The Efficacy of Negative Pressure Wound Therapy Combined with Topical Oxygen Therapy in Treating Chronic Refractory Wounds: A Systematic Review and Meta-Analysis.

Objective: To evaluate the clinical efficacy of negative pressure wound therapy (NPWT) combined with topical oxygen therapy (TOT) for chronic refractory wounds (CRWs), addressing potential hypoxia limitation of NPWT through oxygen supplementation, thereby offering an innovative therapeutic approach for CRWs. Approach: The study was performed according to the 2015 Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. A comprehensive search was conducted in PubMed, Cochrane, Embase, Web of Science, CNKI, VIP, and Wanfang databases for randomized controlled trials (RCTs) on the treatment of CRWs with NPWT combined with TOT (inception to October 2024). Studies were screened based on predefined criteria, and data were extracted and assessed using RevMan 5.4. Meta-analysis, sensitivity analysis, and publication bias assessment were performed using Stata 15.0. Results: Eleven RCTs (844 patients) were included. Compared with NPWT, the combination therapy was associated with the following outcomes: increased healing rate (risk ratio RR = 1.51, 95% confidence interval CI: 1.36-1.69, I2 = 18.1%), reduced time from debridement to skin grafting (mean difference MD = -2.82 days, 95% CI: -3.15 to -2.50, I2 = 4%), shortened healing time (MD = -9.09 days, 95% CI: -11.98 to -6.20, I2 = 91.2%), enhanced granulation coverage (MD = 7.56%, 95% CI: 6.09-9.03, I2 = 0.0%), and decreased bacterial positivity (RR = 0.27, 95% CI: 0.18-0.41, I2 = 0.0%). Innovation: This study provides evidence-based medical research supporting NPWT plus TOT as a synergistic strategy for CRWs. Conclusion: Combined therapy may offer benefits over NPWT alone in CRW treatment, suggesting a promising approach to improve healing outcomes.