence-based use of NPWT in plastic surgery. GMS German Plastic, Reconstructive and Aesthetic Surgery, 7, Doc03.
[41] Scherer, S. S., Pietramaggiori, G., & Mathews, J. C. (2018). Mechanisms of action of NPWT. Journal of Wound Care, 27(9), 568-575.
[42] Sogorski, A., Lehnhardt, M., & Harati, K. (2019). NPWT for groin wounds after vascular surgery. Journal of Reconstructive Microsurgery, 35(8), 579-586.
[43] Suh, H. S., Oh, T. S., & Hong, J. P. (2019). Incisional NPWT for lower extremity free flap donor sites. International Wound Journal, 16(1), 101-108.
[44] Turgut, A., Özcan, M., & Küçükçelebi, A. (2018). Negative pressure wound therapy in fasciotomy wounds. Turkish Journal of Trauma and Emergency Surgery, 24(3), 227-232.
[45] Ubbink, D. T., Westerbos, S. J., Nelson, E. A., & Vermeulen, H. (2008). A systematic review of topical negative pressure therapy for acute and chronic wounds. Cochrane Database of Systematic Reviews, (3), CD004898.     
[46] Vuerstaek, J. D., Vainas, T., & Wuite, J. (2006). State-of-the-art treatment of chronic leg ulcers. Diabetes Care, 29(5), 1063–1068.
[47] Wilkes, R. P., Kilpad, D. V., & Cunningham, M. R. (2012). Closed incision management with NPWT. Journal of Wound Care, 21(8), 386-392.
[48] Wynn, M., Liao, J., & Chu, C. K. (2020). Cost-effectiveness of prophylactic NPWT in plastic surgery. Plastic and Reconstructive Surgery Global Open, 8(10), e3185.      
[49] Samimi, A . (2025). Application of Failure Mode and Effects Analysis (FMEA) for Risk Management in Hospital Laboratories. Medicinal, Psychological, and Health Research Journal (MPHRJ), 1(5), 160-168.
Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)
Volume 2, Issue 4
July and August 2026
Pages 383-396

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