The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

A systematic review of topical negative pressure therapy for acute and chronic wounds. BJS 2008; 95: 685-692.

Published: 29th April 2008

Authors: D. T. Ubbink, S. J. Westerbos, E. A. Nelson, H. Vermeulen

Background

Topical negative pressure (TNP) therapy is becoming increasingly popular for all kinds of wounds. Its clinical and cost effectiveness is unclear.

Method

A search of randomized controlled trials (RCTs) on TNP in adult patients with all kinds of wounds in all settings was undertaken in Medline, Embase, Cinahl (to October 2007) and the Cochrane Library (to issue 4, 2007). Information was also sought from manufacturer of the VAC® device. Selection of trials for analysis, quality assessment, data abstraction and data synthesis were conducted by two authors independently. The primary endpoint was any measure of wound healing. Secondary endpoints were infection, pain, quality of life, oedema, microcirculation, bacterial load, adverse events, duration of hospital stay and cost.

Results

The search identified 15 publications on 13 RCTs. These reported on patients with chronic wounds, diabetic wounds, pressure ulcers, skin grafts and acute wounds. In chronic and diabetic wounds, TNP did not allow earlier complete wound healing. It was, however, associated with a 1–10 day reduction in the time needed to prepare the wound for secondary closure surgery. In one trial on acute wounds, 17 (95 per cent confidence interval (c.i.) 0·02 to 0·32) per cent more wounds appeared to heal with TNP; the number needed to treat was six. This was, however, at the cost of an 11 (95 per cent c.i. 0·01 to 0·21) per cent higher complication rate; the number needed to harm was nine.

Conclusion

There is little evidence to support the use of TNP in the treatment of wounds. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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