Pooled Study-level Analysis of Randomized Controlled Trials Analyzing the Effect of Negative Pressure Wound Therapy With Irrigation vs Traditional Negative Pressure Wound Therapy on Diabetic Foot Outcomes

Introduction. The benefits of NPWT-T for the diabetic foot have been established. The addition of regular periodic irrigation with broad-spectrum antiseptic solution has been shown to reduce bioburden and total bacterial colonies; however, debate remains as to the clinical effect on diabetic foot outcomes. Objective. This study investigated the differences between NPWT-T and NPWT-I for treatment of the diabetic foot and the associated clinical outcomes. Methods. PubMed, Medline/Embase, the Cochrane Library, and Web of Science were searched for relevant literature published between January 1, 2002, and March 1, 2022. Keywords included “Negative Pressure Wound Therapy” AND “Instillation” OR “Irrigation.” Three studies with a total of 421 patients (NPWT-T [n = 223], NPWT-I [n = 198]) were included in the meta-analysis. Results. No significant differences were observed between NPWT-T and NPWT-I for BWC (OR, 1.049; 95% CI, 0.709-1.552; P =.810), time to wound closure (SMD, −0.039; 95% CI, −0.233-0.154; P =.691), LOS (SMD, 0.065; 95% CI, −0.128-0.259; P =.508), or AEs (OR, 1.092; 95% CI, 0.714-1.670; P =.69). Conclusion. Results of this systematic review and meta-analysis indicate that further RCTs are required to assess the role of NPWT-I in the management of DFU and DFI.