Efficacy of Negative-pressure Wound Therapy in Skin Grafts: Updated Systematic Review and Meta-analysis

Background: Skin grafting is a key component of reconstructive surgery; however, inadequate fixation, fluid accumulation and infections remain the major causes of graft failure. The use of negative-pressure wound therapy (NPWT) as an adjunct to enhance wound healing and improve that graft adherence has increased. Nevertheless, further robust research is needed to conclusively determine the overall efficacy of NPWT and clarify its impact on post-operative outcomes. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, Cochrane Central and Scopus were searched for studies comparing NPWT with conventional dressings in patients undergoing skin grafting. Eligible studies included randomised controlled trials and observational studies reporting graft take and post-operative outcomes. Risk of bias (ROB) was assessed using ROB-2 for randomised trials and ROBINS-I for nonrandomised studies. Meta-analysis was performed using Review Manager 5.4 software, applying fixed- or random-effects models based on heterogeneity, which was assessed using the I 2 statistics and effect estimates were reported with 95% confidence intervals (CIs). Results: A total of 20 studies involving 1836 participants were included. NPWT significantly improved graft success rates compared with conventional dressings (risk ratio = 1.26, 95% CI: 1.12–1.43; P = 0.0002), although substantial heterogeneity was observed ( I 22 = 84%), indicating variability in study populations, wound types and treatment protocols. Seven studies ( n = 592) showed that NPWT significantly reduced hospital stay (mean differences = −5.95 days, 95% CI: −8.85 to −3.05; P < 0.0001), with considerable heterogeneity ( I 22 = 98%), also reflecting variability in study populations, wound types and treatment protocols. Six studies ( n = 431) demonstrated that NPWT was associated with a marked reduction in graft dehiscence (odds ratio [OR] = 0.15, 95% CI: 0.06–0.36; P < 0.0001; I 22 = 0%) and three studies ( n = 252) showed a reduction in reoperation rates in favour of NPWT (OR = 0.30, 95% CI: 0.11–0.85; P = 0.02; I 22 = 9%). In addition, three studies ( n = 69) reported that post-operative infection was significantly lower in the NPWT group (OR = 0.36, 95% CI: 0.19–0.69; P = 0.002; I 22 = 2%). Despite a moderate-to-high ROB across the included studies, sensitivity analysis confirmed the robustness of the findings and no clear evidence of publication bias was detected. Conclusion: NPWT significantly improves skin graft success by enhancing graft integration, reducing complications and shortening hospital stay compared with conventional dressings. Despite substantial variation among studies, the overall evidence suggests that NPWT is a valuable adjunct in the management of skin grafts. Further high-quality, standardised studies are needed to identify the specific patient populations and wound types that benefit most from this intervention.