Infection, Healing, and Cost in Open Fractures: A Review of Negative Pressure Wound Therapy

Complex open fractures present substantial challenges, including infectious complications, healing delays, and functional impairment. Sub-atmospheric pressure therapy has gained adoption as a supplementary treatment modality, despite ongoing debate regarding its clinical efficacy. A focused literature search was conducted in PubMed, Google Scholar, and the Cochrane Library (1997-2025). Randomised controlled trials, cohort studies, and systematic reviews on negative pressure wound therapy (NPWT) in open fractures were prioritised. Outcomes of interest included infection rate, healing time, flap/graft requirement, reoperation rate, and cost-effectiveness. Early randomised and cohort studies demonstrated reduced deep infection rates with NPWT compared with standard dressings. Pooled analyses demonstrated reduced infection and flap failure rates, although union times and reoperation rates showed no consistent benefit. The WOLLF multicentre trial found no improvement in long-term functional outcomes, and an accompanying economic analysis questioned cost-effectiveness. NPWT appears most useful in severe open fractures with significant soft-tissue loss, where it may reduce infection and assist in temporary wound management. Its role in routine use remains controversial, and further high-quality studies are needed to clarify patient selection and long-term cost-effectiveness.