The Effect Of NPWT Versus Tie-Over Dressing On Skin Grafting For Avulsion Injury:A Meta-Analysis

ObjectiveThe avulsion injury of skin and soft tissue is a common type of injury,which is mostly caused by traffic accidents and machine violence.The avulsion wound can be repaired by autologous skin replantation,skin grafting and flap transplantation.Negative pressure wound therapy(NPWT)and conventional tie-over dressing can be used after surgery.The purpose of this study is to conduct a meta-analysis based on the existing clinical evidence,and compare the effect of NPWT and conventional tie-over dressing.MethodsLiterature search was conducted on CNKI,Wanfang database,PubMed,Embase,and Cochrane Library.The language was limited to Chinese and English.The retrieval time was from the establishment of the database to December 2022.After searching and screening the literatures,evaluate the quality of the included literatures,and the extracted data were statistically analyzed through Review Manager 5.4 and Stata 17.0 Software.When P>0.05,I2≤50,the fixed effect model is selected.When P≤0.05,I2>50,the random effect model is selected.ResultsA total of 16 articles were finally enrolled,with 5 RCTs and 11 nRCTs.906 patients were included,480 in NPWT group and 426 patients in conventional tie-over dressing group.Metaanalysis displays that compared with compression dressing group,the effective rate(OR=4.58,95%CI:2.83～7.40,P<0.001)and survival area(MD=10.76,95%CI:8.89～12.62,P<0.001)were improved in the NPWT group.The complications rate(OR=0.12,95%CI:0.88～0.19,P<0.001 and secondary operation rate(OR=0.27,95%CI:0.16～0.44,P<0.001)were reduced in the NPWT group.Operation time(MD=-13.84,95%CI:-16.16～-11.52,P<0.001),hospitalization time(MD=-8.96,95%CI:-12.62～-5.31,P<0.001)and wound healing time(MD=-7.94,95%CI:-11.69～-4.19,P<0.001)were shortened.The differences of the above indexes were statistically significant.There was insufficient evidence to prove that the NPWT group is superior in terms of medical expenses.Pain score of visual analog scale(VAS)was only analyzed descriptively due to the small number of included literatures and high heterogeneity.ConclusionCompared with conventional tie-over dressing,NPWT can improve the effective rate and survival area,reduce the complications rate and secondary operation rate,shorten operation time,hospitalization time and wound healing time.More high-quality studies are needed due to the quality and quantity of the included literatures.