Nutritional supplementation is associated with improved wound reduction during negative pressure wound therapy in complex wounds: a retrospective cohort study.

BACKGROUND

Negative pressure wound therapy (NPWT) is central to the management of complex wounds, but wound contraction and granulation require adequate metabolic substrate. We evaluated the association between nutritional supplementation and wound healing outcomes in patients treated with NPWT.

METHODS

This retrospective cohort study included 48 adults who underwent negative pressure wound therapy for complex wounds. Patients were grouped according to receipt of nutritional supplementation. The primary outcome was absence of wound reduction during follow-up.

RESULTS

Nutritional supplementation was provided to 24 patients, while 18 received no supplementation. Absence of wound reduction was less frequent with supplementation (2/24 [8.3%] vs. 8/18 [44.4%]; OR 0.114, exact 95% CI 0.011-0.750; Fisher exact p = 0.010), with directionally consistent findings after exploratory adjustment for body mass index and peripheral arterial disease. In the complete nutritional-risk analysis, supplemented patients had higher nutritional risk and lower visceral-protein markers; the association remained favorable after penalized adjustment for NRS-2002 score, serum albumin, baseline wound area, and wound etiology (adjusted OR 0.22, 95% CI 0.04-1.05; p = 0.058). Among non-amputated patients with valid serial measurements, median absolute wound-area reduction was greater in supplemented patients but narrowly missed conventional significance (15.0 [6.0-33.0] cm2 vs. -0.1 [-2.5-23.2] cm2; p = 0.053). Follow-up culture positivity was lower with supplementation (6/24 [25.0%] vs. 10/18 [55.6%]; p = 0.059). Amputation rates were similar (20.8% vs. 16.7%; p = 1.000), mortality was numerically higher in supplemented patients (29.2% vs. 5.6%; p = 0.109), and composite wound failure did not differ significantly (50.0% vs. 44.4%; p = 0.764).

CONCLUSION

Nutritional supplementation was associated with a more favorable local wound trajectory during negative pressure wound therapy, despite no measurable reduction in systemic endpoints. These findings suggest that nutrition can act where negative pressure wound therapy acts first: at the wound bed.