Effectiveness of negative pressure wound therapy on chronic wound healing: A systematic review and meta-analysis
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Keywords

negative pressure wound therapy
chronic wounds
wound healing
patient care
meta-analysis
nursing intervention

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Burhan, A., Ali Khusein, N. bin, & Sebayang, S. M. (2022). Effectiveness of negative pressure wound therapy on chronic wound healing: A systematic review and meta-analysis. Belitung Nursing Journal, 8(6), 470–480. https://doi.org/10.33546/bnj.2220
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Abstract

Background: Negative Pressure Wound Therapy (NPWT) is considered an effective treatment in facilitating the healing of chronic wounds. However, its effect remains inconsistent, which allows for further investigation.

Objective: This study aimed to assess the effectiveness of the NPWT program in improving the management of chronic wound healing.

Design: Systematic review and meta-analysis was used.

Data Sources: The search strategy ranged from 2016 to 2021 in PubMed, CINAHL, ProQuest, and ScienceDirect.

Review Methods: Risk of bias was done based on the Risk of Bias 2.0 guideline using RevMan 5.4.1, and meta-analysis was done using Jeffreys’s Amazing Statistics Program (JASP) software version 0.16.3. Critical appraisal of the included articles was done according to Joanna Briggs Institute’s (JBI) appraisal checklist.

Results: A total of 15 articles were included, with 3,599 patients with chronic wounds. There was no publication bias in this study seen from the results of the Egger’s test value of 0.447 (p >0.05), symmetrical funnel plot, and fail-safe N of 137. However, heterogeneity among studies was present, with I2 value of 66.7%, Q = 41.663 (p <0.001); thus, Random Effect (RE) model was used. The RE model showed a significant positive effect of the NPWT on chronic wound healing, with z = 3.014, p = 0.003, 95% CI 0.085 to 0.400. The observed effects include decreased rate of surgical site infection, controlled inflammation, edema, and exudate, as well as increased tissue with varying forest plot size, as demonstrated by the small effect size (ES = 0.24, 95% CI -0.26 to 0.79, p <0.05).

Conclusion: The analysis results show that the standard low pressure of 80-125 mmHg could improve microcirculation and accelerate the healing process of chronic wounds. Therefore, applying the NPWT program could be an alternative to nursing interventions. However, it should be carried out by competent wound nurses who carry out procedure steps, implement general patient care, and give tips on overcoming device problems and evaluation.

PROSPERO registration number: CRD42022348457

https://doi.org/10.33546/bnj.2220
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Copyright (c) 2022 Asmat Burhan, Nizam bin Ali Khusein, Septian Mixrova Sebayang

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors declared no conflict of interest.

Acknowledgment

The authors acknowledge the School of Nursing, Health Faculty, Universitas Harapan Bangsa, Indonesia.

Authors’ Contributions

All authors contributed equally to the conception and design of the study, databases search, methodology, data extraction, analysis of the risk of bias, data analysis, interpretation, review, and editing. All authors were accountable in each stage of the study and agreed with the final version of the manuscript to be published.

Data Availability

The datasets generated during or analyzed during the current study are available from the corresponding author upon reasonable request.


References

Agarwal, P., Kukrele, R., & Sharma, D. (2019). Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT) for difficult wounds: A review. Journal of Clinical Orthopaedics and Trauma, 10(5), 845-848. https://doi.org/10.1016/j.jcot.2019.06.015

Ahajj, M., & Goyal, A. (2022). Physiology, granulation tissue. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554402/

Alghadir, A. H., Anwer, S., Iqbal, A., & Iqbal, Z. A. (2018). Test–retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. Journal of Pain Research, 11, 851-856. https://doi.org/10.2147/JPR.S158847

Apelqvist, J., Willy, C., Fagerdahl, A.-M., Fraccalvieri, M., Malmsjö, M., Piaggesi, A., Probst, A., & Vowden, P. (2017). EWMA document: Negative pressure wound therapy: overview, challenges and perspectives. Journal of Wound Care, 26(Sup3), S1-S154. https://doi.org/10.12968/jowc.2017.26.Sup3.S1

