Effectiveness of negative-pressure wound therapy in partial-thickness and full-thickness burns: a systematic reviewABSTRACT
Purpose: To evaluate the effectiveness of negative-pressure wound therapy (NPWT) in healing partial- and full-thickness burns in humans.
Methods: This systematic review followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA checklist.
Results: Eight studies published between 2014 and 2024 were included, involving 466 patients with partial- and full-thickness burns. The sample comprised five randomized controlled trials, two retrospective observational studies, and one prospective cohort study. NPWT was applied in continuous or intermittent modes, with pressures ranging from 40 to 125 mmHg. The most frequently assessed outcome was re-epithelialization time, with NPWT superiority reported in three studies. NPWT was also associated with greater reduction in wound area and bacterial load. Additional outcomes included pain, graft integration, and scar quality, as well as logistical advantages such as reduced dressing change frequency.
Conclusion: NPWT provides benefits in burn treatment, including reduction of wound area, bacterial count, and re-epithelialization time, along with effectiveness in graft integration and healing quality. Despite limitations, such as application difficulties and prolonged treatment in pediatric patients, NPWT stands out for decreasing dressing changes, improving care logistics and psychological well-being.
Key words
Wound Healing; Burns; Negative-Pressure Wound Therapy
Introduction
As the primary interface with the external environment, the skin is subject to various forms of trauma over the lifespan, including burns, defined as damage to the skin or any organic tissue, caused mainly by thermal, chemical, electrical, radioactive agents, or friction. Burns constitute a heterogeneous group of injuries that can be classified according to the depth of tissue damage and are categorized as superficial thickness, partial thickness (superficial or deep), and full thickness1-3.
Unlike partial-thickness burns, which preserve remnants of the dermal appendages and have the potential for spontaneous re-epithelialization, full-thickness burns result in complete destruction of the epidermis and dermis, compromising tissue regeneration, and therefore, require surgical interventions such as skin grafting4.
From an epidemiological perspective, burns are a significant global public health problem. The World Health Organization (WHO) estimates that approximately 180,000 deaths occur annually because of these injuries, with the majority concentrated in low- and middle-income countries, where access to specialized services and advanced care technologies is limited5,6.
Burn treatment does not always provide an ideal environment for tissue regeneration, especially in deep burns or those with high exudate production. This has driven the incorporation of adjuvant therapies, such as negative-pressure wound therapy (NPWT), in the management of these injuries7.
NPWT was introduced commercially in 1997 and consists of a system of three essential components: an open-cell foam, a semi-occlusive dressing, and a controlled subatmospheric pressure source. The application of this system promotes exudate removal, edema reduction, increased local perfusion, wound margin contraction, and the formation of a microenvironment favorable to cell proliferation and angiogenesis8-10.
Several studies suggest benefits of NPWT in the treatment of burns of varying depths, including reduced bacterial load, accelerated re-epithelialization, and improved skin graft integration11-13. However, limitations related to variability in application protocols and methodological heterogeneity between studies persist, making it difficult to draw consistent conclusions about their actual magnitude of effectiveness.
NPWT in burn care still has significant limitations, such as high cost, the need for specific equipment, risk of bleeding, and heterogeneity of results depending on the depth and extent of the injury among the available studies. Given this scenario, there is a clear need for a critical and up-to-date summary of the available evidence on the use of NPWT in the treatment of burns. Therefore, the aim of this study was to evaluate the effectiveness of NPWT in the healing of partial- and full-thickness burns in humans.
Methods
This is a systematic review developed to evaluate the effect of NPWT in the treatment of partial- and full-thickness burns. The review followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions14. The study report was structured according to the checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 202015. The full PRISMA 2020 checklist is provided as Suppl. Mat. 116. The review protocol was previously registered at International Prospective Register of Systematic Reviews (PROSPERO), under registration number CRD42024576732.
The guiding question of the review was formulated using the PICO (Population, Intervention, Comparison, Outcomes) strategy, as recommended for systematic reviews of interventions15, and was as follows: What is the effect of NPWT on the healing process of partial- and full-thickness burns?
