Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May 26;5(5):CD011334.
doi: 10.1002/14651858.CD011334.pub3.

Negative pressure wound therapy for treating pressure ulcers

Jiyuan Shi  1 , Ya Gao  2 , Jinhui Tian  2 , Jiang Li  3 , Jianguo Xu  2 , Fan Mei  4 , Zheng Li  1
Affiliations
Review

Negative pressure wound therapy for treating pressure ulcers

Jiyuan Shi et al. Cochrane Database Syst Rev. .

Abstract

Background: Pressure ulcers, also known as bedsores, pressure sores, or pressure injuries, are localised damage to the skin and underlying soft tissue, usually caused by intense or long-term pressure, shear, or friction. Negative pressure wound therapy (NPWT) has been widely used in the treatment of pressure ulcers, but its effect needs to be further clarified. This is an update of a Cochrane Review first published in 2015.

Objectives: To evaluate the effectiveness of NPWT for treating adult with pressure ulcers in any care setting.

Search methods: On 13 January 2022, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase, and EBSCO CINAHL Plus. We also searched ClinicalTrials.gov and the WHO ICTRP Search Portal for ongoing and unpublished studies and scanned reference lists of relevant included studies as well as reviews, meta-analyses, and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication, or study setting.

Selection criteria: We included published and unpublished randomised controlled trials (RCTs) comparing the effects of NPWT with alternative treatments or different types of NPWT in the treatment of adults with pressure ulcers (stage II or above).

Data collection and analysis: Two review authors independently conducted study selection, data extraction, risk of bias assessment using the Cochrane risk of bias tool, and the certainty of the evidence assessment using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Any disagreement was resolved by discussion with a third review author.

Main results: This review included eight RCTs with a total of 327 randomised participants. Six of the eight included studies were deemed to be at a high risk of bias in one or more risk of bias domains, and evidence for all outcomes of interest was deemed to be of very low certainty. Most studies had small sample sizes (range: 12 to 96, median: 37 participants). Five studies compared NPWT with dressings, but only one study reported usable primary outcome data (complete wound healing and adverse events). This study had only 12 participants and there were very few events; only one participant was healed in the study (risk ratio (RR) 3.00, 95% confidence interval (CI) 0.15 to 61.74, very low-certainly evidence). There was no evidence of a difference in the number of participants with adverse events in the NPWT group and the dressing group, but the evidence for this outcome was also assessed as very low certainty (RR 1.25, 95% CI 0.64 to 2.44, very low-certainty evidence). Changes in ulcer size, pressure ulcer severity, cost, and pressure ulcer scale for healing (PUSH) sores were also reported, but we were unable to draw conclusions due to the low certainly of the evidence. One study compared NPWT with a series of gel treatments, but this study provided no usable data. Another study compared NPWT with 'moist wound healing', which did not report primary outcome data. Changes in ulcer size and cost were reported in this study, but we assessed the evidence as being of very low certainty; One study compared NPWT combined with internet-plus home care with standard care, but no primary outcome data were reported. Changes in ulcer size, pain, and dressing change times were reported, but we also assessed the evidence as being of very low certainty. None of the included studies reported time to complete healing, health-related quality of life, wound infection, or wound recurrence.

Authors' conclusions: The efficacy, safety, and acceptability of NPWT in treating pressure ulcers compared to usual care are uncertain due to the lack of key data on complete wound healing, adverse events, time to complete healing, and cost-effectiveness. Compared with usual care, using NPWT may speed up the reduction of pressure ulcer size and severity of pressure ulcer, reduce pain, and dressing change times. Still, trials were small, poorly described, had short follow-up times, and with a high risk of bias; any conclusions drawn from the current evidence should be interpreted with considerable caution. In the future, high-quality research with large sample sizes and low risk of bias is still needed to further verify the efficacy, safety, and cost-effectiveness of NPWT in the treatment of pressure ulcers. Future researchers need to recognise the importance of complete and accurate reporting of clinically important outcomes such as the complete healing rate, healing time, and adverse events.

