The quality of evidence is downgraded by indirectness (differences between the population of interest and those studied: most participants were treated as in-patients until healing occurred) and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 1 study with 60 subjects with leg ulcers that were venous arteriolosclerotic and venous/arterial in origin, and had not healed after treatment over a 6-month period. The study compared negative pressure wound therapy (NPWT) followed by a punch skin-graft transplant and further NPWT treatment (for 4 days postoperatively) with standard wound care followed by a punch skin-graft transplant and subsequent standard care. All participants were treated as in-patients until healing occurred.
The median time to healing in the NPWT group was 28 days (95% CI 25.5 to 32.5) compared with 45 days (95% CI 36.2 to 53.8) in the standard care group. The study reported an adjusted hazard ratio (HR) of 3.2 (95% CI 1.7 to 6.2) suggesting a higher hazard (chance) of healing with NPWT. The follow-up period of the study was a minimum of 12 months. There was no evidence of a difference in the total number of ulcers healed (29/30 in each group; RR 1.00, 95% CI 0.91 to 1.10) over the follow-up period. There was a difference in time to wound preparation for surgery that favoured NPWT (HR 2.4, 95% CI 1.2 to 4.7). The median time to preparation for surgery was 7 days (95% CI 5.7 to 8.3) in the NPWT group and 17 days (95% CI 10 to 24) in the standard care group. There was no difference in pain scores and participants health-related quality of life/health status measured by Euroqol (EQ-5D) scores at 8 weeks after surgery. There were very limited results for adverse events.
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