Baek, W., Lee, N., Han, E. J., Roh, T. S., & Lee, W. J. (2020). A prospective randomized study: The usefulness and efficacy of negative pressure wound therapy with lipidocolloid polyester mesh compared to traditional negative pressure wound therapy for treatment of pressure ulcers. Pharmaceutics, 12(9), 813. https://doi.org/10.3390/pharmaceutics12090813

Benrashid, E., Youngwirth, L. M., Guest, K., Cox, M. W., Shortell, C. K., & Dillavou, E. D. (2020). Negative pressure wound therapy reduces surgical site infections. Journal of Vascular Surgery, 71(3), 896-904. https://doi.org/10.1016/j.jvs.2019.05.066

Bertges, D. J., Smith, L., Scully, R. E., Wyers, M., Eldrup-Jorgensen, J., Suckow, B., Ozaki, C. K., Nguyen, L., Alef, M., & Belkin, M. (2021). A multicenter, prospective randomized trial of negative pressure wound therapy for infrainguinal revascularization with a groin incision. Journal of Vascular Surgery, 74(1), 257-267. https://doi.org/10.1016/j.jvs.2020.12.100

Chen, S.-j., Chen, Y.-x., Xiao, J.-r., Wei, X.-z., Chen, S.-m., & Jiang, W.-z. (2019). Negative pressure wound therapy in necrotizing fasciitis of the head and neck. Journal of Oral and Maxillofacial Surgery, 77(1), 87-92. https://doi.org/10.1016/j.joms.2018.08.016

Chiang, N., Rodda, O. A., Sleigh, J., & Vasudevan, T. (2017). Effects of topical negative pressure therapy on tissue oxygenation and wound healing in vascular foot wounds. Journal of Vascular Surgery, 66(2), 564-571. https://doi.org/10.1016/j.jvs.2017.02.050

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Routledge.

Costa, M. L., Achten, J., Knight, R., Bruce, J., Dutton, S. J., Madan, J., Dritsaki, M., Parsons, N., Fernandez, M., & Grant, R. (2020). Effect of incisional negative pressure wound therapy vs standard wound dressing on deep surgical site infection after surgery for lower limb fractures associated with major trauma: The WHIST randomized clinical trial. JAMA, 323(6), 519-526. https://doi.org/10.1001/jama.2020.0059

De Rooij, L., van Kuijk, S. M. J., van Haaren, E. R. M., Janssen, A., Vissers, Y. L. J., Beets, G. L., & van Bastelaar, J. (2021). Negative pressure wound therapy does not decrease postoperative wound complications in patients undergoing mastectomy and flap fixation. Scientific Reports, 11(1), 1-7. https://doi.org/10.1038/s41598-021-89036-3

Deborre, C., Ezissi, A., Jaenisch, M., Khoury, M., Burger, C., Randau, T. M., & Kohlhof, H. (2021). Use of a negative-pressure wound dressing to prevent surgical site complications after revision knee arthroplasty—a randomized controlled trial. Applied Sciences, 11(19), 9102. https://doi.org/10.3390/app11199102

FrykbergRobert, G. (2015). Challenges in the treatment of chronic wounds. Advances in Wound Care, 4(9), 560-582. https://doi.org/10.1089/wound.2015.0635

Gonzalez, A. C. d. O., Costa, T. F., Andrade, Z. d. A., & Medrado, A. R. A. P. (2016). Wound healing-A literature review. Anais Brasileiros de Dermatologia, 91, 614-620. https://doi.org/10.1590/abd1806-4841.20164741

Gonzalez, I. G., Angel, M. A. L., Baez, M. V. J., Ruiz Flores, B., de los Angeles Martinez Ferretiz, M., Woolf, S. V., López, I., Sandoval-Jurado, L., Pat-Espadas, F. G., & Cruz, A. A. R. (2017). Handcrafted vacuum-assisted device for skin ulcers treatment versus traditional therapy, randomized controlled trial. World Journal of Surgery, 41(2), 386-393. https://doi.org/10.1007/s00268-016-3782-9

