Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2025
Incidence of surgical site infections at skin graft recipient sites with negative pressure wound therapy: A meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Shadid Omar, Novo Jennifer, Saini Raj, Seth Ishith, Terrill Patricia J, Rozen Warren M
Аннотация
BACKGROUND: Skin graft failure remains a common and challenging source of postoperative morbidity, often driven by surgical site infections. Negative pressure wound therapy (NPWT), a technique that applies controlled suction to the wound surface, has been proposed to improve graft outcomes. This systematic review assessed the efficacy of NPWT in reducing SSIs following grafting procedures.
METHODS: A comprehensive search of the PubMed, MEDLINE, Embase, Cochrane Library, and Web of Science was performed in March 2025. Twenty-eight studies involving 2366 patients were included. The primary outcome was SSI incidence. Subgroup analyses examined NPWT type (traditional vs single-use), wound etiology and graft location.
RESULTS: NPWT significantly reduced SSI rates compared to conventional dressings (5.9% vs 14.3%). Meta-analysis using a random-effects model showed a 59% reduction in the odds of infection (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.25-0.67; p < 0.001; I² = 41.6%). Traditional NPWT was effective (OR = 0.38; 95% CI, 0.23-0.63), while single-use NPWT was not (OR = 1.32; 95% CI, 0.19-9.27). NPWT showed significant benefit in burn wounds (OR = 0.09; 95% CI, 0.01-0.82; based on one study) and non-significant trend toward benefit in trauma wounds (OR = 0.31; 95% CI, 0.10-1.01). Lower-limb grafts demonstrated a numerical reduction in infection rates (OR = 0.55), though this was not significant. Mean graft take was approximately 7% higher in the NPWT group; however, these findings are only descriptive and were not subjected to meta-analysis.
CONCLUSIONS: NPWT significantly lowers SSI risk in skin grafts, particularly with traditional systems. Subgroup trends in trauma and lower-limb wounds are promising but not statistically significant and should be considered as hypothesis-generating. Single-use NPWT requires further evaluation. These findings support NPWT's broader integration into high-risk graft protocols, with device selection tailored to wound complexity and care setting.
METHODS: A comprehensive search of the PubMed, MEDLINE, Embase, Cochrane Library, and Web of Science was performed in March 2025. Twenty-eight studies involving 2366 patients were included. The primary outcome was SSI incidence. Subgroup analyses examined NPWT type (traditional vs single-use), wound etiology and graft location.
RESULTS: NPWT significantly reduced SSI rates compared to conventional dressings (5.9% vs 14.3%). Meta-analysis using a random-effects model showed a 59% reduction in the odds of infection (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.25-0.67; p < 0.001; I² = 41.6%). Traditional NPWT was effective (OR = 0.38; 95% CI, 0.23-0.63), while single-use NPWT was not (OR = 1.32; 95% CI, 0.19-9.27). NPWT showed significant benefit in burn wounds (OR = 0.09; 95% CI, 0.01-0.82; based on one study) and non-significant trend toward benefit in trauma wounds (OR = 0.31; 95% CI, 0.10-1.01). Lower-limb grafts demonstrated a numerical reduction in infection rates (OR = 0.55), though this was not significant. Mean graft take was approximately 7% higher in the NPWT group; however, these findings are only descriptive and were not subjected to meta-analysis.
CONCLUSIONS: NPWT significantly lowers SSI risk in skin grafts, particularly with traditional systems. Subgroup trends in trauma and lower-limb wounds are promising but not statistically significant and should be considered as hypothesis-generating. Single-use NPWT requires further evaluation. These findings support NPWT's broader integration into high-risk graft protocols, with device selection tailored to wound complexity and care setting.