Abstract

Complex surgical and traumatic wounds carry high infection risk, prolonged healing, and substantial resource use. Negative pressure wound therapy with instillation and dwell (NPWTi-d) augments standard NPWT by intermittently instilling topical solutions to improve wound cleansing and reduce bioburden, but its comparative effectiveness remains uncertain. We conducted a PRISMA-2020–compliant systematic review of adults with complex surgical or traumatic wounds, searching multiple databases from 1 January 2010 through 4 November 2025 for randomized controlled trials and systematic reviews/meta-analyses directly comparing NPWTi-d with standard NPWT. Two reviewers independently screened, extracted, and appraised risk of bias (RoB 2 for RCTs; ROBIS for reviews). Six studies (3 RCTs, 3 systematic reviews/meta-analyses; 825 participants) met strict inclusion criteria. Across studies, NPWTi-d was associated with fewer surgical procedures and greater post-treatment wound area reduction than standard NPWT, while time to definitive closure showed mixed results. Measures of bioburden consistently favored NPWTi-d, and skin maceration was the most frequently reported adverse event. Overall, NPWTi-d appears to offer procedural efficiency and enhanced bacterial clearance particularly in contaminated wounds though benefits for closure time remain inconsistent; larger, standardized RCTs are needed to clarify effects on time to closure and patient-centered outcomes and to define optimal instillation protocols.

Key words: Efficacy , negative pressure , wound therapy , instillation , complex surgical and traumatic wound management , systematic review.