-
P (Population): individuals of any age with partial- or full-thickness burns;
-
I (Intervention): NPWT;
-
C (Comparison): conventional treatment or other approaches described in the included studies, according to the methodological design of each study;
-
O (Outcomes): parameters related to healing, including re-epithelialization time, granulation tissue formation, graft integration rate, infection control, pain intensity, hospital stay, and other relevant clinical variables.
The electronic search was performed in the following databases: MEDLINE (PubMed), Web of Science, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), Virtual Health Library, and Scopus, using the advanced search mode. Studies published between June 2014 and July 2025 were included, without language restrictions. The inclusion period (2014–2025) was defined to capture more recent evidence consistent with current clinical practices in burn management.
To develop the search strategy, Medical Subject Headings (MeSH) terms were selected using a conceptual mapping approach16, as described by Ribeiro-Rotta et al.17. The search strategies were subsequently adapted to the specific characteristics of each database16 .
The inclusion criteria were randomized controlled trials and observational studies that evaluated NPWT as the primary intervention or as a central adjunctive treatment, including its use for wound bed preparation or skin graft fixation, in partial- and full-thickness burns in humans.
The exclusion criteria were review studies, experimental animal studies, case reports or case series, letters to the editor, recommendations and guidelines, and studies in which NPWT was used only as a secondary or supportive component of combination therapies, without isolated evaluation of its clinical effects.
The screening and organization of articles were conducted using Rayyan software, which was used to identify duplicates, organize references, and optimize the selection process18. Two reviewers independently (TGS and VCONLS) read the titles and abstracts, following the previously established eligibility criteria. Studies considered potentially eligible were read in full. Disagreements between reviewers were resolved by a third evaluator (RSLJ). Reasons for exclusion after full-text review are presented in Suppl. Mat. 416.
The selection process was documented using a flowchart in accordance with PRISMA guidelines (Fig. 1). Data from the included studies were extracted and recorded in a Microsoft Excel spreadsheet. The following variables were collected: title, DOI, study type, country, year of publication, study design, burn classification, study population, sample size, affected body surface area, intervention, comparison groups, therapy-related complications, outcomes, treatment duration, and statistical findings.
The risk of bias assessment was conducted by two reviewers independently (TGS and VCONLS). For randomized controlled trials, the Cochrane Risk of Bias 2.0 (RoB 2) tool was used19. For non-randomized observational studies, Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) was used20.
Results
Eight studies were included in this systematic review, of which two retrospective observational studies21,22, five randomized controlled trials23-27, and one prospective cohort study28, including a total of 466 patients with total body surface area (TBSA) burned ranging from 0.5 to 40%.
The publications included data from the period between 2014 and 2024 and involved individuals with partial- and full-thickness burns. The process of identification, screening, eligibility, and inclusion of studies is described in the PRISMA flowchart, shown in Fig. 1. The data extracted from these eight studies formed the basis of this review and are organized in Table 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flowchart.
Characteristics and main outcomes of studies evaluating negative-pressure wound therapy in burn injuries.
The risk of bias of randomized controlled trials was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool. Overall, most studies were judged to present low risk of bias across the main evaluated domains, as illustrated in Fig. 2. However, differences in study design and relatively small sample sizes were observed across trials, which should be considered when interpreting the findings. These factors may limit the precision of effect estimates, despite the overall favorable methodological assessment.
The risk of bias in retrospective observational studies and the prospective single-center cohort was evaluated using the ROBINS-I tool. Although some methodological limitations were identified in specific domains, particularly those inherent to observational designs, the included studies demonstrated acceptable overall methodological quality. Consequently, the risk of bias was considered low to moderate, as presented in Fig. 3.
