Authors' objectives:

The aim of this report is to update the 2004 health technology and policy appraisal on vacuum assisted closure (VAC) therapy in light of new, emerging evidence, and the availability of new negative pressure wound therapy (NPWT) systems.

Authors' results and conclusions: Seven international health technology assessments on NPWT were identified, including the original health technology review on NPWT by the Medical Advisory Secretariat from 2004. The assessments consistently reported that NPWT may be useful for healing various types of wounds, but that its effectiveness could not be empirically quantified because the studies were poorly done, the patient populations and outcome measures could not be compared, and the sample sizes were small. Six RCTs were identified that compared NPWT to standard care. Five of the 6 studies were of low or very low quality according to GRADE criteria. The low quality and very low quality RCTs were flawed with various problems including small sample sizes, inconsistent reporting of results, and patients lost to follow-up. Analysis of the highest quality study (N=162), which forms the basis of this HTPA, revealed that: - There was not a statistically significant difference (>20%) between NPWT and standard care in the rate of complete wound closure in patients who had complete wound closure but did not undergo surgical wound closure (P=.15). - The length of time to complete closure between NPWT and standard care in patients who had complete wound closure but did not undergo surgical wound closure was not reported. - There was not a statistically significant difference (>20%) in the rate of secondary amputations between the patients receiving NPWT and those receiving standard care (P=.06) - There may be an increased risk of wound infection in patients receiving NPWT compared to those receiving standard care.

Authors' recommendations: Based on the evidence to date, the clinical effectiveness of NPWT to heal wounds is unclear. Furthermore saline dressing are not the standard of practice in Ontario, thereby rendering the literature base irrelevant in an Ontario context. Nonetheless, despite the lack of methodologically sound studies, NPWT has diffused across Ontario.

Authors' methods: Review

Project Status: Completed

Year Published: 2006

URL for published report: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_npwt_070106.pdf

URL for additional information: http://www.hqontario.ca/en/mas/mas_ohtas_tech_npwt_070106.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care