PubMed Disclaimer

Conflict of interest statement

Jiyuan Shi: nothing to declare.

Ya Gao: nothing to declare.

JinHui Tian: nothing to declare.

Jiang Li: nothing to declare.

JianGuo Xu: nothing to declare.

Fan Mei: nothing to declare.

Zheng Li: nothing to declare.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1: NPWT compared with standard dressings: short‐term follow‐up, Outcome 1: Proportion of ulcers with 50% or greater reduction in wound area
1.2
1.2. Analysis
Comparison 1: NPWT compared with standard dressings: short‐term follow‐up, Outcome 2: Change in wound size
1.3
1.3. Analysis
Comparison 1: NPWT compared with standard dressings: short‐term follow‐up, Outcome 3: PUSH score
2.1
2.1. Analysis
Comparison 2: NPWT compared with standard dressings: medium‐term follow‐up, Outcome 1: Proportion of wounds healed
2.2
2.2. Analysis
Comparison 2: NPWT compared with standard dressings: medium‐term follow‐up, Outcome 2: Adverse events
3.1
3.1. Analysis
Comparison 3: NPWT combined with internet‐plus home care compared with standard care: short‐term follow‐up, Outcome 1: Rate of change in ulcer size
4.1
4.1. Analysis
Comparison 4: NPWT combined with internet‐plus home care compared with standard care: medium‐term follow‐up, Outcome 1: Rate of change in ulcer size
4.2
4.2. Analysis
Comparison 4: NPWT combined with internet‐plus home care compared with standard care: medium‐term follow‐up, Outcome 2: Pain
4.3
4.3. Analysis
Comparison 4: NPWT combined with internet‐plus home care compared with standard care: medium‐term follow‐up, Outcome 3: Frequency of dressing change
See this image and copyright information in PMC

Update of

Comment in

Similar articles

See all similar articles

Cited by

References

References to studies included in this review

Ashby 2012 {published data only}
    1. Ashby R, Dumville J, Soares M, McGinnis E, Stubbs N, Adderley U et al. A pilot study of negative pressure wound therapy for the treatment of grade III/IV pressure ulcers. Trials 2012;13:119. [DOI: 10.1186/1745-6215-13-119] - DOI - PMC - PubMed
de Laat 2011 {published data only}
    1. Laat EH, den Boogaard MH, Spauwen PH, Kuppevelt DH, Goor H, Schoonhoven L. Faster wound healing with topical negative pressure therapy in difficult-to-heal wounds: a prospective randomized controlled trial. Annals of Plastic Surgery 2011;67:626-31. - PubMed
Dwivedi 2016 {published data only}
    1. Dwivedi MK, Srivastava RN, Bhagat AK, Agarwal R, Baghel K, Jain A, Raj S. Pressure ulcer management in paraplegic patients with a novel negative pressure device: a randomised controlled trial. Journal of Wound Care 2016;25(4):199-200, 202-4, 206-7. - PubMed
Dwivedi 2017 {published data only}
    1. Dwivedi MK, Bhagat AK, Srivastava RN, Jain A, Baghel K, Raj S. Expression of MMP-8 in Pressure Injuries in Spinal Cord Injury Patients Managed by Negative Pressure Wound Therapy or Conventional Wound Care: A Randomized Controlled Trial. Journal of Wound, Ostomy, & Continence Nursing 2017;44(4):343-349. - PubMed
Ford 2002 {published data only}
    1. Ford CN, Reinhard ER, Yeh D, Syrek D, De Las Morenas A, Bergman SB et al. Interim analysis of a prospective, randomized trial of vacuum-assisted closure versus the Healthpoint system in the management of pressure ulcers. Annals of Plastic Surgery 2002;49:55-61. - PubMed
Niezgoda 2004 {published data only}
    1. Niezgoda JA. A comparison of vacuum assisted closure therapy to moist wound care in the treatment of pressure ulcers: preliminary results of a multicenter trial. In: 2nd World Union of Wound Healing Societies Meeting; 2004 July 8-13; Paris. 2004.
Şahin 2022 {published data only}
    1. Şahin E, Rizalar S, Özker E 2022. Effectiveness of negative-pressure wound therapy compared to wet-dry dressing in pressure injuries. J Tissue Viability 2022;31(1):164-172. - PubMed
Tang 2019 {published data only}
    1. Tang Yanhua, Wang Jiaqi, Yang Juan. Application of negative pressure wound therapy combined with internet-plus home care for elderly patients with severe pressure injuries. Nursing of Integrated Traditional Chinese and Western Medicine 2019;5:8.

