{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:52Z","timestamp":1784557072588,"version":"3.55.0"},"reference-count":31,"publisher":"Bioscientifica","issue":"8","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["eor.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,8,1]]},"abstract":"\n Purpose<\/jats:title>\n \n \n \n Incisional negative pressure wound therapy (iNPWT) has shown effectiveness in the treatment of high-risk surgical wounds. Especially patients with diabetes-induced peripheral arterial disease undergoing major limb amputation have a high intrinsic risk for post-surgical wound infections. While normal gauze wound dressings do not cause stimulation of microvasculature, iNPWT might improve wound healing and reduce wound complications. The purpose of this study was to systematically review the literature for rates of wound complications and readmissions, as well as post-surgical\n 30-<\/jats:italic>\n day mortality.\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n \n We conducted a systematic review searching the Cochrane, PubMed, and Ovid databases. Inclusion criteria were the modified Coleman methodology Score >60, non-traumatic major limb amputation, and adult patients. Traumatic amputations and animal studies were excluded. Relevant articles were reviewed independently by referring to the title and abstract. In a meta-analysis, we compared 3 studies and 457 patients.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n \n \n A significantly overall lower rate of postoperative complications is associated with usage of iNPWT (odds ratio (OR)\u2009=\u20090.52; 95% CI: 0.30\u20130.89;\n P<\/jats:italic>\n \u2009=\u20090.02). There was no significant improvement for\n 30-<\/jats:italic>\n day mortality, when iNPWT was used (OR= 081; 95% CI: 0.46 \u2013 1.45;\n P<\/jats:italic>\n \u2009=\u20090.48). Nevertheless, we did not note\n a<\/jats:italic>\n significant difference in the readmission rate or revision surgery between the two groups.\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n \n \n Overall, the usage of iNPWT may reduce the risk of postoperative wound complications in major lower limb amputations but does not improve\n 30-<\/jats:italic>\n day mortality rates significantly. However, to anticipate surgical-site infection, iNPWT has shown effectiveness and thus should be used whenever applicable.\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/eor-22-0049","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T05:28:15Z","timestamp":1659590895000},"page":"526-532","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-16","source":"Crossref","is-referenced-by-count":13,"title":["Incisional negative pressure wound therapy to reduce surgical-site infections in major limb amputations: a meta-analysis"],"prefix":"10.1530","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3899-9345","authenticated-orcid":true,"given":"A","family":"Frodl","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Geisteuer","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Asklepios Hospital Harburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Nymark","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University Hospital Odense, Odense C, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Schmal","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany"},{"name":"Department of Orthopedic Surgery, University Hospital Odense, Odense C, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"European Surgery","first-page":"249","article-title":"Closed-incision negative-pressure wound management in surgery \u2013 literature review and recommendations","volume":"52","author":"Smolle","year":"2020","unstructured":"Smolle MANischwitz SPHutan MTrunk PLumenta DBernhardt GA. Closed-incision negative-pressure wound management in surgery \u2013 literature review and recommendations. European Surgery202052249\u2013267. (https:\/\/doi.org\/10.1007\/s10353-020-00657-w)"},{"key":"bib2","series-title":"International Wound Journal","first-page":"1171","article-title":"Does closed incision negative wound pressure therapy in non-traumatic major lower-extremity amputations improve survival rates?","volume":"16","author":"Stenqvist","year":"2019","unstructured":"Stenqvist