Negative pressure wound therapy versus conventional wound care following surgical debridement of fournier’s gangrene: a systematic review and meta-analysis of observational studies

Abstract

Fournier’s gangrene is associated with high morbidity and mortality, and optimal postoperative wound management remains uncertain. This study compared negative pressure wound therapy (NPWT) with conventional wound care following surgical debridement. A systematic review and meta-analysis of observational studies was conducted according to PRISMA guidelines. PubMed, Embase, and Scopus were searched to September 2025. Outcomes were pooled using random-effects models and reported as mean differences (MD) or risk ratios (RR) with 95% confidence intervals. Eighteen studies (691 patients) were included. NPWT significantly reduced postoperative analgesic use (MD − 2.16; 95% CI − 3.63 to − 0.70; p = 0.004) and time to wound closure (MD − 10.17; 95% CI − 24.98 to 4.29; p = 0.17). There were no significant differences in mortality (RR 0.66; 95% CI 0.44–1.31), number of debridements (MD − 0.83; 95% CI − 2.42 to 0.76), or length of hospital stay (MD − 1.03; 95% CI − 4.28 to 2.21). Heterogeneity was high across outcomes. NPWT is associated with reduced postoperative analgesic consumption following debridement for Fournier’s gangrene. However, based on low-to-moderate certainty observational evidence, it does not significantly reduce mortality, surgical debridement frequency, length of stay, or overall time to wound closure. Consequently, NPWT should be considered a supportive adjunct rather than a replacement for standard surgical management. Further high-quality, prospective comparative studies are required to define its cost-effectiveness and optimal clinical indications.