Han, G., & Ceilley, R. (2017). Chronic wound healing: A review of current management and treatments. Advances in Therapy, 34(3), 599-610. https://doi.org/10.1007/s12325-017-0478-y

Hunter, J. E., & Schmidt, F. L. (2000). Fixed effects vs. random effects meta‐analysis models: Implications for cumulative research knowledge. International Journal of Selection and Assessment, 8(4), 275-292. https://doi.org/10.1111/1468-2389.00156

Iqbal, M. N., Noor, M., Sajid, M. T., Ahmed, Z., Iqbal, M. H., & Ahmed, M. (2016). Efficacy of vacuum assisted closure in management of open wounds as compared to moist wound dressing-experience at CMH Rawalpindi. Pakistan Armed Forces Medical Journal, 66(4), 502-505.

Janssen, A. H. J., Mommers, E. H. H., Notter, J., de Vries Reilingh, T. S., & Wegdam, J. A. (2016). Negative pressure wound therapy versus standard wound care on quality of life: A systematic review. Journal of Wound Care, 25(3), 154-159. https://doi.org/10.12968/jowc.2016.25.3.154

JASP. (2021). Jeffreys’s Amazing Statistics Program [Eng; GNU Affero General Public License]. In (Version 0.16.3) University of Amsterdam. https://jasp-stats.org/

Joanna Briggs Institute. (2020). Critical appraisal tools: Checklist for randomized controlled trials. https://jbi.global/critical-appraisal-tools

Kadam, S., Nadkarni, S., Lele, J., Sakhalkar, S., Mokashi, P., & Kaushik, K. S. (2019). Bioengineered platforms for chronic wound infection studies: how can we make them more human-relevant? Frontiers in Bioengineering and Biotechnology, 7, 418. https://doi.org/10.3389/fbioe.2019.00418

Kamamoto, F., Lima, A. L. M., Rezende, M. R. d., Mattar-Junior, R., Leonhardt, M. d. C., Kojima, K. E., & Santos, C. C. d. (2017). A new low-cost negative-pressure wound therapy versus a commercially available therapy device widely used to treat complex traumatic injuries: A prospective, randomized, non-inferiority trial. Clinics, 72(12), 737-742. https://doi.org/10.6061/clinics/2017(12)04

Kirsner, R., Dove, C., Reyzelman, A., Vayser, D., & Jaimes, H. (2019). A prospective, randomized, controlled clinical trial on the efficacy of a single‐use negative pressure wound therapy system, compared to traditional negative pressure wound therapy in the treatment of chronic ulcers of the lower extremities. Wound Repair and Regeneration, 27(5), 519-529. https://doi.org/10.1111/wrr.12727

Lavery, L. A., Killeen, A. L., Farrar, D., Akgul, Y., Crisologo, P. A., Malone, M., & Davis, K. E. (2020). The effect of continuous diffusion of oxygen treatment on cytokines, perfusion, bacterial load, and healing in patients with diabetic foot ulcers. International Wound Journal, 17(6), 1986-1995. https://doi.org/10.1111/iwj.13490

Liu, X., Zhang, H., Cen, S., & Huang, F. (2018). Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: A systematic review and meta-analysis. International Journal of Surgery, 53, 72-79. https://doi.org/10.1016/j.ijsu.2018.02.064

Lockwood, C., Sfetcu, R., & Oh, E. G. (2011). Synthesizing quantitative evidence. Philadelphia, PA: Lippincott Williams & Wilkins.

