Indigenous Negative Pressure Wound Therapy: A Low-cost Equivalent Alternative to Conventional Vacuum-assisted Closure Therapy – A Prospective Randomized Open-blind Endpoint Study

Abstract

Background:

Vacuum assisted closure therapy (VAC) is a noninvasive, cost-effective alternative to surgical wound management. Indigenous negative pressure wound therapy (NPWT) systems offer comparable clinical outcomes without financial constraints.

Materials and Methods:

This prospective comparative study was conducted over 1 year at the Orthopedics department of RIMS, Ranchi. Eligibility criteria included patients with Gustilo–Anderson class 2, 3A, or 3B wounds, with exclusion criteria such as vascular injury or wound <10mm. Sample size was calculated to be 86 participants (43 per group). Data collection involved semi-quantitative wound assessments and wound surface area measurements, and statistical analysis was performed using SPSS software. Student t-test and Chi-square test were used to test statistical significance.

Results:

The study revealed that the conventional negative pressure wound therapy led to faster wound healing, with a mean time of 31.1 days compared to 34.7 days in the indigenous therapy group. Assessment of wound bed score parameters showed similar results between the groups initially, with slight variations noted in certain aspects like severity of exposed bone/tendon during the second VAC applications.

Conclusion:

The study found that indigenous VAC therapy reduced wound healing time significantly. Both therapies had similar wound management outcomes, with minor differences in wound bed score parameters. However, conventional therapy displayed better wound healing progress. Complications were slightly lower but comparable in the indigenous group, suggesting indigenous VAC therapy as a cost-effective and safe alternative to conventional VAC therapy.

INTRODUCTION

The management of complex wounds, especially open infected wounds, often necessitates the complete removal of necrotic tissues and subsequent repair using skin grafts or flaps. This process, typically conducted under local anesthesia with sedation or general anesthesia, frequently requires multiple surgical interventions. However, several factors, including poor general health, allergies, or patient refusal to undergo surgery, can contraindicate such surgical treatments. In these scenarios, Vacuum-assisted closure (VAC^®) therapy, a form of negative pressure wound therapy (NPWT), offers a safe, painless, and effective alternative that significantly reduces healing time and simplifies patient management without the need for hospitalization, anesthesia, or surgery.[1]

Numerous studies have highlighted the various benefits of NPWT. These include a decrease in wound size, stimulation of granulation tissue, reduced protease content, removal of small tissue debris, as well as efficient exudate removal. NPWT also decreases interstitial edema,[2,3,4] thereby improving microcirculation, local blood flow, and oxygenation.[4] Additionally, it promotes angiogenesis and increase levels of Vascular Endothelial Growth Factor (VEGF),[2,5] crucial for wound healing. NPWT is particularly beneficial in managing infected wounds with substantial exudate, where frequent dressing changes and prolonged hospitalization can impose significant financial burdens on patients and healthcare systems. By decreasing the frequency of dressing changes and shortening hospital stays, NPWT effectively mitigates these costs.

These processes collectively lead to decrease in wound dimensions, facilitating closure with secondary suturing or skin grafting. In many cases, the depth of the wound diminishes. This closed environment also enhances the extravascular migration of neutrophils and macrophages, which aids in phagocytosis of bacteria, reduces bacterial load, and creates a favorable hypoxic environment during the initial stages of neo-vascularization sufficiently to allow spontaneous epithelialization, obviating the need for further surgical procedures.

Despite its benefits, the high cost and limited availability of commercial NPWT systems, such as KCI Wound VAC, pose significant challenges, particularly in resource-limited settings.[6,7] This has prompted the development of indigenous NPWT systems using readily available, cost-effective materials. Our study explores the efficacy of an indigenous VAC therapy system, assembled from off-the-shelf components such as Ioban drapes, sterile gauze, Ryles tubes, and suction catheters [Figure 1], connected to wall-mounted suction [Figure 2] to create the necessary negative pressure (75–125 mmHg). The cost of this indigenous system is significantly lower (approximately INR 500) compared to the commercial systems, which can exceed INR 1000 per day.

Figure 1.

Sponge and adhesive drape

Figure 2.

Wall mounted suction set with tube and pressure gauge

Thus, the introduction of an indigenous VAC therapy system represents a significant advancement in wound care, particularly for resource-constrained settings. By comparing the efficacy, safety, and cost-effectiveness of this system with conventional VAC therapy, this prospective randomized open-blind endpoint study aims to establish a viable alternative that can enhance patient outcomes and reduce the financial burden on healthcare systems.

Aim of the study

To compare the efficacy of cost-effective VAC therapy and conventional VAC therapy among patients with open and infected wounds.

Objectives

Primary objective

To compare the average time taken for complete wound healing following indigenous VAC therapy and conventional VAC therapy in patients with open and infected wounds.

