Incidence of surgical site infections at skin graft recipient sites with negative pressure wound therapy: A meta-analysis.

Abstract

Skin graft failure remains a common and challenging source of postoperative morbidity, often driven by surgical site infections. Negative pressure wound therapy (NPWT), a technique that applies controlled suction to the wound surface, has been proposed to improve graft outcomes. This systematic review assessed the efficacy of NPWT in reducing SSIs following grafting procedures. A comprehensive search of the PubMed, MEDLINE, Embase, Cochrane Library, and Web of Science was performed in March 2025. Twenty-eight studies involving 2366 patients were included. The primary outcome was SSI incidence. Subgroup analyses examined NPWT type (traditional vs single-use), wound etiology and graft location. NPWT significantly reduced SSI rates compared to conventional dressings (5.9% vs 14.3%). Meta-analysis using a random-effects model showed a 59% reduction in the odds of infection (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.25-0.67; p < 0.001; I² = 41.6%). Traditional NPWT was effective (OR = 0.38; 95% CI, 0.23-0.63), while single-use NPWT was not (OR = 1.32; 95% CI, 0.19-9.27). NPWT showed significant benefit in burn wounds (OR = 0.09; 95% CI, 0.01-0.82; based on one study) and non-significant trend toward benefit in trauma wounds (OR = 0.31; 95% CI, 0.10-1.01). Lower-limb grafts demonstrated a numerical reduction in infection rates (OR = 0.55), though this was not significant. Mean graft take was approximately 7% higher in the NPWT group; however, these findings are only descriptive and were not subjected to meta-analysis. NPWT significantly lowers SSI risk in skin grafts, particularly with traditional systems. Subgroup trends in trauma and lower-limb wounds are promising but not statistically significant and should be considered as hypothesis-generating. Single-use NPWT requires further evaluation. These findings support NPWT's broader integration into high-risk graft protocols, with device selection tailored to wound complexity and care setting.