Among the different modes of NPWT application, six studies used the continuous mode21, 22, 24, 25, 27, 28, and one study used the intermittent mode23. The pressures applied ranged from 40 to 125 mmHg, with 125 mmHg being the most common. Different treatments were used in the control groups of the randomized studies. In the study by Tapking et al.26, patients treated with debridement and dressings containing polyhexanide, oily gauze, and cotton changed every 48 hours, compared with patients who underwent tangential surgical debridement, and received skin grafts followed by additional NPWT. The study by Ibrahim et al.23 evaluated the effectiveness of microcurrent electrical stimulation (MES) and standard wound care compared to NPWT, highlighting technological approaches to stimulate healing. Frear et al.24 used a silver mesh as a standard dressing in the control group. Sun et al.25 used iodine-soaked gauze as a dressing. In all groups, initial debridement was performed, in addition to cleaning the wound at each dressing change.
The primary outcomes assessed across the selected studies included re-epithelialization time, graft integration, bacterial load, pain, and scar quality. The most frequently investigated outcome was re-epithelialization time, assessed in five of the eight studies21,24-26,28. Among these, Sun et al.25 and Babu et al.28 showed statistically significant differences in favor of NPWT. Sun et al.25 demonstrated a significantly shorter wound closure time, approximately five days less than in the control group (p < 0.05). In the study by Babu et al.28, the percentage of re-epithelialization was greater than 90% in a significantly higher proportion of patients in the NPWT group (p = 0.036). In the study by Frear et al.24, NPWT significantly reduced time to re-epithelialization compared with the control group, based on adjusted models accounting for burn depth, anatomical location, and etiology incidence rate ratio (IRR) = 0.78, 95% confidence interval [95%CI] 0.66–0.93; p = 0.005). Ibrahim et al.23, although did not measure complete re-epithelialization, demonstrated a significantly greater reduction in wound area in the group undergoing NPWT after 21 days of treatment compared with the standard care control group (p < 0.001).
The reduction in bacterial load also showed a statistical difference in favor of NPWT, especially in the study by Ibrahim et al.23, which reported, on day 10, a lower mean bacterial count (p < 0.001) in the NPWT group, whereas the control group showed the highest mean bacterial count (84.1 ± 17.0) (p < 0.001).
Discussion
Since its introduction into clinical practice in 1997, NPWT has been increasingly adopted in the management of complex wounds, including burn injuries9,30. In this context, the present systematic review aimed to synthesize the available evidence regarding the effectiveness of NPWT in the treatment of partial- and full-thickness burns. Overall, the findings indicate that NPWT is associated with favorable clinical outcomes when compared with conventional dressings, including a reduction in wound area, decreased bacterial burden, accelerated re-epithelialization, and improved skin graft integration in selected scenarios31. These results support the role of NPWT as an adjunctive therapeutic strategy across different stages of burn care, particularly in complex wounds requiring optimized wound bed preparation and graft stabilization. However, despite the consistency of positive outcomes reported in the literature, the substantial clinical and methodological heterogeneity among the included studies highlights the need for cautious interpretation and reinforces the importance of individualized treatment protocols. In addition, part of the available evidence is derived from observational studies without control groups, which does not allow for direct inference regarding comparative effectiveness.
The application of NPWT in different degrees of burn severity, including partial- and full-thickness injuries, has demonstrated favorable outcomes in multiple anatomical regions, with evidence of efficacy in body areas ranging from 0.5 to 10% of the TBSA. Studies also point to significant benefits in patients with more extensive burns (≥ 15% TBSA), including reduced risk of infection, improved re-epithelialization, and greater efficiency in fluid control, which are crucial aspects for clinical stabilization and favorable clinical outcomes in these patients32.
The results of this review indicate that NPWT not only promotes wound closure but also has a positive impact on functional and reconstructive outcomes, particularly in the context of skin graft integration. The incorporation of NPWT in the acute phases of treatment was associated with graft integration rates close to 100%, underscoring its role as a key adjunct for the adequate preparation of the wound bed and for the success of the surgical procedure. NPWT enhances graft integration by stabilizing the graft–wound interface, minimizing shear forces, and reducing hematoma and seroma formation, thereby facilitating capillary inosculation and graft adherence. These findings are further supported by a meta-analysis demonstrating that NPWT significantly increases graft integration rates and reduces infection rates when compared with conventional therapies, reinforcing its superiority in certain clinical scenarios11.