References to studies excluded from this review

Ali 2015 {published data only}
    1. Ali Z, Anjum A, Khurshid L. Evaluation of low-cost custom made VAC therapy compared with conventional wound dressings in the treatment of non-healing lower limb ulcers in lower socio-economic group patients of Kashmir valley. JJournal of Orthopaedic Surgery and Research 2015;10:183. - PMC - PubMed
Andrianasolo 2018 {published data only}
    1. Andrianasolo J, Ferry T, Boucher F, Chateau J, Shipkov H, Daoud F, et al. Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy. BMC Infectious Diseases 2018;18(1):166. - PMC - PubMed
Baek 2020 {published data only}
    1. Baek W, Lee N, Han EJ, Roh TS, Lee WJ. A prospective randomized study: the usefulness and efficacy of negative pressure wound therapy with lipidocolloid polyester mesh compared to traditional negative pressure wound therapy for treatment of pressure ulcers. Pharmaceutics 2020;12(9):27. - PMC - PubMed
Braakenburg 2006 {published data only}
    1. Braakenburg A, Obdeijn MC, Feitz R, Rooij IA, Griethuysen AJ, Klinkenbijl JH. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plastic and Reconstructive Surgery 2006;118:390-400. - PubMed
Chen 2018 {published data only}
    1. Chen CS, Yu CC. Prospective randomized control study comparing gauze-based with foam-based negative pressure wound therapy for the stage 4 pressure injuries. Formosan Journal of Surgery 2018;51(6):223-7.
Ciliberti 2016 {published data only}
    1. Ciliberti M, De Lara F, Serra G, Tafuro F, Iazzetta FM, Filosa A, et al. The effect of a bacteria- and fungi- binding mesh dressing on the bacterial load of pressure ulcers treated with negative pressure wound therapy: a pilot study. Wounds-A Compendium of Clinical Research & Practice 2016;28(11):408-20. - PubMed
Dwivedi 2020 {published data only}
    1. Dwivedi MK, Bhagat A, Srivastava RN, Raj L . Management of Grade IV pressure ulcers with a novel negative pressure device in traumatic paraplegia subjects. Cureus 2020;12(7):e9327. - PMC - PubMed
Gao 2015 {published data only}
    1. Gao YB, Tong SL, Pan F, Yu JH. [Myogenic elephant skin cream combined with Vacuum sealing drainage (VSD) for the treatment of bedsores]. Zhongguo Gushang 2015;28(2):150-4. - PubMed
Greer 1999 {published data only}
    1. Greer SE, Longaker MT, Margiotta M. Preliminary results from a multicenter, randomized, controlled study of the use of subatmospheric pressure dressing for pressure ulcer healing. In: Wound Repair and Regeneration. Vol. 7. 1999:Abstract A255.
Hampton 2015 {published data only}
    1. Hampton J. Providing cost-effective treatment of hard-to-heal wounds in the community through use of NPWT. British Journal of Community Nursing 2015;Community Wound Care (Supplement):S14, S16-20. - PubMed
Hu 2009 {published data only}
    1. Hu KX, Zhang HW, Zhou F, Yao G, Shi JP, Wang LF. Observation on the therapeutic effects of negative-pressure wound therapy on the treatment of complicated and refractory wounds. Zhonghua Shao Shang Za Zhi [Chinese Journal of Burns] 2009;4:249-52. - PubMed
Joseph 2000 {published data only}
    1. Joseph E, Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW. A prospective randomized trial of vacuum-assisted closure versus standard therapy of chronic nonhealing wounds. Wounds 2000;12:60-7.
Kumar 2021 {published data only}
    1. Kumar V, Rasouliyan L, Long S, Rao MB. PIT1 negative pressure wound therapy for pressure ulcer: effect on outcomes and utilization using real-world data. Value in Health 2021;24(Supplement 1):S122.
Leonardi 2017 {published data only}
    1. Leonardi F. Experience with a new negative pressure incision dressing in pressure sore reconstruction. Journal of Wound Care 2017;26(SUPPL 6):395.
Liu 2021 {published data only}
    1. Liu Q, Zhang N, Li Z, He H. Efficacy of autologous platelet-rich plasma gel in thetreatment of refractory pressure injuries and its effecton wound healing time and patient quality of life . Clinics 2021;5:76:e2355 . - PMC - PubMed
Mari 2019 {published data only}
