Negative Pressure Wound Therapy Versus Conventional Dressings After Debridement for Necrotizing Fasciitis or Gas Gangrene: Impact on Hospital Stay and Wound Closure Methods

Background: The efficacy of negative pressure wound therapy (NPWT) in managing severe soft tissue infections (SSTIs), including necrotizing fasciitis and gas gangrene, remains controversial. This study aimed to compare clinical outcomes of NPWT versus conventional dressings following surgical debridement in patients with these conditions. Methods: We conducted a multicenter retrospective cohort study across 11 tertiary hospitals (2015-2024). We included adult patients with necrotizing fasciitis or gas gangrene of the lower extremity and trunk who underwent surgical debridement. Patients were divided into two groups based on postoperative wound management: NPWT (n = 28) and conventional dressings (n = 46). The primary outcome was total hospital length of stay. Secondary outcomes included the number of debridements, wound closure method, and functional decline at discharge. Results: We analyzed 74 patients. Hospital stay was significantly longer in the NPWT group versus the conventional dressing group (mean = 80.36 vs. 43.17 days; mean difference = 37.19 days; p < 0.001). Patients in the NPWT group also required more debridement procedures (mean = 2.64 vs. 1.70; p = 0.008) and were significantly more likely to undergo split-thickness skin grafting (57.1% vs. 13.0%; p < 0.001), whereas primary closure was more common in the conventional group (17.9% vs. 50.0%). Ambulatory functional decline was not significantly different between the groups. Conclusion: In the management of necrotizing fasciitis or gas gangrene, NPWT was associated with significantly longer hospital stay and more complex wound closure procedures, without clear benefits in functional recovery at discharge. These findings suggest that while NPWT may be useful for local wound management, its routine use should be approached with caution, and careful patient selection remains essential.