Secondary objectives

• To compare granulation tissue formation between indigenous and conventional VAC therapy among patients with open and infected wounds using the visual score.

METHODS

Study design

The study was conducted in the Department of Orthopaedics after the approval from the Institutional Ethics Committee (IEC No: 211 Dated 04.10.2023). This was the prospective open randomized blind endpoint study (PROBE) conducted over the period of 1 year. The inclusion criteria included patients of any age or sex with open traumatic wounds classified as Gustilo-Anderson (GA) class 2 (which cannot be managed by conventional dressing), 3A, or 3B, or surgically infected open wounds and willingness to participate in the trial with proper written consent from the patient and legal guardian. Those patients were excluded who had vascular injuries, with gangrenous changes or wounds <10 mm or wounds that can be closed by primary sutures.

Sample size calculation

The sample size for the study was determined using the parameters obtained from a previous study:[8] Estimated sample size (N) is 78, with 39 participants per group. To account for a 10% attrition rate and potential losses, the sample size was adjusted to 86, resulting in 43 participants per group.

A detailed history, clinical examination, and relevant investigations were performed for all patients. Written informed consent was obtained from all participants, and the patients were given the freedom to leave the study at any point in time.

Allocation of patients to receive indigenous or conventional VAC was done using computer-generated random sequence numbers. Both the patient and the doctor were aware of the type of VAC applied.

Patient preparation

• All participants with open infected wounds enrolled in the research underwent comprehensive cleansing of their wounds using povidone-iodine solution, normal saline, and hydrogen peroxide

• Each patient, irrespective of their assigned group, underwent initial surgical debridement, followed by multiple irrigations with saline, and minor debridement to eliminate slough or necrotic tissue as necessary. Any underlying fractures necessitating fixation were addressed during this phase.

Initial wound assessment

• Prior to applying either form of VAC, several clinical metrics were documented, including wound measurements (length, width, and depth), underlying tissues (muscle, adipose tissue, fascia, tendons, implants, bone), characteristics of discharge, amount of granulation tissue, condition of wound edge, edema, and color of the wound bed.

Wound bed preparation

• The previous dressing was extracted and disposed. If needed, a microbiological culture swab was obtained prior to flushing the wound with normal saline

• A minor surgical debridement was executed to eliminate superficial slough or necrotic tissue, ensuring sufficient hemostasis

• In patients requiring more than one surgical debridement, sequential debridement was performed before applying the VAC.

Conventional vacuum-assisted closure therapy

• Foam insertion [Figure 3]: Foam dressing was carefully inserted into the wound cavity to ensure even distribution of negative pressure across the entire wound surface. The materials utilized included sterilized black foam or polyurethane ether (PU)

• Sealant application [Figure 4]: Area was secured using an iodine-infused commercial adhesive drape, ensuring coverage of at least 5–7 cm around the wound’s perimeter. Separate drape was utilized for the suction tubing, covering a minimum of 7–10 cm of the tubing

• Suction tubing [Figure 5]: Suction tubing was positioned within the foam, connecting it to a regulated vacuum pump equipped with a pressure gauge for monitoring. The recommended pressure range was 120–130 mm/Hg

• Application of negative pressure [Figure 6]: Controlled pressure was administered uniformly to all tissue surfaces within the wound with an optimum pressure setting of 125 mm/Hg. For larger cavity wounds, higher pressures (150 mm/Hg or greater) were applied.

Figure 3.

Insertion of foam in wound

Figure 4.

Adhesive drape applied and a hole made for suction

Figure 5.

Suction tube applied making air seal compartment

Figure 6.

Tube connected to wall mounted suction

Indigenous negative pressure wound therapy

• Sterile dressing gauze [Figure 7]: Sterilized dressing gauze, treated with ethylene oxide for sterility was used

• Gauze application [Figure 8]: Gauze was tailored to fit the wound’s dimensions precisely, ensuring it does not extend beyond the wound edges. A passage was created for the distal fenestrated end of a feeding tube to pass through the foam. For larger wounds, additional perforations were done

• Adhesive covering [Figure 9]: Gauze was positioned over the wound area and overlayed it with an antimicrobial barrier (such as Ioban by 3M), ensuring at least 2–3 cm coverage of the surrounding skin to establish an airtight seal

• Suction arrangement [Figure 10]: Proximal end of the feeding tube was linked to a suction catheter (FG 12/14) connected to a vacuum pressure gauge. The pressure was applied within the range of − 125 to − 150 mmHg, continuously for the initial 24 h. Subsequently, a two-hour-on and a one-hour-off regimen for the following 72 h was done

• Antibiotic administration: Empirical antibiotic therapy was provided initially, following which targeted antibiotics were given based on culture and sensitivity findings.

Figure 7.

