Vacuum-assisted closure versus conventional dressing in necrotizing fasciitis: a systematic review and meta-analysis

Rongli Zhang, Yahui Zhang, Liyuan Hou, Chengyong Yan, Rongli Zhang, Yahui Zhang, Liyuan Hou, Chengyong Yan

Abstract

Background: Necrotizing fasciitis is a rapid and severe soft tissue infection that targets subcutaneous fat tissue, muscle, and fascia. This study compares the clinical outcomes of vacuum-assisted closure (VAC) versus conventional dressing on necrotizing fasciitis.

Methods: We systematically searched Embase, Cochrane, and PubMed for clinical trials (published between January 1, 1995 and September 30, 2021), which compared VAC with conventional dressing for necrotizing fasciitis. The mortality rate of necrotizing fasciitis was the primary outcome of this study. The number of debridements, the total length of hospital stay, and the complication rate were secondary outcomes. A random effects model assessed all pooled data.

Results: A total of 230 identified studies and seven controlled clinical trials met the inclusion criteria and were included in this analysis (n = 249 participants). Compared to the conventional dressing, patients treated with VAC had a significantly lower mortality rate [OR = 0.27, 95% CI (0.09, 0.87)] (P = 0.03). Total length of hospital stays [MD = 8.46, 95% CI (- 0.53, 17.45)] (P = 0.07), number of debridements [MD = 0.86, 95% CI (- 0.58, 2.30)] (P = 0.24), and complication rate [OR = 0.64, 95% CI (0.07, 5.94)] (P = 0.69) were not significant. These results did not show significant differences between both groups treated with VAC or conventional treatment.

Conclusion: VAC could significantly decrease the death rate compared to conventional dressing. No significant impacts were found on the number of debridements, the total length of hospital stay, and the complication rate in this study. Level of evidence Level-III. Registration Research Registry (reviewregistry1246).

Keywords: Conventional dressing; Meta-analysis; Necrotizing fasciitis; Vacuum-assisted closure.

Conflict of interest statement

The authors declare no competing financial interests.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of studies included in the systematic review
Fig. 2
Fig. 2
Forest plot of the odds ratio of mortality rate between VAC and conventional dressing
Fig. 3
Fig. 3
Forest plot of the mean difference of total length of hospital stay between VAC and conventional dressing
Fig. 4
Fig. 4
Forest plot of the mean difference in the number of debridements between VAC and conventional dressing
Fig. 5
Fig. 5
Forest plot of the odds ratio of complication rate between VAC and conventional dressing

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Source: PubMed

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