SynthesisFrontiers in endocrinology2026
Negative pressure wound therapy versus standard wound care for diabetic foot ulcers: a systematic review and meta-analysis of healing and limb outcomes.
Synthesis in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Background: Diabetic foot ulcers (DFUs) are major diabetes-related complications that often require prolonged wound care, debridement, or limb-salvage surgery. Negative pressure wound therapy (NPWT) is widely used as an adjunct, but its comparative effectiveness remains debated. Objective: To meta-analyze the efficacy and safety of NPWT versus standard wound care in adults with DFUs. Methods: PubMed/MEDLINE, Cochrane CENTRAL, EMBASE, and Web of Science were searched from January 2000 to January 2025 for randomized, quasi-randomized, or prospective controlled studies. The primary outcome was complete healing; secondary outcomes were time to healing, amputation, wound infection, length of stay, and adverse events. Binary outcomes were pooled with random-effects (REML) models using the Hartung-Knapp adjustment; we report 95% prediction intervals and leave-one-out analyses and graded certainty using GRADE. Results: Nineteen studies (2,046 patients) were included. NPWT improved complete healing. Because one large trial was a clear statistical outlier driving heterogeneity (I2 = 83%), the primary healing estimate excludes it: risk ratio (RR) 1.42 (95% CI 1.15-1.74; prediction interval 1.08-1.85; I2 = 33%); the full-set estimate including that trial (RR 1.67, 1.24-2.25, P = 0.004) is reported secondarily. The benefit was robust to leave-one-out analysis (RR 1.42-1.78) and to exclusion of high-risk-of-bias studies. For amputation (5 studies) and wound infection (3 studies), point estimates favored NPWT (RR 0.46 and 0.52) but Hartung-Knapp intervals were wide and crossed 1 (0.18-1.17 and 0.25-1.06); with so few studies these reflect insufficient evidence rather than a demonstrated absence of effect. Time-to-healing data were too incompatible to pool (I2 = 91%) and are summarized narratively. Conclusions: NPWT is associated with improved complete wound healing in adults with DFUs; this conclusion rests on the most defensible, outlier-excluded analysis and is robust to conservative adjustment, leave-one-out analysis, and exclusion of high-risk studies. Evidence on amputation and infection is insufficient rather than negative. NPWT may be considered for selected patients with deeper or high-risk DFUs when perfusion is adequate and standard care has been insufficient.
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