Sterile gauze and feeding tube taken

Figure 8.

Insertion of gauze and feeding tube in wound

Figure 9.

Ioban drape applied making airtight compartment

Figure 10.

Feeding tube connected to wall mounted suction via suction tube

Monitoring and dressing removal

• Exudate assessment: Wound drainage was evaluated on a daily basis, monitoring both its volume and coloration

• Dressing change: Dressings was replaced after 96 hours from the initial application. The wound was evaluated for its size, appearance, presence of necrotic tissue, and any discharge. Wound swab was collected for culture and sensitivity analysis

• NPWT sessions: All patients received two NPWT sessions initially, with the provision for additional cycles, if necessary

• Wound bed assessmnt: Wound bed was assessed for color, area of granulation tissue, exposed bones, tendons, implant, condition of healing wound edge, and edema

• Monitoring of patient:

  • Hemoglobin, albumin, and electrolytes level were monitored in all patients on every 3^rd and 5^th days, according to the condition of the patient, wound condition, and the amount of collection in the container

  • Blood glucose level was monitored regularly in all diabetic patients

  • Adequate nutrition was ensured in all the patients.

End points and failure criteria

1. End Points of NPWT dressing:

   • Wound is ready for secondary procedures such as secondary suturing, split thickness skin graft (SSG), and flap coverage. This was determined by comparing initial and subsequent wound conditions to ensure significant improvement

2. Failure Criteria:

   1. Increase in wound dimensions (even due to re-debridement)

   2. Worsening wound infection and discharge.

Data collection and statistical analysis

Details of the technique used for data collection

• The general wound condition was assessed using a semi-quantitative scoring system that evaluates the color of the bed, exudate production, edema, healing edge of wound, and exposed bone or tendons or implant. Each parameter was scored from zero to three, corresponding to severe, moderate, or mild, respectively (wound bed score). Consequently, the total wound bed score can range from a minimum of 0 to a maximum of 10

• The total score was recorded at the start of the study (day 1) and compared to subsequent scores to assess treatment efficacy

• Wound surface area and depth measurement were performed after debridement and throughout the therapy by tracing the wound edge onto clear polyethylene film, covering the entire wound surface.

Data analysis

• Data analysis was done by another resident doctor of the orthopedic department who was unaware of the type of VAC applied to the patient.

Statistical tools utilized for data analysis

• All collected information of the study participants were recorded in MS Excel to develop Master Chart

• Analysis of data was done using IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp.)

• Descriptive statistics was summarized as frequencies, percentages, mean, and standard deviation

• Student t-test and Chi-square test were used to test statistical significance of difference between continuous and categorical variables, respectively

• P < 0.05 is considered statistically significant.

RESULTS

Distribution of age

86 participants, divided equally between the two therapies, with 43 participants in each group. This distribution indicates that most participants in the indigenous therapy group were younger (21–40 years), while the conventional therapy group had a higher proportion of participants in the 41–60 years age category.

Sex distribution of the study participants across both the therapies (n = 86)

For the indigenous negative pressure wound therapy group, 79.1% (n = 34) of participants were male, and 20.9% (n = 9) were female. In the conventional VAC therapy group, 65.1% (n = 28) of participants were male, and 34.9% (n = 15) were female.

Distribution of the sites of wound across both the groups (n = 86)

For the indigenous negative pressure wound therapy group, the most common wound sites were the anterior leg (30.2%, n = 13), anterior thigh (11.6%, n = 5), dorsum of foot (9.3%, n = 4), lateral thigh (7%, n = 3), and proximal leg (7%, n = 3). In the conventional VAC therapy group, the wound sites were anterior leg (16.3%, n = 7), anterior thigh (14%, n = 6), dorsum of foot (11.6%, n = 5), lateral thigh (9.3%, n = 4), and proximal leg (9.3%, n = 4). This distribution indicates that the anterior leg was the most common wound site in both groups, with a higher percentage in the indigenous therapy group. The other wound sites had relatively similar distributions between the two groups.

Comparison of the time taken for complete wound healing across both therapies (n = 86)

Indigenous negative pressure wound therapy demonstrated a significantly slightly longer mean time (in days) for complete wound healing (M = 34.7, SD = 1.6) compared to conventional VAC therapy (M = 31.1, SD = 1.8), with a mean difference of 3.6 (95% CI:-1.2 to 4.7). The independent Student t-test yielded a t statistic of 8.3 and a P < 0.05, indicating statistical significance. This suggests that conventional VAC therapy was associated with faster wound healing compared to indigenous negative pressure wound therapy in the study population.

