Efficacy and safety of negative pressure wound therapy in managing lower limb amputation: An updated systematic review and meta-analysis with individual patients data meta-analysis and GRADE assessment

Title : Efficacy and safety of negative pressure wound therapy in managing lower limb amputation: An updated systematic review and meta-analysis with individual patients data meta-analysis and GRADE assessment

Abstract:

Major lower-limb amputation often results in wound complications that hinder recovery and delay prosthetic rehabilitation. Negative Pressure Wound Therapy (NPWT) has been proposed to improve outcomes, but evidence remains inconsistent.To synthesize available evidence comparing NPWT with standard wound therapy in fresh amputation stumps.

We conducted a systematic review and meta-analysis in accordance with PRISMA and Cochrane guidelines (PROSPERO: CRD420251088214). Eligible studies included randomized and controlled observational trials of NPWT versus conventional dressings. Primary outcomes were wound complications and surgical-site infection (SSI); secondary outcomes included wound dehiscence, re-amputation, healing outcomes, and resource use.

Twenty studies including over 1,000 patients were analyzed. NPWT significantly reduced total wound complications (RR 0.49, 95% CI 0.37–0.66) and SSIs (RR 0.50, 95% CI 0.27–0.90). Subgroup analyses confirmed reductions in both superficial (RR 0.30, 95% CI 0.12–0.73) and deep infections (RR 0.26, 95% CI 0.11–0.63). The need for secondary amputation was lowered by one-third (RR 0.67, 95% CI 0.50–0.89). Wound dehiscence risk decreased (RR 0.53, 95% CI 0.30–0.94). Mortality, readmission, and hospital stay showed no significant differences between groups. Healing endpoints strongly favored NPWT: mean time to ≥76% granulation was shortened by 25 days, while complete closure occurred nearly two weeks earlier. Kaplan–Meier reconstruction confirmed that NPWT accelerated wound maturation by 77% (HR 0.23, 95% CI 0.12–0.44). Economic evaluations, though limited, indicated fewer dressing changes, reduced outpatient visits, and overall cost savings.

NPWT after major lower-limb amputation halves the risk of wound complications and infections, reduces re-amputation, and accelerates wound healing. These local benefits are clinically significant even though systemic outcomes remain unchanged. NPWT should be considered as part of standard post-amputation care protocols.

Keywords: Negative Pressure Wound Therapy, Amputation, Surgical Site Infection, Wound Healing, Meta-analysis

Biography:

Dr. Abdullah ElRefae studied Trauma and Orthopedics at the University of Debrecen. Following his academic training, he continued to develop his clinical and surgical expertise in the field of orthopedics. He is currently practicing in the Orthopedic Department at Northwick Park Hospital, where he is actively involved in patient care and surgical procedures. Dr. ElRefae has a strong interest in advancing orthopedic techniques and continues to contribute to the field through both clinical practice and ongoing professional development.