In addition to conventional dressings, several other strategies have been employed for burn wound bed preparation, including dermal substitutes and skin allografts. Dermal substitutes such as Integra, Matriderm, and NovoSorb BTM have emerged as important tools in the management of deep partial- and full-thickness burns, particularly in patients with limited donor sites or exposed tendon and bone, due to their ability to promote neodermis formation and improve long-term scar quality33,34. However, these approaches may require staged surgical procedures and, in some settings, have been associated with delayed re-epithelialization and higher treatment costs33. Skin allografts remain an important temporary coverage strategy in extensive burns, helping reduce fluid loss, pain, and infection risk while preparing the wound bed for definitive autografting35. Rather than acting as a skin substitute itself, NPWT optimizes the wound environment through edema reduction, exudate control, improved perfusion, and graft stabilization. Therefore, NPWT may play a complementary role alongside dermal substitutes and allografts, particularly in complex wounds requiring enhanced wound bed preparation and graft integration.
In burns affecting functionally critical areas, such as the hands, NPWT appears to offer additional benefits in terms of preserving mobility and scar retraction, and improving aesthetic and functional appearance. Patients with partial- and full-thickness burns on their hands treated with NPWT showed significant long-term maintenance of finger mobility and better-quality scar formation22. Similar results were observed in a study that associated NPWT with an early rehabilitation protocol in patients with partial-thickness burns on the hands, whose areas ranged from 0.5 to 2% of TBSA, showing functional improvement and acceleration of the healing process36. These findings reinforce the importance of NPWT as a resource integrated into multidisciplinary rehabilitation strategies.
Another relevant aspect concerns the definition of the ideal subatmospheric pressure to be used during treatment. In the studies included in this review, the pressures applied predominantly ranged between -75 and -125 mmHg21–23,26, except for pediatric patients younger than 12 months old, in whom a reduced pressure of 40 mmHg was used24. These parameters are in line with the recommendations of the European Wound Management Association, which establishes the range between -75 and -125 mmHg as the most widely indicated for stimulating granulation tissue formation, wound contraction, and exudate removal9. According to this document, pressures close to -125 mmHg are traditionally used to maximize angiogenesis and granulation tissue formation, while moderate pressures (-75 to -100 mmHg) are preferable in more sensitive or compromised tissues, due to the lower risk of hypoperfusion and local ischemia, in addition to the ability to modulate cytokines and stimulate growth factors, such as vascular endothelial growth factor and basic fibroblast growth factor. Excessive high pressures can induce pain and potential tissue damage, while very low pressures tend to be ineffective, highlighting the need for individualized therapy according to the characteristics of the wound and the patient9.
This need for dynamic pressure adjustment is evidenced in reports such as the one by Gómez-Ortega et al.37, who described the management of patients with electrical burns using, initially, a pressure of -125 mmHg for five days and, after grafting, a reduction to -100 mmHg for another four or five days. This strategy resulted in graft integration rates ranging from 85 to 100%, emphasizing the usefulness of NPWT both in the preparatory phase for reconstruction and in post-grafting support, especially in deep lesions with a high risk of complications38.
The most frequently evaluated outcome in this review was the time to re-epithelialization, which is recognized as one of the main indicators of therapeutic efficacy in wounds. Re-epithelialization is directly related not only to the restoration of skin integrity but also to functional recovery and reduced risk of secondary infections and may be enhanced by NPWT through the maintenance of a moist wound environment, reduction of interstitial edema, and improvement of local perfusion, which collectively facilitate keratinocyte migration and proliferation21,24-26.
Although the study by Waltzman and Bell21 found no statistically significant association between the occurrence of burns and the variables of age and gender, the literature consistently recognizes the impact of social determinants on the distribution of these events. Epidemiological evidence indicates that children and adult women are among the groups most vulnerable to burns, which may be related to factors such as greater exposure to heat sources at home, socioeconomic inequalities, and unsafe working conditions39.