CPNielsen CTNapolitano GMLarsen BMFlies MJBrander DCLynge EPallesen P. Does closed incision negative wound pressure therapy in non-traumatic major lower-extremity amputations improve survival rates?International Wound Journal2019161171\u20131177. (https:\/\/doi.org\/10.1111\/iwj.13176)"},{"key":"bib3","series-title":"Current Diabetes Reports","article-title":"Management of hyperglycemia and diabetes in orthopedic surgery","volume":"17","author":"Akiboye","year":"2017","unstructured":"Akiboye FRayman G. Management of hyperglycemia and diabetes in orthopedic surgery. Current Diabetes Reports201717 13. (https:\/\/doi.org\/10.1007\/s11892-017-0839-6)"},{"key":"bib4","series-title":"Journal of Bone and Joint Surgery: American Volume","first-page":"1181","article-title":"Relationship of hyperglycemia and surgical-site infection in orthopaedic surgery","volume":"94","author":"Richards","year":"2012","unstructured":"Richards JEKauffmann RMZuckerman SLObremskey WTMay AK. Relationship of hyperglycemia and surgical-site infection in orthopaedic surgery. Journal of Bone and Joint Surgery: American Volume2012941181\u20131186. 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(https:\/\/doi.org\/10.1111\/iwj.12612)"},{"key":"bib6","series-title":"International Wound Journal","first-page":"511","article-title":"Topical negative pressure wound therapy: a review of its role and guidelines for its use in the management of acute wounds","volume":"5","author":"Bovill","year":"2008","unstructured":"Bovill EBanwell PETeot LEriksson ESong CMahoney JGustafsson RHorch RDeva AWhitworth ITopical negative pressure wound therapy: a review of its role and guidelines for its use in the management of acute wounds. International Wound Journal20085511\u2013529. (https:\/\/doi.org\/10.1111\/j.1742-481X.2008.00437.x)"},{"key":"bib7","series-title":"International Wound Journal","first-page":"274","article-title":"Treatment of the open abdomen with topical negative pressure therapy: a retrospective study of 46 cases","volume":"8","author":"Caro","year":"2011","unstructured":"Caro AOlona CJim\u00e9nez AVadillo JFeliu FVicente V. Treatment of the open abdomen with topical negative pressure therapy: a retrospective study of 46 cases. International Wound Journal20118274\u2013279. (https:\/\/doi.org\/10.1111\/j.1742-481X.2011.00782.x)"},{"key":"bib8","series-title":"Lancet","first-page":"1704","article-title":"Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial","volume":"366","author":"Armstrong","year":"2005","unstructured":"Armstrong DGLavery LA & Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet20053661704\u20131710. (https:\/\/doi.org\/10.1016\/S0140-6736(0567695-7)"},{"key":"bib9","series-title":"PLoS Medicine","article-title":"Preferred Reporting Items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","unstructured":"Moher DLiberati ATetzlaff JAltman DG & PRISMA Group. Preferred Reporting Items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine20096 e1000097. (https:\/\/doi.org\/10.1371\/journal.pmed.1000097)"},{"key":"bib10","article-title":"OCEBM levels of evidence \u2013 Centre for Evidence-Based Medicine (CEBM), University of Oxford [Internet]. [cited 2020 Nov 1]","unstructured":"OCEBM levels of evidence \u2013 Centre for Evidence-Based Medicine (CEBM), University of Oxford [Internet]. [cited 2020 Nov 1]. (available at: https:\/\/www.cebm.ox.ac.uk\/resources\/levels-of-evidence\/ocebm-levels-of-evidence)"},{"key":"bib11","series-title":"Journal of Orthopaedics","first-page":"507","article-title":"Postoperative negative pressure wound therapy is associated with decreased surgical site infections in all lower extremity amputations","volume":"21","author":"Gantz","year":"2020","unstructured":"Gantz OBRynecki NDPara ALevidy MBeebe KS. Postoperative negative pressure wound therapy is associated with decreased surgical site infections in all lower extremity amputations. Journal of Orthopaedics202021507\u2013511. (https:\/\/doi.org\/10.1016\/j.jor.2020.09.005)"},{"key":"bib12","series-title":"Journal of Vascular Surgery","first-page":"1041","article-title":"Closed incision negative pressure wound therapy may decrease wound complications