    1. Mari W, Younes S, Naqvi J, Issa AA, Oroszi TL, Cool DR, et al. Use of a natural porcine extracellular matrix with negative pressure wound therapy hastens the healing rate in Stage 4 pressure ulcers. Wounds-A Compendium of Clinical Research & Practice 2019;31(5):117-22. - PubMed
McCallon 2015 {published data only}
    1. McCallon S K, Frilot C. A retrospective study of the effects of clostridial collagenase ointment and negative pressure wound therapy for the treatment of chronic pressure ulcers. Wounds-A Compendium of Clinical Research & Practice 2015;27(3):44-53. - PubMed
Mody 2008 {published data only}
    1. Mody GN, Nirmal IA, Duraisamy S, Perakath B. A blinded, prospective, randomized controlled trial of topical negative pressure wound closure in India. Ostomy Wound Management 2008;12:36-46. - PubMed
Mohammed 2020 {published data only}
    1. Mohammed A H, Hamed S A, Abdelghany A I. Comparison between two different protocols of negative pressure therapy for healing of chronic ulcers. Journal of Tissue Viability 2020;29(1):37-41. - PubMed
Moues 2007 {published data only}
    1. Moues CM, Van Den Bemd GJ, Meerding WJ, Hovius SE. Cost analysis comparing vacuum-assisted closure wound therapy to conventional moist gauze therapy. In: 2nd World Union of Wound Healing Societies Meeting 8-13 July; Paris. Vol. 87, Abstract no. A008. 2004.
    1. Moues CM, Vos MC, den Bemd GJ, Stijnen T, Hovius SE. Bacterial load in relation to vacuum-assisted closure wound therapy. 13th conference of the European Wound Management Association 2003, 22-24 May; Pisa, Italy:Presentation 42.
    1. Moues CM, Vos MC, den Bemd GJ, Stijnen T, Hovius SE. Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair and Regeneration 2004;12:11-7. - PubMed
    1. Mouës CM, den Bemd GJ, Heule F, Hovius SE. Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: a prospective randomised trial. Journal of Plastic, Reconstructive and Aesthetic Surgery 2007;60:672-81. - PubMed
Mullner 1997 {published data only}
    1. Mullner T, Mrkonjic L, Kwasny O, Vecsei V. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. British Journal of Plastic Surgery 1997;50:194-9. - PubMed
Papp 2018 {published data only}
    1. Papp AA. Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction. IInternational Wound Journal 2018 Apr;16(2):394-400. - PMC - PubMed
Schwarz 2012 {published data only}
    1. Rahmanian-Schwarz A, Willkomm LM, Gonser P, Hirt B, Schaller HE. A novel option in negative pressure wound therapy (NPWT) for chronic and acute wound care. Burns 2012;38:573-7. - PubMed
Srivastava 2016 {published data only}
    1. Srivastava RN, Dwivedi MK, Bhagat AK, Raj S, Agarwal R, Chandra A. A non-randomised, controlled clinical trial of an innovative device for negative pressure wound therapy of pressure ulcers in traumatic paraplegia patients. International Wound Journal 2016;13(3):343-8. - PMC - PubMed
Tauro 2007 {published data only}
    1. Tauro LF, Ravikrishnan J, Satish Rao BS, Divakar Shenoy H, Shetty SR, Menezes LT. A comparative study of the efficacy of topical negative pressure moist dressings and conventional moist dressings in chronic wounds. Indian Journal of Plastic Surgery 2007;40:133-40.
Wagstaff 2014 {published data only}
    1. Wagstaff MJ, Driver S, Coghlan P, Greenwood JE. A randomized, controlled trial of negative pressure wound therapy of pressure ulcers via a novel polyurethane foam. Wound Repair and Regeneration 2014;22:205-11. - PubMed
Wild 2008 {published data only}
    1. Wild T, Stremitzer S, Budzanowski A, Hoelzenbein T, Ludwig C, Ohrenberger G. Definition of efficiency in vacuum therapy - a randomised controlled trial comparing with V.A.C. therapy. International Wound Journal 2008;5:641-7. - PMC - PubMed
Zhang 2012 {published data only}
    1. Zhang C, Yang JC, Feng YQ, Wang HT, Li X, Chen NJ. Clinical observations of negative pressure wound therapy and basic fibroblast growth factor in the treatment of intractable pressure ulcer. Zhonghua Yi Xue Za Zhi 2012;92:2862-4. - PubMed