In addition, the reduction in microbial load associated with NPWT use represents one of its most relevant mechanisms in the context of burns, since secondary infections remain one of the leading causes of morbidity and mortality in these patients. The study by Ibrahim et al.23 demonstrated a statistically significant reduction in microbial colonization in wounds treated with NPWT, a finding of extreme relevance given the risk of progression to sepsis and septic shock, a complication known to be associated with high mortality rates in patients with extensive burns. Continuous exudate removal, decreased tissue edema, improved oxygenation, and disruption of bacterial biofilms create a less favorable environment for microbial proliferation40.
NPWT has demonstrated a favorable cost–benefit profile, particularly when both clinical and economic outcomes are considered. In a randomized controlled trial involving pediatric burn patients, NPWT was associated with a mean cost per patient of AUD $903.69 compared to AUD $1,669.01 for standard care, resulting in an average cost savings of $948.57 per patient, in addition to a reduction in time to re-epithelialization and a high probability (89%) of being a dominant strategy41. Although these values are reported in Australian dollars, they reflect a substantial reduction in overall healthcare costs. Furthermore, a systematic review and meta-analysis found that NPWT was associated with a higher likelihood of wound healing (odds ratio = 1.56; 95%CI 1.15–2.13) and a reduction in hospital length of stay by an average of 4.78 days, which indirectly contributes to cost savings, although no direct monetary estimates in U.S. dollars were reported42. Therefore, despite potentially higher initial costs related to devices and materials, NPWT tends to be cost-effective by reducing treatment duration, the need for additional interventions, and overall healthcare resource utilization.
Overall, the findings of this review corroborate the role of NPWT as a promising, safe, and potentially superior intervention compared with traditional approaches in specific contexts of partial- and full-thickness burns. However, the heterogeneity of the study designs, populations evaluated, and therapeutic protocols underscores the need for additional randomized controlled trials with greater methodological rigor and standardized outcomes to strengthen the level of evidence and broaden the clinical applicability of these results.
Observational studies without control groups21,22 were included for descriptive purposes, but they did not allow for direct inference regarding comparative effectiveness. The reported outcomes indicated successful graft take and favorable scar quality.
Conclusion
The systematic review demonstrated that NPWT is associated with favorable outcomes in the treatment of partial- and full-thickness burns, including reduction in wound area, decreased bacterial load, and accelerated re-epithelialization time when compared with conventional approaches. In addition, NPWT showed a positive impact on skin graft integration and overall improvement in healing quality, particularly when applied at strategic stages of surgical and reconstructive management. Taken together, these findings suggest that NPWT may serve as an adjunctive strategy in selected burn scenarios, particularly graft stabilization, and infection control are clinical priorities.
Acknowledgements
Not applicable.
Funding
Declaration of use of artificial intelligence tools
Data availability statement
All datasets were generated or analyzed in the current study.
References
-
1 Garcia-Espinoza JA, Aguilar-Aragon VB, Ortiz-Villalobos EH, Garcia-Manzano RA, Antonio BA. Definition, classification, pathophysiology and initial approach. Gen Med. 2017;5:5. https://doi.org/10.4172/2327-5146.1000298
» https://doi.org/10.4172/2327-5146.1000298 -
2 Jeschke MG, Van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers. 2020;6(1):11. https://doi.org/10.1038/s41572-020-0145-5
» https://doi.org/10.1038/s41572-020-0145-5 -
3 Martin NA, Falder S. A review of the evidence for threshold of burn injury. Burns. 2017;43(8):1624–39. https://doi.org/10.1016/j.burns.2017.04.003
» https://doi.org/10.1016/j.burns.2017.04.003 -
4 McCann C, Watson A, Barnes D. Major burns: Part 1. Epidemiology, pathophysiology and initial management. BJA Educ. 2022;22(3):94–103. https://doi.org/10.1016/j.bjae.2021.10.001
» https://doi.org/10.1016/j.bjae.2021.10.001 -
5 Dai NT, Chang HI, Wang YW, Fu KY, Huang TC, Huang NC, Li JK, Hsieh PS, Dai LG, Hsu CK, Maitz PK. Restoration of skin pigmentation after deep partial or full-thickness burn injury. Adv Drug Deliv Rev. 2018;123:155–64. https://doi.org/10.1016/j.addr.2017.10.010
» https://doi.org/10.1016/j.addr.2017.10.010 -
6 World Health Organization (WHO). Burns. Geneva: WHO; 2018 [cited 2025 Aug 3]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/burns
» https://www.who.int/en/news-room/fact-sheets/detail/burns -
7 Wang Y, Beekman J, Hew J, Jackson S, Issler-Fisher AC, Parungao R, Lajevardi SS, Li Z, Maitz PKM. Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev. 2018;123:3–17. https://doi.org/10.1016/j.addr.2017.09.018
» https://doi.org/10.1016/j.addr.2017.09.018 - 8 Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563–76; discussion 577.
