A systematic review of topical negative pressure therapy for acute and chronic wounds.
BACKGROUND
Topical negative pressure (TNP) therapy is becoming increasingly popular for all kinds of wounds. Its clinical and cost effectiveness is unclear.


METHODS
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.


CONCLUSIONS
There is little evidence to support the use of TNP in the treatment of wounds.
Ubbink
D T
DT
Department of Quality Assurance and Process Innovation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. D.Ubbink@amc.nl
Westerbos
S J
SJ
Nelson
E A
EA
Vermeulen
H
H
D000208:Acute Disease; D002908:Chronic Disease; D003625:Data Collection; D048909:Diabetes Complications / Q000628:therapy; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D003668:Pressure Ulcer / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D016038:Skin Transplantation; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000628:therapy*