Topical negative pressure for treating chronic wounds: a systematic review

Some wounds take a long time to heal, fail to heal or recur, causing signif icant pain and discomfort to the patient and cost to the National Health Se rvice. This review assesses the effectiveness of topical negative pressure (TNP) in treating chronic wounds. The Cochrane Wounds Group Specialised Tri als Register was searched for randomised controlled trials (RCTs) that eval uated the effectiveness of TNP on chronic-wound healing. Eligibility for in clusion, data extraction and details of trial quality were conducted by two reviewers independently. A narrative synthesis of results was undertaken a s only two small trials, with different outcome measures, fulfilled the sel ection criteria. Trial 1 considered any type of chronic wound, trial 2 cons idered diabetic foot ulcers. Both trials compared TNP with saline-gauze dre ssings. Trial 1 reported a statistically significant difference in the perc entage change in wound volume after 6 weeks, in favour of TNP. Trial 2 repo rted a difference in the number of days to healing and a difference in the percentage change in wound surface area after 2 weeks, in favour of TNP. Th ese two small trials provide weak evidence to suggest that TNP may be super ior to saline-gauze dressings in terms of wound healing. However, due to th e small sample sizes and the methodological limitations of the studies, the se findings must be interpreted with extreme caution. The effects of TNP on cost, quality of life, pain and comfort were not reported. It was not poss ible to determine the optimum TNP regimen. Further high-quality RCTs that a ddress these issues are required. (C) 2001 The British Association of Plast ic Surgeons.