References to studies awaiting assessment

Pruksapong 2011 {published data only}
    1. Pruksapong C. Efficacy of portable vacuum dressing in chronic wound care: a prospective randomized control trial. Journal of the Medical Association of Thailand 2011;94:1212-7. - PubMed
Wanner 2003 {published data only}
    1. Wanner MB, Schwarzl F, Strub B, Zaech GA, Pierer G. Vacuum-assisted wound closure for cheaper and more comfortable healing of pressure sores: a prospective study. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 2003;37:28-33. - PubMed
Yu 2012 {published data only}
    1. Yu C. Negative pressure wound therapy using gauze versus polyurethene foam filler in the healing undermining of pressure ulcers, a prospective randomised controlled trial. In: 4th Congress of the World Union of Wound Healing Societies; September 2-6; Yokohama, Japan. 2012.

Additional references

ACP 2015
    1. Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 2015 Mar; 3;162(5):370-9. - PubMed
Ali 2017
    1. Ali Z, Anjum A, Khurshid L, Ahad H, Maajid S, Dhar SA. Retraction Note: Evaluation of low-cost custom made VAC therapy compared with conventional wound dressings in the treatment of non-healing lower limb ulcers in lower socio-economic group patients of Kashmir valley. Journal of Orthopaedic Surgery and Research 2017 Apr 20;12(1):62. - PMC - PubMed
Alipoor 2021
    1. Alipoor E, Mehrdadi P, Yaseri M, Hosseinzadeh-Attar M. Association of overweight and obesity with the prevalence and incidence of pressure ulcers: a systematic review and meta-analysis. Clinical Nutrition 2021 Sep;40(9):5089-98. - PubMed
Allman 1997
    1. Allman RM. Pressure ulcer prevalence, incidence, risk factors, and impact. Clinical Geriatric Medicine 1997;13(3):421-36. - PubMed
Bergstrom 1998
    1. Bergstrom N, Braden B, Champagne M, Kemp M, Ruby E. Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden Scale. Nursing Research 1998;47(5):261-9. - PubMed
Berlowitz 1990
    1. Berlowitz DR, Wilikin SVB. Risk factors for pressure sores: a comparison of cross-sectional and cohort derived data. Journal of the American Geriatrics Society 1990;37(11):1043-50. - PubMed
Berlowitz 1997
    1. Berlowitz DR, Brandeis GH, Anderson J, Brand HK. Predictors of pressure ulcer healing among long-term care residents. Journal of the American Geriatrics Society 1997;45(1):30-4. - PubMed
Brandeis 1994
    1. Brandeis GH, Ooi WL, Hossain M, Morris JN, Lipsitz LA. A longitudinal study of risk factors associated with the formation of pressure ulcers in nursing homes. Journal of the American Geriatrics Society 1994;42:388-93. - PubMed
Chaboyer 2022
    1. Chaboyer W, Coyer F, Harbeck E, Thalib L, Latimer S, Wan CS, et al. Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting: A systematic review and meta-analysis. International Journal of Nursing Studies 2022 Apr;128:104189. - PubMed
Chan 2013
    1. Chan B, Ieraci L, Mitsakakis N, Pham B, Krahn M. Net costs of hospital-acquired and pre-admission PUs among older people hospitalised in Ontario. Journal of Wound Care 2013;22:341-2. - PubMed
Coleman 2013
    1. Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R. Patient risk factors for pressure ulcer development: systematic review. International Journal of Nursing Studies 2013;50(7):974-1003. - PubMed
