Intermittent Versus Continuous Negative Pressure Wound Therapy Following Reconstruction of Complex Skin Avulsion Injuries: A Retrospective Comparative Study

Negative pressure wound therapy (NPWT) is widely used to stabilize reconstructed avulsed skin, yet the optimal pressure mode-intermittent versus continuous-remains debated. To our knowledge, no published clinical comparative study has specifically evaluated intermittent versus continuous NPWT following reconstruction of complex skin avulsion injuries. This retrospective single-center cohort study included 68 patients with complex skin avulsion injuries who underwent surgical repair between October 2021 and October 2024. Forty-two patients received intermittent NPWT (-300 mm Hg for 30 min alternating with -125 to -130 mm Hg for 3 h), and 26 received continuous NPWT (-200 mm Hg). Outcomes included reconstructed skin survival rate, Composite Graft Assessment and Outcome Score (CGAOS), infection rate, and hospital stay. The intermittent group demonstrated significantly higher reconstructed skin survival rates (98.6 ± 3.8% vs 92.7 ± 4.0%, P < 0.001), lower infection rates (14.3% vs 53.8%, P < 0.001), shorter hospital stays (12.0 ± 3.9 vs 14.9 ± 3.6 days, P = 0.003), and a more favorable CGAOS grade distribution (excellent: 81.0% vs 23.1%; overall exact P < 0.001). No statistically significant differences were detected in baseline characteristics (all P > 0.05). Intermittent NPWT was associated with improved reconstructed skin survival, reduced infection, and shorter hospitalization in this retrospective cohort. Given the study's retrospective nature and the importance of intermittent parameter selection, prospective randomized trials comparing different intermittent protocols are warranted.