A Systematic Review: Analyzing Various Outcomes Of Negative Pressure Wound Therapy (NPWT) And Standard Surgical Dressings (SSDs) On Malignant Wounds
Gurtej Singh, PhD, Thomas R. Hays, BS, Jamie Saragossi, MS, Shruthi Shekar, Jason Park, BS, Jocellie Marquez, MD, Sagar Mulay, MD, Sami Khan, MD, Fazel Khan, MD, Alexander B. Dagum, MD, Duc Bui, MD.
Stony Brook University, Stony Brook, NY, USA.
PURPOSE- NPWT has gained popularity as a post-operative substitute to traditional wet-to-dry dressings for the treatment and healing of a wide variety of wounds. There are numerous benefits to the use of NPWT such as quicker wound healing and reduced infection and complication rates. In addition, NPWT is continually to be used on patients having cancer wound beds, although its use is contraindicated for such purposes. A systematic review was performed to evaluate the outcomes of NPWT application on cancer resected wounds.
METHODS- A systematic review was performed following PRISMA guidelines using PubMed, EMBASE, CINAHL, and Cochrane Central. Inclusion criteria contained randomized controlled trials (RCTs) and retrospective or prospective cohort studies detailing the use of NPWT on cancer resected wound beds (including sarcoma, malignancy and neoplasms). Case reports were excluded.
RESULTS- Thirty-three of 746 identified articles met inclusion criteria. These studies included skin, breast and sarcoma and other malignancies. Two studies were RCTs, 13 were prospective cohort studies and 18 were retrospective reviews. 88% of papers (n=29) recommended NPWT use in cancer resected wounds. 1,119 subjects (46.37%) received NPWT and 1,294 subjects (53.63%) received standard dressings. Mean NPWT group wound area ranged from 7.2-107 cm2, recurrence rates ranged from 0-28.57%, SSI rates were 0-70%, Mean control group wound area ranged from 7.1-34.2 cm2, recurrence rates ranged from 0-45.63%, SSI rates were 7.2-61.5%.
CONCLUSIONS- Our systematic literature review did not reveal statistically significant differences in wound healing outcomes between patients receiving NPWT versus SSD post-operative therapy for malignant tumor resected wounds; however, recent studies have produced results that are challenging NPWTÂ's clinical reputation. Some studies involving skin, rectal and gastrointestinal malignancy are recommending against the use of NPWT. This review validates the need for more high-power RCTs to accurately assess the impact of NPWT on malignant wound beds.
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