Dealey 2012
    1. Dealey C, Posnett J, Walker A. The cost of pressure ulcers in the United Kingdom. Journal of Wound Care 2012;21:261-2, 264, 266. - PubMed
Deeks 2022
    1. Deeks JJ, Higgins JP, Altman DG, editor(s). Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook.
Demarré 2015
    1. Demarré L, Van Lancker A, Van Hecke A, Verhaeghe S, Grypdonck M, Lemey J. The cost of prevention and treatment of pressure ulcers: a systematic review. International Journal of Nursing Studies 2015 Nov;52(11):1754-74. - PubMed
Department of Health and Human Services 2009
    1. Department of Health and Human Services, Office of Inspector General. Comparison of prices for negative pressure wound therapy pumps. https://oig.hhs.gov/oei/reports/oei-02-07-00660.pdf 2009;Accessed Dec 2012; OEI-02-07-00660.
Donini 2005
    1. Donini LM, De Felice MR, Tagliaccica A, De Bernardini L, Cannella C. Nutritional status and evolution of pressure sores in geriatric patients. Journal of Nutrition and Health in Aging 2005;9:446-54. - PubMed
EPUAP/NPUAP/PPPIA 2019
    1. European Pressure Ulcer Advisory Panel National pressure injury advisory Panel, and Pan Pacific pressure injury alliance, Prevention and Treatment of Pressure ulcers/injuries: clinical Practice guideline(2019). The International Guideline. Emily Haesler (Ed.). EPUAP/NPUAP/PPPIA; 2019.
Essex 2009
    1. Essex HN, Clark M, Sims J, Warriner A, Cullum N. Health-related quality of life in hospital inpatients with pressure ulceration: assessment using generic health-related quality of life measures. Wound Repair and Regeneration 2009;17:797-805. - PubMed
FDA 2011
    1. US Food and Drug Administration. FDA Safety Communication: Update on serious complications associated with negative pressure wound therapy systems. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm244211.htm 2011;Accessed Nov 2012.
Gebhardt 2002
    1. Gebhardt K. Pressure ulcer prevention. Part 1. Causes of pressure ulcers. Nursing Times 2002;98:41-4. - PubMed
Gefen 2014
    1. Gefen A. Tissue changes in patients following spinal cord injury and implications for wheelchair cushions and tissue loading: a literature review. Ostomy Wound Management 2014;60:34-45. - PubMed
Glanville 2019
    1. Glanville J, Dooley G, Wisniewski S, Foxlee R, Noel-Storr A. Development of a search filter to identify reports of controlled clinical trials within CINAHL Plus. Health Information and Libraries Journal 2019;36(1):73-90. - PubMed
Guy 2012
    1. Guy H, Grothier l. Using negative pressure therapy in wound healing. Nursing Times 2012;108:18, 20. - PubMed
Hajhosseini 2020
    1. Hajhosseini B, Longaker MT, Gurtner GC. Pressure Injury. Annals of Surgery 2020 Apr;271(4):671-679. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. - PMC - PubMed
Higgins 2011
    1. Higgins JP, Altman DG, Sterne, JA (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Higgins 2022
    1. Higgins JP, Eldridge S, Li T, editor(s). Chapter 23: Including variants on randomized trials. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook.
JSPU 2016
    1. Takafumi K, Katsunori F, Yayoi N. JSPU Guidelines for the Prevention and Management of Pressure Ulcers (4th Ed.). Clinical Guideline 2016;16:4.
Kinetic Concepts Inc 2012
    1. Kinetic Concepts Inc. Science behind wound therapy. http://www.kci1.com/KCI1/sciencebehindwoundtherapy (accessed 11 May 2012).