in major lower extremity amputations","volume":"73","author":"Chang","year":"2021","unstructured":"Chang HMaldonado TSRockman CBCayne NSBerland TLBarfield MEJacobowitz GRSadek M. Closed incision negative pressure wound therapy may decrease wound complications in major lower extremity amputations. Journal of Vascular Surgery2021731041\u20131047. (https:\/\/doi.org\/10.1016\/j.jvs.2020.07.061)"},{"key":"bib13","series-title":"American Heart Journal","first-page":"809","article-title":"High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease","volume":"165","author":"Jones","year":"2013","unstructured":"Jones WSPatel MRDai DVemulapalli SSubherwal SStafford JPeterson ED. High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease. American Heart Journal2013165809\u2013815, 815.e1. (https:\/\/doi.org\/10.1016\/j.ahj.2012.12.002)"},{"key":"bib14","series-title":"Journal of Vascular Surgery","first-page":"1276","article-title":"Predictors of operative mortality following major lower extremity amputations using the National Surgical Quality Improvement Program public use data","volume":"58","author":"Karam","year":"2013","unstructured":"Karam JShepard ARubinfeld I. 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(https:\/\/doi.org\/10.1016\/j.arth.2015.11.010)"},{"key":"bib16","series-title":"Journal of the American Academy of Orthopaedic Surgeons","first-page":"295","article-title":"The use of closed incision negative-pressure wound therapy in orthopaedic surgery","volume":"26","author":"Nam","year":"2018","unstructured":"Nam DSershon RALevine BRDella Valle CJ. The use of closed incision negative-pressure wound therapy in orthopaedic surgery. Journal of the American Academy of Orthopaedic Surgeons201826295\u2013302. (https:\/\/doi.org\/10.5435\/JAAOS-D-17-00054)"},{"key":"bib17","series-title":"BMJ Open","article-title":"Standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for major trauma to the lower limb-a two-arm parallel group superiority randomised controlled trial: protocol for Wound Healing in Surgery for Trauma (WHIST)","volume":"8","author":"Achten","year":"2018","unstructured":"Achten JVadher KBruce JNanchahal JSpoors LMasters JPDutton SMadan JCosta ML. Standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for major trauma to the lower limb-a two-arm parallel group superiority randomised controlled trial: protocol for Wound Healing in Surgery for Trauma (WHIST). BMJ Open20188 e022115. (https:\/\/doi.org\/10.1136\/bmjopen-2018-022115)"},{"key":"bib18","series-title":"Advances in Wound Care","first-page":"368","article-title":"Incisional negative pressure wound therapy: an effective tool for major limb amputation and amputation revision site closure","volume":"8","author":"Zayan","year":"2019","unstructured":"Zayan NEWest JMSchulz SAJordan SWValerio IL. Incisional negative pressure wound therapy: an effective tool for major limb amputation and amputation revision site closure. Advances in Wound Care20198368\u2013373. (https:\/\/doi.org\/10.1089\/wound.2018.0935)"},{"key":"bib19","series-title":"Annals of Plastic Surgery","first-page":"665","article-title":"The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion","volume":"55","author":"Timmers","year":"2005","unstructured":"Timmers MSLe Cessie SBanwell PJukema GN. The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Annals of Plastic Surgery200555665\u2013671. (https:\/\/doi.org\/10.1097\/01.sap.0000187182.90907.3d)"},{"key":"bib20","series-title":"Plastic and Reconstructive Surgery","first-page":"1086","article-title":"Vacuum-assisted closure: microdeformations of wounds and cell proliferation","volume":"114","author":"Saxena","year":"2004","unstructured":"Saxena VHwang CWHuang SEichbaum QIngber DOrgill DP. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plastic and Reconstructive Surgery20041141086\u20131096; discussion 1097\u20131098. (https:\/\/doi.org\/10.1097\/01.prs.0000135330.51408.97)"},{"issue":"7","key":"bib21","series-title":"Plastic and Reconstructive Surgery","first-page":"121S","article-title":"Vacuum-assisted closure: state of basic research and physiologic foundation","volume":"117","author":"Morykwas","year":"2006","unstructured":"Morykwas MJSimpson JPunger KArgenta AKremers LArgenta J. Vacuum-assisted closure: state of basic research and physiologic foundation. Plastic and Reconstructive Surgery2006117 (7Supplement) 121S\u2013126S. (https:\/\/doi.org\/10.1097\/01.prs.0000225450.12593.12)"},{"key":"bib22","series-title":"International Wound Journal","first-page":"1260","article-title":"Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of incisional negative pressure wound therapy. A systematic review of the literature","volume":"13","author":"Scalise","year":"2016","unstructured":"Scalise ACalamita RTartaglione CPierangeli MBolletta EGioacchini MGesuita RDi Benedetto G. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of incisional negative pressure wound therapy. A systematic review of the literature. International Wound Journal2016131260\u20131281. (https:\/\/doi.org\/10.1111\/iwj.12492)"},{"key":"bib23","series-title":"Wound Repair and Regeneration","first-page":"838","article-title":"Effects of negative pressure wound therapy on fibroblast viability, chemotactic signaling, and proliferation in a provisional wound (fibrin) matrix","volume":"15","author":"McNulty","year":"2007","unstructured":"McNulty AKSchmidt MFeeley TKieswetter K. Effects of negative pressure wound therapy on fibroblast viability, chemotactic signaling, and proliferation in a provisional wound (fibrin) matrix. Wound Repair and Regeneration200715838\u2013846. (https:\/\/doi.org\/10.1111\/j.1524-475X.2007.00287.x)"},{"key":"bib24","series-title":"Plastic and Reconstructive Surgery","first-page":"592","article-title":"Closed incision negative-pressure therapy is associated with decreased surgical-site infections: a meta-analysis","volume":"136","author":"Semsarzadeh","year":"2015","unstructured":"Semsarzadeh NNTadisina KKMaddox JChopra KSingh DP. Closed incision negative-pressure therapy is associated with decreased surgical-site infections: a meta-analysis. Plastic and Reconstructive Surgery2015136592\u2013602. (https:\/\/doi.org\/10.1097\/PRS.0000000000001519)"},{"key":"bib25","series-title":"Methods in Molecular Biology","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/978-1-4939-9841-8_1","article-title":"Diabetic nephropathy: an overview","volume":"2067","author":"Sagoo","year":"2020","unstructured":"Sagoo MKGnudi L. Diabetic nephropathy: an overview. Methods in Molecular Biology202020673\u20137. (https:\/\/doi.org\/10.1007\/978-1-4939-9841-8_1)"},{"key":"bib26","series-title":"Annals of Vascular Surgery","first-page":"322","article-title":"A Meta-analysis of long-term mortality and associated risk factors following lower extremity amputation","volume":"42","author":"Stern","year":"2017","unstructured":"Stern JRWong CKYerovinkina MSpindler SJSee ASPanjaki SLoven SLD\u2019Andrea RFNowygrod R. A Meta-analysis of long-term mortality and associated risk factors following lower extremity amputation. Annals of Vascular Surgery201742322\u2013327. (https:\/\/doi.org\/10.1016\/j.avsg.2016.12.015)"},{"key":"bib27","series-title":"EPlasty","article-title":"Does the application of incisional negative pressure therapy to high-risk wounds prevent surgical site complications? A systematic review","volume":"13","author":"Ingargiola","year":"2013","unstructured":"Ingargiola MJDaniali LNLee ES. 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American Journal of Orthopedics200534329\u2013332."}],"container-title":["EFORT Open Reviews"],"original-title":[],"link":[{"URL":"https:\/\/eor.bioscientifica.com\/view\/journals\/eor\/7\/8\/EOR-22-0049.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eor.bioscientifica.com\/downloadpdf\/journals\/eor\/7\/8\/EOR-22-0049.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/eor.bioscientifica.com\/downloadpdf\/journals\/eor\/7\/8\/EOR-22-0049.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:50:46Z","timestamp":1784555446000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/eor\/article\/7\/8\/526-532\/2485"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,1]]},"references-count":31,"journal-issue":{"issue":"8"},"URL":"https:\/\/doi.org\/10.1530\/eor-22-0049","relation":{},"ISSN":["2058-5241"],"issn-type":[{"value":"2058-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,1]]}}}