Negative pressure wound therapy versus standard wound dressings for open fractures of the extremities: A systematic review and meta-analysis

Background In recent years, negative pressure wound therapy (NPWT) has become increasingly employed in clinical practice for managing open extremity fractures, despite limited evidence, highlighting the need for an updated synthesis of evidence on this topic. This meta-analysis aims to assess the effectiveness of NPWT compared to standard wound dressings for open fracture wounds of the extremities. Methods The meta-analysis was registered with PROSPERO (ID: CRD420251148559). PubMed, EMBASE, Scopus, Cochrane, and Google Scholar were searched on April 12, 2025 for randomized controlled trials (RCTs) comparing NPWT with standard dressings in open fractures of the extremities. Primary outcomes were overall infection rates, deep infection rates, acute infection rates and length of hospital stay. Secondary outcomes included positive wound culture rate, and further interventions defined as graft repair, flap repair, or delayed wound closure. Data was pooled using random-effects models. The Cochrane Risk of Bias-2 Tool was implemented to assess risk of bias. Results 10 RCTs involving 1171 patients were included. NPWT demonstrated no statistical reduction in overall or acute infection rate, length of hospital stay, or need for further interventions. NPWT significantly reduced deep infection rates (OR = 0.39, 95% CI 0.17–0.88) and positive wound culture rates (OR = 0.35, 95% CI 0.14–0.89), although these findings should be interpreted cautiously given the limited sample size and clinical heterogeneity. Overall risk of bias was low across most domains. Conclusion Compared to standard dressings, NPWT did not reduce overall or acute infection rates, length of hospital stay, and the need for further interventions. Heterogeneity was high for several outcomes and the certainty of evidence was very low for the majority of outcomes, highlighting the need for further high-quality studies. The current evidence does not demonstrate consistent superiority of either approach.