Kontopantelis 2012
    1. Kontopantelis E, Reeves D. Performance of statistical methods for meta-analysis when true study effects are non-normally distributed: a simulation study. Statistical Methods in Medical Research 2012;21(4):409-26. - PubMed
Kontopantelis 2013
    1. Kontopantelis E, Springate DA, Reeves D. A re-analysis of the Cochrane Library data: the dangers of unobserved heterogeneity in meta-analysis. PLOS One 2013;8(7):e69930. - PMC - PubMed
Källman 2022
    1. Källman U, Hommel A, Borgstedt Risberg M, Gunningberg L, Sving E, Bååth C. Pressure ulcer prevalence and prevention interventions - a ten-year nationwide survey in Sweden. International Wound Journal 2022 Nov;19(7):1736-47. - PMC - PubMed
Labeau 2021
    1. Labeau SO, Afonso E, Benbenishty J, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Medicine 2021 Feb;47(2):160-9. - PMC - PubMed
Langer 2003
    1. Langer G, Knerr A, Kuss O, Behrens J, Schlömer GJ. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No: CD003216. [DOI: 10.1002/14651858.CD003216] - DOI - PubMed
Lefebvre 2021
    1. Lefebvre C, Glanville J, Briscoe S, Littlewood A, Marshall C, Metzendorf M-I, et al. Chapter 4: Searching for and selecting studies. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021)Cochrane, 2021. Available from www.training.cochrane.org/handbook.
Liberati 2009
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLOS Medicine 2009;6:e1000100. - PMC - PubMed
Lyder 2012
    1. Lyder CH, Wang Y, Metersky M, Curry M, Kliman R, Verzier NR, et al. Hospital-acquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study. Journal of the American Geriatrics Society 2012;60:1603-8. - PubMed
Nghiem 2022
    1. Nghiem S, Campbell J, Walker RM, Byrnes J, Chaboyer W. Pressure injuries in Australian public hospitals: A cost of illness study. International Journal of Nursing Studies 2022 Jun;130:104191. - PubMed
NICE 2014
    1. National Institute for Health and Clinical Excellence. Pressure ulcers: prevention and management of pressure ulcers. Clinical Guideline 179 April 2014:Accessed 21 Jan 2015.
NICE 2018
    1. National Institute for Health and Clinical Excellence. 2018 surveillance of pressure ulcers: prevention and management. Clinical Guideline 179. 30 November 2018. - PubMed
NPUAP 2016
    1. National Pressure Ulcer Advisory Panel (NPUAP). NPUAP Pressure Injury Stages; 2016.. Available at cdn.ymaws.com/npuap.site-ym.com/resource/resmgr/npuap_pressure_injury_st....
Page 2022
    1. Page MJ, Higgins JP, Sterne JA. Chapter 13: Assessing risk of bias due to missing results in a synthesis. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook.
Parmar 1998
    1. Parmar MK, Torri V, Stewert L. Extracting summary statistics to perform meta-analysis of the published literature for survival endpoints. Statistics in Medicine 1998;17:2815-34. - PubMed
RevMan 2020 [Computer program]
    1. Review Manager (RevMan) 5.4. Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020.
Rrapi 2021
    1. Rrapi R, Chand S, Lo JA, Gabel CK, Song S, Holcomb Z. The significance of pressure injuries and purpura in COVID-19 patients hospitalized at a large urban academic medical center: a retrospective cohort study. Journal of the American Academy of Dermatology 2021 Aug;85(2):462-4. - PMC - PubMed