Ma, J., Liu, M., Chen, D., Wang, C., Liu, G., & Ran, X. (2017). The validity and reliability between automated oscillometric measurement of ankle-brachial index and standard measurement by eco-Doppler in diabetic patients with or without diabetic foot. International Journal of Endocrinology, 2383651. https://doi.org/10.1155/2017/2383651

Maduba, C. C., Nnadozie, U. U., Modekwe, V. I., & Onah, I. I. (2020). Split skin graft take in leg ulcers: Conventional dressing versus locally adapted negative pressure dressing. Journal of Surgical Research, 251, 296-302. https://doi.org/10.1016/j.jss.2020.01.029

Matiasek, J., Djedovic, G., Kiehlmann, M., Verstappen, R., & Rieger, U. M. (2018). Negative pressure wound therapy with instillation: Effects on healing of category 4 pressure ulcers. Plastic and Aesthetic Research, 5, 36. https://doi.org/10.20517/2347-9264.2018.50

Page, M. J., & Moher, D. (2017). Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement and extensions: A scoping review. Systematic Reviews, 6(1), 1-14. https://doi.org/10.1186/s13643-017-0663-8

Review Manager. (2022). RevMan. In (Version 5.4.1) Cochrane Collaboration. https://training.cochrane.org/online-learning/core-software/revman/revman-5-download

Rhee, S. M., Valle, M. F., Wilson, L. M., Lazarus, G., Zenilman, J. M., & Robinson, K. A. (2015). Negative pressure wound therapy technologies for chronic wound care in the home setting: A systematic review. Wound Repair and Regeneration, 23(4), 506-517. https://doi.org/10.1111/wrr.12295

Rodrigues, M., Kosaric, N., Bonham, C. A., & Gurtner, G. C. (2019). Wound healing: A cellular perspective. Physiological Reviews, 99(1), 665-706. https://doi.org/10.1152/physrev.00067.2017

Rosenthal, R. (1984). Meta-analytic procedures for social science research Beverly Hills, CA: Sage Publications.

Sandoz, H. (2015). Negative pressure wound therapy: Clinical utility. Chronic Wound Care Management and Research, 2, 71-79. https://doi.org/10.2147/CWCMR.S48885

Seidel, D., Mathes, T., Lefering, R., Storck, M., Lawall, H., & Neugebauer, E. A. M. (2014). Negative pressure wound therapy versus standard wound care in chronic diabetic foot wounds: Study protocol for a randomized controlled trial. Trials, 15(1), 1-11. https://doi.org/10.1186/1745-6215-15-334

Seidel, D., Storck, M., Lawall, H., Wozniak, G., Mauckner, P., Hochlenert, D., Wetzel-Roth, W., Sondern, K., Hahn, M., & Rothenaicher, G. (2020). Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: Results of the German DiaFu-RCT. BMJ Open, 10(3), e026345. http://dx.doi.org/10.1136/bmjopen-2018-026345

Selya, A. S., Rose, J. S., Dierker, L. C., Hedeker, D., & Mermelstein, R. J. (2012). A practical guide to calculating Cohen’sf 2, a measure of local effect size, from PROC MIXED. Frontiers in Psychology, 3, 111. https://doi.org/10.3389/fpsyg.2012.00111

Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 349. https://doi.org/10.1136/bmj.g7647

Webster, J., Liu, Z., Norman, G., Dumville, J. C., Chiverton, L., Scuffham, P., Stankiewicz, M., & Chaboyer, W. P. (2019). Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews, 3(3), Cd009261. https://doi.org/10.1002/14651858.CD009261.pub4

Xie, X., McGregor, M., & Dendukuri, N. (2010). The clinical effectiveness of negative pressure wound therapy: A systematic review. Journal of Wound Care, 19(11), 490-495. https://doi.org/10.12968/jowc.2010.19.11.79697

Yoon, T., & Kim, S. W. (2021). Negative-pressure wound therapy in a patient with osteomyelitis caused by multidrug-resistant bacterial infection: A case report. Journal of Wound Management and Research, 17(3), 193-197.

Zhou, Z.-Y., Liu, Y.-K., Chen, H.-L., & Liu, F. (2016). Prevention of surgical site infection after ankle surgery using vacuum-assisted closure therapy in high-risk patients with diabetes. The Journal of Foot and Ankle Surgery, 55(1), 129-131. https://doi.org/10.1053/j.jfas.2015.08.013