NPWT Take Rates: Similar to Traditional Wound Care
Based on the highest quality evidence available, NPWT does not demonstrate superior graft or wound take rates compared to standard wound care methods. The most rigorous randomized controlled trial found no statistically significant difference in complete wound closure rates between NPWT and standard care 1.
Evidence Quality and Key Findings
Primary Outcome Data
No significant improvement in wound closure: The highest quality RCT (the only study rated above "low quality" by GRADE criteria) showed no statistically significant difference (≥20%) in complete wound closure rates between NPWT and standard care (P = 0.15) 1.
Open fracture wounds show similar healing: Moderate-certainty evidence from 460 participants demonstrated no clear difference in wound healing at 6 weeks between NPWT at 125 mmHg and standard care (RR 1.01,95% CI 0.81 to 1.27) 2.
Infection Rates (Not Take Rates, But Relevant)
Uncertain infection benefit: Pooled data from 596 participants with open fractures showed uncertain evidence for infection reduction (RR 0.48,95% CI 0.20 to 1.13; I² = 56%), with very low-certainty evidence due to inconsistency and imprecision 2.
Soft tissue wounds: For other open traumatic wounds (509 participants), there was no clear difference in infection risk between NPWT at 125 mmHg and standard care (RR 0.61,95% CI 0.31 to 1.18) 2.
Important Caveats
Study Quality Issues
The evidence base is fundamentally limited by poor methodology across most studies:
Five of six RCTs were rated as low or very low quality due to small sample sizes, inconsistent reporting, and patients lost to follow-up 1.
No clear empirical quantification of NPWT effectiveness is possible because studies used incomparable patient populations, outcome measures, and had inadequate sample sizes 1.
Mechanism vs. Outcome Disconnect
While preclinical research suggests NPWT creates favorable wound conditions (moist environment, reduced edema, mechanical stimulation, potential angiogenesis), no clear evidence demonstrates that these mechanisms translate to accelerated wound healing compared to other interventions 3.
Cost-Effectiveness Consideration
- NPWT is unlikely to be cost-effective: Moderate-certainty evidence from UK data shows NPWT was more costly with minimal additional quality-adjusted life years (incremental cost-effectiveness ratio: £267,910), making it unlikely to be cost-effective for open fractures 2.
Specialized Applications
- NPWTi-d may offer advantages: A 2023 meta-analysis in orthoplastic surgery showed NPWT with instillation and dwell time demonstrated significantly higher primary wound closure and lower complication rates compared to standard NPWT or conventional dressings (P < 0.05) 4. However, study quality was limited 4.