-
9 Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjö M, Piaggesi A, Probst A, Vowden P. EWMA Document: negative pressure wound therapy. J Wound Care. 2017;26(Suppl.3):S1–S154. https://doi.org/10.12968/jowc.2017.26.Sup3.S1. Erratum in: J Wound Care. 2018;27(4):253. https://doi.org/10.12968/jowc.2018.27.4.253b
» https://doi.org/10.12968/jowc.2017.26.Sup3.S1 -
10 Singh D, Chopra K, Sabino J, Brown E. Practical things you should know about wound healing and vacuum-assisted closure management. Plast Reconstr Surg. 2020;145(4):839e–54e. https://doi.org/10.1097/PRS.0000000000006652
» https://doi.org/10.1097/PRS.0000000000006652 -
11 Lin DZ, Kao YC, Chen C, Wang HJ, Chiu WK. Negative pressure wound therapy for burn patients: A meta-analysis and systematic review. Int Wound J. 2021;18(1):112-–23. https://doi.org/10.1111/iwj.13500
» https://doi.org/10.1111/iwj.13500 -
12 Santos PCP, Pires BMFB, Peres EM, Rocha RG, Gomes VGM, Gomes HF, Mello LF, Silva RP, Souza NVDP, Andrade PCST, Costa CCP. The effectiveness of negative pressure therapy in burns: scoping review. ESTIMA. 2024;22:e1415. https://doi.org/10.30886/estima.v22.1415_PT
» https://doi.org/10.30886/estima.v22.1415_PT -
13 Nuhiji E. Trends and innovation in negative pressure wound therapy: a review of burn wound management. Adv Wound Care. 2024;13(8):391–9. https://doi.org/10.1089/wound.2023.0114
» https://doi.org/10.1089/wound.2023.0114 - 14 Chandler J, Cumpston M, Thomas J, Higgins JPT, Deeks JJ, Clarke MJ. Introduction. In: Cumpston M, Flemyng E, Thomas J, Higgins JPT, Deeks JJ, Clarke MJ, editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.4. Cochrane; 2023.