Schmitt 2019
    1. Schmitt J, Lange T, Kottner J, Prinsen C, Weberschock T, Hahnel E, et al. Cochrane Reviews and DermatologicalTtrials Outcome Concordance: why core outcome sets could make trial results more usable. Journal of Investigative Dermatology 2019 May;139(5):1045-53. - PubMed
Schulz 2010
    1. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. PLOS Medicine 2010;7(3):e1000251. - PMC - PubMed
Schunemann 2022
    1. Schünemann HJ, Higgins JP, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing 'Summary of findings' tables and grading the certainty of the evidence. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook.
Smith 2013
    1. Smith ME, Totten A, Hickam DH, Fu R, Wasson N, Rahman B et, al. Pressure ulcer treatment strategies: a systematic comparative effectiveness review. Annals of Internal Medicine 2013;159:39-50. - PubMed
Soares 2013
    1. Soares MO, Dumville JC, Ashby RL, Iglesias CP, Bojke L, Adderley U, et al. Methods to assess cost-effectiveness and value of further research when data are sparse: negative-pressure wound therapy for severe pressure ulcers. Medical Decision Making 2013;33:415-36. - PubMed
Song 2021
    1. Song YP, Wang L, Yuan BF. Negative-pressure wound therapy for III/IV pressure injuries: a meta-analysis. Wound Repair and Regeneration 2021 Jan;29(1):20-33. - PubMed
Stevenson 2013
    1. Stevenson R, Collinson M, Henderson V, Wilson L, Dealey C, McGinnis E, et al. The prevalence of pressure ulcers in community settings: an observational study. International Journal of Nursing Studies 2013;50:1550-7. - PubMed
Thompson 1999
    1. Thompson SG, Sharp SJ. Explaining heterogeneity in meta-analysis: a comparison of methods. Statistics in Medicine 1999;18:2693-708. - PubMed
VanGilder 2017
    1. VanGilder C, Lachenbruch C, Algrim-Boyle C. The International Pressure Ulcer Prevalence™ Survey: 2006-2015: a 10-Year Pressure Injury Prevalence and Demographic Trend Analysis by Care Setting. Journal of Wound, Ostomy, and Continence Nursing 2017;44:20-8. - PubMed
Walker 2017
    1. Walker RM, Gillespie BM, Thalib L, Higgins NS, Whitty JA. Foam dressings for treating pressure ulcers. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No: CD011332. [DOI: 10.1002/14651858.CD011332.pub2] - DOI - PMC - PubMed
WHS 2015
    1. Gould L, Stuntz M, Giovannelli M. Wound Healing Society 2015 update on guidelines for pressure ulcers. Wound Repair and Regeneration 2016;Jan-Feb;24(1):145-62. - PubMed
WOCN 2016
    1. Wound, Ostomy and Continence Nurses (WOCN) Society-Wound Guidelines Task Force. WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers): An Executive Summary. Journal of Wound, Ostomy, and Continence Nursing 2016;May/Jun;44(3):241-6. - PubMed

References to other published versions of this review

Dumville 2014
    1. Dumville JC, Webster J, Evans D, Land L. Negative pressure wound therapy for treating pressure ulcers. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No: CD011334. [DOI: 10.1002/14651858.CD011334] - DOI - PubMed
Dumville 2015
    1. Dumville JC, Webster J, Evans D, Land L. Negative pressure wound therapy for treating pressure ulcers. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No: CD011334. [DOI: 10.1002/14651858.CD011334.pub2] - DOI - PubMed