Efficacy and safety of combined negative pressure therapy after skin grafting on limbs: A systematic review and meta-analysis.

Numerous studies have demonstrated that negative pressure wound therapy (NPWT) can enhance wound healing; however, its use following skin grafting remains a subject of debate. Given the high rate of graft failure in extremities and the critical role these areas play in human mobility, this study aimed to evaluate whether NPWT improves skin grafts take rates after extremity skin grafting. A comprehensive literature search was conducted across multiple databases, and 18 studies involved 1098 patients met the inclusion criteria and were included in the analysis. The effectiveness of NPWT versus conventional therapy after extremity skin grafting was compared. The primary outcome was the graft take rate, while secondary outcomes included postoperative complications and length of hospital stay. Additionally, we evaluated the influence of graft position, graft thickness, and negative pressure on graft take rates. Compared to conventional therapy, NPWT significantly improved the graft take rates (MD = 11.04, 95 % CI [5.57, 16.51], p < 0.0001), reduced the incidence of postoperative infection, seroma, and reoperation, and shortened the length of hospital stay. However, no significant differences were observed in tendon exposure and delayed healing. Subgroup analyses revealed improved skin graft take rates when skin graft thickness was ≤0.2 mm and negative pressure was ≤100 mmHg. These findings suggest that NPWT is an adjunctive therapy for skin grafting in the extremities. Furthermore, we observed that the application of NPWT on the upper extremities and the optimal negative pressure value require further investigation.