-
15 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
» https://doi.org/10.1136/bmj.n71 -
16 Souza VCONL, Silva AC, Lino Junior RS, Silveira TG. Supplementary material for: Effectiveness of negative-pressure wound therapy in partial-thickness and full-thickness burns: a systematic review [dataset]. Zenodo. 2026. https://doi.org/10.5281/zenodo.21780438
» https://doi.org/10.5281/zenodo.21780438 -
17 Ribeiro-Rotta RF, Rosa EA, Milani V, Dias NR, Masterson D, Silva EN, Zara ALSA. The cost of oral cancer: A systematic review. PLoS One. 2022;17(4):e0266346. https://doi.org/10.1371/journal.pone.0266346
» https://doi.org/10.1371/journal.pone.0266346 -
18 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. https://doi.org/10.1186/s13643-016-0384-4
» https://doi.org/10.1186/s13643-016-0384-4 -
19 Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898
» https://doi.org/10.1136/bmj.l4898 -
20 Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919
» https://doi.org/10.1136/bmj.i4919 -
21 Waltzman JT, Bell DE. Vacuum-assisted closure device as a split-thickness skin graft bolster in the burn population. J Burn Care Res. 2014;35(5):e338–42. https://doi.org/10.1097/bcr.0000000000000009
» https://doi.org/10.1097/bcr.0000000000000009 -
22 Ehrl D, Heidekrueger PI, Broer PN, Erne HC. Topical negative pressure wound therapy of burned hands: functional outcomes. J Burn Care Res. 2017;39(1):121–8. https://doi.org/10.1097/bcr.0000000000000557
» https://doi.org/10.1097/bcr.0000000000000557 -
23 Ibrahim ZM, Waked IS, Ibrahim O. Negative pressure wound therapy versus microcurrent electrical stimulation in wound healing in burns. J Wound Care. 2019;28(4):214–9. https://doi.org/10.12968/jowc.2019.28.4.214
» https://doi.org/10.12968/jowc.2019.28.4.214 -
24 Frear CC, Cuttle L, McPhail SM, Chatfield MD, Kimble RM, Griffin BR. Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children. Br J Surg. 2020;107(13):1741–50. https://doi.org/10.1002/bjs.11993
» https://doi.org/10.1002/bjs.11993 -
25 Sun T, Ying W, Wang S, Chen C, Sun P, Tan J. Clinical application of vacuum sealing drainage for the treatment of deep burn wounds. Am Surg. 2021;89(4):1018–23. https://doi.org/10.1177/00031348211054527
» https://doi.org/10.1177/00031348211054527 -
26 Tapking C, Endlein J, Warszawski J, Kotsougiani-Fischer D, Gazyakan E, Hundeshagen G, Hirche C, Trofimenko D, Burkard T, Kneser U, Fischer S. Negative pressure wound therapy in burns: a prospective, randomized-controlled trial. Burns. 2024;50(7):1840–7. https://doi.org/10.1016/j.burns.2024.04.005
» https://doi.org/10.1016/j.burns.2024.04.005 -
27 Hsiao SF, Ma H, Wang YH, Wang TH. Occlusive drainage system for split-thickness skin graft: A prospective randomized controlled trial. Burns. 2017;43(2):379–87. https://doi.org/10.1016/j.burns.2016.08.025
» https://doi.org/10.1016/j.burns.2016.08.025 -
28 Babu B, Gaba S, John JR, Subair M. Comparison of efficacy of vacuum dressing versus conventional dressing over autologous split skin grafts in burn wounds: a single-center prospective cohort study. J Burn Care Res. 2024;45(2):468–77. https://doi.org/10.1093/jbcr/irad181
» https://doi.org/10.1093/jbcr/irad181 -
29 Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev. 2022;18(2):e1230. https://doi.org/10.1002/cl2.1230
» https://doi.org/10.1002/cl2.1230 -
30 Bernatchez SF. Current state of science in negative pressure wound therapy. Adv Wound Care. 2025;14(6):273–8. https://doi.org/10.1089/wound.2024.0180
» https://doi.org/10.1089/wound.2024.0180 -
31 Santos PCP, Pires BMFB, Peres EM, Rocha RG, Gomes VGM, Gomes HF, Mello LF, Silva RP, Souza NVDO, Andrade PCST, Costa CCP. The effectiveness of negative pressure therapy in burns: scope review. ESTIMA, Braz J Enterostomal Ther. 2024;22:e1415. https://doi.org/10.30886/estima.v22.1415_IN
