Keck School of Medicine of University of Southern California, Los Angeles, CA, United States.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
J Tissue Viability. 2022 Nov;31(4):630-636. doi: 10.1016/j.jtv.2022.10.002. Epub 2022 Oct 20.
Negative pressure wound therapy (NPWT) has been described as an effective treatment for wounds of various etiologies, however it is expensive. Various authors have investigated low-cost alternatives to commercial NPWT devices. A systematic review summarizing their findings is needed for clinicians operating in resource-limited locations and for those interested in potential cost savings.
A systematic review was performed evaluating articles from Cochrane, PubMed and EMBASE. The studies included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared commercially available Vacuum-Assisted Closure (VAC) devices with non-commercial NPWT modalities in human subjects.
Seven hundred and ninety-six articles were retrieved, of which six met inclusion criteria. All six studies were RCTs and had in total 409 participants with wounds of various etiologies, including acute, chronic, and traumatic wounds. All studies compared VAC to a non-commercial NPWT device. Five studies were found to have low risk of bias, and one study had high risk of bias. There were three types of non-commercial NPWT devices used: wall suction applied to a sealed gauze dressing (GSUC), AquaVac, and Redon drains. The following outcomes were assessed: granulation tissue formation, effect on wound size area, skin graft take, pain/time associated with dressing changes and cost. In trials that compared GSUC vs VAC, there was no significant difference between the two groups for the following outcomes: granulation tissue formation, effect on wound size and skin graft take. GSUC dressings were significantly less painful and less time-consuming than VAC dressings. In the trial that compared AquaVac vs VAC, there was no significant difference between the two groups for the following outcomes: granulation tissue formation, effect on wound size, and the time or pain associated with dressing changes. In the trial that compared Redon drains vs VAC, there was significantly more granulation tissue formed in the VAC group. All non-commercial NPWT devices were found to be less costly than VAC.
The data from the trials evaluated in this review indicate that GSUC and AquaVac are two non-commercial NPWT devices that are non-inferior to VAC for various outcomes while also being less costly. GSUC was less painful and less time-consuming than VAC. Of the non-commercial NPWT devices evaluated in this review, GSUC had the most evidence to support its future use. Prospective, multi-institutional RCTs with a large sample size are needed to confirm the findings presented here.
负压伤口疗法（NPWT）已被描述为治疗各种病因的伤口的有效方法，但它很昂贵。许多作者研究了商业 NPWT 设备的低成本替代品。对于在资源有限的地方工作的临床医生和对潜在成本节约感兴趣的人来说，需要进行系统综述来总结他们的发现。
对 Cochrane、PubMed 和 EMBASE 中的文章进行了系统综述。研究包括将商业可用的真空辅助闭合（VAC）装置与人体中商业上不可用的 NPWT 模式进行比较的随机对照试验（RCT）和对照临床试验（CCT）。
共检索到 796 篇文章，其中 6 篇符合纳入标准。所有 6 项研究均为 RCT，共有 409 名患有各种病因的伤口的参与者，包括急性、慢性和创伤性伤口。所有研究均将 VAC 与非商业 NPWT 设备进行了比较。有 5 项研究被认为具有低偏倚风险，有 1 项研究具有高偏倚风险。使用了三种类型的非商业 NPWT 设备：应用于密封纱布敷料的壁式抽吸（GSUC）、AquaVac 和 Redon 引流管。评估了以下结果：肉芽组织形成、对伤口面积的影响、皮肤移植物的成活率、与敷料更换相关的疼痛/时间和成本。在将 GSUC 与 VAC 进行比较的试验中，两组之间以下结果无显著差异：肉芽组织形成、对伤口大小和皮肤移植物成活率的影响。GSUC 敷料比 VAC 敷料明显更疼痛和耗时更少。在将 AquaVac 与 VAC 进行比较的试验中，两组之间以下结果无显著差异：肉芽组织形成、对伤口大小的影响，以及敷料更换的时间或疼痛。在将 Redon 引流管与 VAC 进行比较的试验中，VAC 组形成的肉芽组织明显更多。所有非商业 NPWT 设备均发现比 VAC 成本更低。
本综述评估的试验数据表明，GSUC 和 AquaVac 是非商业 NPWT 设备，在各种结果方面与 VAC 相比无差异，同时成本更低。GSUC 比 VAC 更疼痛和耗时更少。在本综述评估的非商业 NPWT 设备中，GSUC 有最多的证据支持其未来使用。需要进行前瞻性、多机构 RCT 研究，样本量要大，以证实这里提出的研究结果。
