Negative Pressure Wound Therapy in Free Flap Reconstruction: A Systematic Review and Meta-Analysis.

[BACKGROUND] Despite extensive research on negative pressure wound therapy (NPWT), its impact on immediate post-operative application in free flap reconstruction remains underexplored. The objective of this systematic review and meta-analysis is to evaluate the efficacy of NPWT compared with conventional wound therapy (CWT) in post-operative management of free flap, focusing on flap survival, complication rates, and flap size.

[METHODS] Searches were carried out in CENTRAL, Medline, and Embase. All prospective or retrospective clinical studies examining the effect of immediate post-operative application of NPWT after free flap reconstruction were considered for the review. No restrictions were placed on the date of publication but only papers written in English were included.

[RESULTS] 13 studies were included in the review, with 6 studies eligible for the meta-analysis. A total of 321 free flaps were included in the pooled analysis. NPWT reduced overall complication rates compared with CWT (OR 0.34, 95% CI 0.13 to 0.88, p = 0.03, n = 240) and also resulted in a statistically significant reduction in flap size (SMD -1.54, 95% CI ‒2.48 to -0.54, p = 0.002, n = 43). However, there was no significant difference in flap survival rates (OR 2.34, 95% CI 0.77 to 7.09, p = 0.13, n = 252).

[CONCLUSION] NPWT appears to offer benefits over CWT in reducing complications and flap size, but precautions should be taken in interpreting these results. Further high-quality randomized controlled trials are required to validate these findings.