» https://doi.org/10.30886/estima.v22.1415_IN -
32 Varon DE, Smith JD, Mistry R, Kantak NA, Halvorson EG. Negative-pressure wound therapy for large burn wounds. In: Shiffman, M., Low, M., editors. Burns, infections and wound management: recent clinical techniques, results, and research in wounds. Cham: Springer; 2018. v. 2. p. 251–9. https://doi.org/10.1007/15695_2018_112
» https://doi.org/10.1007/15695_2018_112 -
33 van den Bosch AS, Verwilligen RAF, Pijpe A, Bosma E, van der Vlies CH, Lucas Y, Burchell GL, van Zuijlen PPM, Middelkoop E; National Burn Care, Education & Research group, The Netherlands. Outcomes of dermal substitutes in burns and burn scar reconstruction: A systematic review and meta-analysis. Wound Repair Regen. 2024;32(6):960–78. https://doi.org/10.1111/wrr.13226
» https://doi.org/10.1111/wrr.13226 -
34 van den Bosch AS, Verwilligen RAF, Pijpe A, Jansen LB, van der Vlies CH, van Eck ME, Burchell GL, van Zuijlen PPM, Middelkoop E; National Burn Care, Education & Research Group, The Netherlands. Indications for the use of dermal substitutes in patients with acute burns and in reconstructive surgery after burns: A systematic review. Wound Repair Regen. 2025;33(1):e13248. https://doi.org/10.1111/wrr.13248
» https://doi.org/10.1111/wrr.13248 -
35 Paggiaro AO, Bastianelli R, Carvalho VF, Isaac C, Gemperli R. Is allograft skin, the gold-standard for burn skin substitute? A systematic literature review and meta-analysis. J Plast Reconstr Aesthet Surg. 2019;72(8):1245–53. https://doi.org/10.1016/j.bjps.2019.04.013
» https://doi.org/10.1016/j.bjps.2019.04.013 -
36 Liu C, Xie H, Wei P, Gong T, Wu G, Xu Z, Chen S. Clinical study of early rehabilitation training combined with negative pressure wound therapy for the treatment of deep partial-thickness hand burns. Front Surg. 2023;10:1040407. https://doi.org/10.3389/fsurg.2023.1040407
» https://doi.org/10.3389/fsurg.2023.1040407 -
37 Gómez-Ortega V, Vergara-Rodriguez MJ, Mendoza B, García T. Effect of negative pressure wound therapy in electrical burns. Plast Reconstr Surg Glob Open. 2021;9(2):e3383. https://doi.org/10.1097/GOX.0000000000003383
» https://doi.org/10.1097/GOX.0000000000003383 -
38 Amaris-Acuña JS, Mendoza-Toro B, Camacho-Obando D, Gómez-Ortega V. Customized negative pressure wound therapy: innovative design in polyurethane foam for complex burn reconstruction. Plast Reconstr Surg Glob Open. 2024;12(8):6028. https://doi.org/10.1097/GOX.0000000000006028
» https://doi.org/10.1097/GOX.0000000000006028 -
39 Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, Huss F, Kamolz LP. Recent trends in burn epidemiology worldwide: A systematic review. Burns. 2017;43(2):249–57. https://doi.org/10.1016/j.burns.2016.08.013
» https://doi.org/10.1016/j.burns.2016.08.013 -
40 Zhang P, Zou B, Liou YC, Huang C. The pathogenesis and diagnosis of sepsis post burn injury. Burns Trauma. 2021;9:tkaa047. https://doi.org/10.1093/burnst/tkaa047
» https://doi.org/10.1093/burnst/tkaa047 -
41 Frear CC, Griffin BR, Cuttle L, Kimble RM, McPhail SM. Cost-effectiveness of adjunctive negative pressure wound therapy in paediatric burn care: evidence from the SONATA in C randomised controlled trial. Sci Rep. 2021;11(1):16650. https://doi.org/10.1038/s41598-021-95893-9
» https://doi.org/10.1038/s41598-021-95893-9 -
42 Zens Y, Barth M, Bucher HC, Dreck K, Felsch M, Groß W, Jaschinski T, Kölsch H, Kromp M, Overesch I, Sauerland S, Gregor S. Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials. Syst Rev. 2020;9(1):238. https://doi.org/10.1186/s13643-020-01476-6
» https://doi.org/10.1186/s13643-020-01476-6
LILACS: Latin American and Caribbean Health Sciences Literature; BVS: Virtual Health Library. Source: Haddaway et al.
Source: Elaborated by the authors.
Source: Elaborated by the authors.