Preventive Negative Pressure Wound Therapy versus Standard Postoperative Dressings in Plastic and Reconstructive Surgery: A Systematic Review and Meta-Analysis

Background: Surgical site complications (SSCs), including infection, dehiscence, and seroma formation, remain a significant burden in plastic and reconstructive surgery, often leading to prolonged hospitalization, additional interventions, and suboptimal aesthetic outcomes. Prophylactic negative pressure wound therapy (pNPWT) has emerged as a potential strategy to mitigate these risks, yet its efficacy compared with standard dressings (SD) in clean or clean-contaminated reconstructive procedures is not well defined.Objective: To systematically review and meta-analyze randomized controlled trials (RCTs) and high-quality cohort studies comparing pNPWT versus SD for preventing SSCs in plastic and reconstructive surgery.Methods: PubMed, Embase, CENTRAL, and Web of Science searched from inception to January ۲۰۲۶. Included studies reported on adult patients undergoing any form of plastic or reconstructive surgery, comparing pNPWT applied over closed incisions versus any SD. Primary outcomes were surgical site infection (SSI), wound dehiscence, and seroma. Secondary outcomes included hospital stay and reoperation rate. Risk of bias assessed using Cochrane RoB ۲ and ROBINS-I tools. Random-effects meta-analyses performed.Results: Thirteen studies (n=۲,۸۴۷ patients) met inclusion criteria. pNPWT significantly reduced SSI (RR ۰.۴۲; ۹۵% CI ۰.۲۸–۰.۶۴; p<۰.۰۰۱; I²=۳۴%) and wound dehiscence (RR ۰.۵۱; ۹۵% CI ۰.۳۵–۰.۷۴; p=۰.۰۰۰۳; I²=۲۲%) compared to SD. Seroma risk was also lower with pNPWT (RR ۰.۶۲; ۹۵% CI ۰.۴۴–۰.۸۷; p=۰.۰۰۶; I²=۰%). No significant difference in hospital stay (MD -۰.۸ days; p=۰.۰۹) or reoperation rate (RR ۰.۷۹; p=۰.۳۱) was observed.Conclusion: Prophylactic NPWT reduces key surgical site complications—specifically SSI, dehiscence, and seroma—compared with standard dressings in plastic and reconstructive surgery. These findings support integrating pNPWT into routine postoperative protocols for high-risk incisions.

کلیدواژه ها:

Prophylactic negative pressure wound therapy ، Surgical Site Infection ، plastic surgery ، Wound dehiscence ، reconstructive surgery