Written by Kevin Liu
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In patients with lower extremity wounds, negative pressure wound therapy (NPWT) neither improved wound healing nor decreased complication rates when compared to surgical wound healing by secondary intention (SWHSI).
Wound vacs – it just sucks!
Wound vacs were first introduced in 1997, promising improved wound health and healing through negative-pressure-induced fibroblast activation, with faster granulation and tissue healing. A Cochrane review in 2015 could only identify limited robust evidence in this largely unchanged technology of 30 years, stating that until a rigorous RCT could validate the reported benefits, the benefits and risks of NPWT were largely uncertain.
The SWHSI-2 trial is that rigorous RCT, and it unfortunately did not show any benefit with NPWT when compared to usual care. Although this trial included all patients in the UK with acute SWHSI on any part of their body, > 90% had a wound located on their foot or leg. There was no clear evidence that NPWT reduced the time to wound healing compared with usual care, hazard ratio 1.08 (95%CI 0·88–1·32, p=0·47). Additionally, NPWT was not found to be cost-effective when compared to usual care.
While the trial did not successfully randomize equal amounts of smokers (more in the NPWT) and patients with cardiovascular disease (more in usual care), overall severity of wounds, post-operative contamination, and wound pain scores were almost equal.
How does this change my practice?
As a hospitalist, I’ve seen my share of complicated lower extremity wounds where disposition can prove challenging, especially for discharge. This often delays discharge and may not be cost-effective given the need for treatment-related complications. While I have seen practice habits at an academic medical center move away from wound vacs over the last decade, this article encourages me to approach our surgical staff to ask if we could post-operatively keep patients wound-vac free and attempt secondary intention only.
Source
Negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention in the UK (SWHSI-2): an open-label, multicentre, parallel-group, randomised controlled trial. Lancet. 2025 May 10;405(10490):1689-1699. doi: 10.1016/S0140-6736(25)00143-6. Epub 2025 Apr 15. PMID: 40250455
