Skin graft bolstered by negative pressure therapy in chronic wounds: A systematic review

Chronic ulcers represent a significant burden for patients, often requiring advanced therapeutic interventions. Skin grafting is a critical treatment option, yet the risk of graft failure remains substantial. Negative pressure wound therapy (NPWT) has demonstrated efficacy in enhancing graft survival in acute wounds, but its effectiveness in chronic ulcers remains underexplored. This systematic review aimed to evaluate the efficacy of NPWT in bolstering skin grafts for the treatment of chronic ulcers. We conducted this systematic literature review using the scientific databases PUBMED, COCHRANE and EMBASE. Studies involving skin grafts supported by NPWT for chronic wounds were included, while those focussing on acute wounds, burns or post-surgical wounds were excluded. Data on patient demographics, wound characteristics, NPWT parameters and graft outcomes were extracted and analysed. A total of 21 articles, encompassing 186 patients, were included. The maximal graft uptake (≥95%) was observed in 33% of patients, while 77% achieved a graft uptake of ≥90%. The mean graft take was 92% (89.7, 93.5, 95% confidence interval). Complete recovery was achieved in 79% of patients, with a mean recovery time of 73 days. Complete response without recurrence was noticed in 38% of the cases, with a mean time without recurrence of 197 days. Exploratory analyses indicated higher graft take rates in patients under 65 years, males, diabetics and those without arterial disease. Venous and neurotrophic ulcers also showed superior graft uptake. NPWT appears to significantly enhance graft survival in chronic ulcers, with an excellent safety and tolerance profile. As there was no control group, historical controls of graft take without NPWT were used. Short-term NPWT application (less than 1 week) is recommended for optimal outcomes. These findings suggest that NPWT should be considered a preferred method for securing skin grafts in chronic ulcer management. PROSPERO registration number: CRD420251005192.