Patient data on wound parameters prior to the application of negative pressure wound therapy across both the groups (n = 86)

For the indigenous negative pressure wound therapy group, the mean wound area was 96.5 cm² (SD = 2.8), mean wound depth was 2.2 cm (SD = 0.5), mean wound granulation tissue area was 37.5 cm² (SD = 2.5), and mean exudate from the wound was 246.4 ml/day (SD = 5.8). In comparison, for the conventional VAC therapy group, the mean wound area was 89.3 cm² (SD = 3.3), mean wound depth was 2.1 cm (SD = 0.4), mean wound granulation tissue area was 35.4 cm² (SD = 1.9), and mean exudate from the wound was 266.9 ml/day (SD = 5.1). These findings suggest that prior to NPWT application, wound parameters were similar between the two groups, with slight differences observed in mean wound area and mean exudate from the wound.

Patient data on wound parameters after two cycles of vacuum assisted closure across both the groups (n = 86)

For the indigenous negative pressure wound therapy group, the mean wound area was 54.9 cm² (SD = 2.2), which showed a reduction by 16 cm² when compared to assessment made during the 1^st VAC therapy. Similarly, mean wound depth was 1.3 cm (SD = 0.3) and mean wound granulation tissue area was 48.0 cm² (SD = 1.5), which showed an improvement by 5.6 cm² when compared to assessment made during 1^st VAC therapy. The mean exudate from the wound was 39.2 ml/day (SD = 3.5). In comparison, for the conventional VAC therapy group, the mean wound area was 49.3 cm² (SD = 2.6), which showed a reduction by 17.3 cm² when compared to assessment made during 1^st VAC therapy. Similarly, mean wound depth was 1.2 cm (SD = 0.2) and mean wound granulation tissue area was 46.9 cm² (SD = 2.0), which showed an improvement by 5.7 cm² when compared to assessment made during the 1^st VAC therapy. The mean exudate from the wound was 34.4 ml/day (SD = 3.3). In addition, the color of the exudate varied across both groups, with greenish brown (9.3%, n = 4), greyish brown (25.6%, n = 11), reddish brown (44.2%, n = 19), and yellowish brown (20.9%, n = 9) being observed in the indigenous therapy group, while grayish brown (23.3%, n = 10), reddish brown (69.8%, n = 30), and yellowish brown (4.7%, n = 2) were predominant in the conventional therapy group. These findings suggest slight variations in wound parameters and exudate characteristics between the two therapy groups after two VAC cycles.

Results of negative pressure wound therapy across both the therapies (n = 86)

For the indigenous therapy group, the mean reduction in wound area was 43.1%, mean reduction in wound depth was 40.9%, mean increase in granulation tissue area was 28%, and mean exudate reduction was 84.1%. In addition, bone fixation was performed in 90.7% (n = 39) of cases. In terms of definitive management, flap coverage was done in 37.2% (n = 16) of cases, secondary suturing in 18.6% (n = 8) of cases, and split-thickness skin graft (SSG) in 44.2% (n = 19) of cases. In comparison, for the conventional therapy group, the mean reduction in wound area was 44.8%, mean reduction in wound depth was 42.9%, mean increase in granulation tissue area was 32.5%, and mean exudate reduction was 87.1%. Bone fixation was performed in 69.8% (n = 30) of cases. For definitive management, flap coverage was done in 11.6% (n = 5) of cases, healing by secondary intention in 4.7% (n = 2) of cases, secondary suturing in 23.3% (n = 10) of cases, and SSG in 60.5% (n = 26) of cases. These results suggest comparable effectiveness of NPWT in terms of wound size reduction, increase in granulation tissue area and exudate management between the two groups, with variations observed in bone fixation and definitive management approaches according to the wound condition.

Comparison of mean wound bed score prior to vacuum assisted closure across both the groups (n = 43)

In the comparison of mean wound bed score prior to VAC therapy across both groups, indigenous therapy presented a mean wound bed score of 2.9 (SD = 0.7), while conventional therapy exhibited a higher mean wound bed score of 3.4 (SD = 1.0). The independent Student t-test yielded a statistically significant mean difference of − 0.5 (95% CI:-0.76 to − 0.02), with a t statistic of − 2.1 and a P = 0.03.

Comparison of mean wound bed score at end of 2^nd vacuum assisted closure across both the groups (N = 43)

In the comparison of mean wound bed score at the end of 2^nd VAC therapy across both groups, indigenous therapy demonstrated a mean wound bed score of 7.5 (SD = 0.7), whereas conventional therapy exhibited a higher mean wound bed score of 8.4 (SD = 0.7). The independent Student t-test revealed a statistically significant mean difference of-0.9 (95% CI: −1.2 to − 0.6), with a t statistic of − 6.15 and a P = 0.000. In wound bed scoring systems, higher values typically indicate better wound healing progress. Therefore, the higher mean wound bed score observed in the conventional vacuum-assisted closure therapy group suggests superior wound healing progress compared to indigenous negative pressure wound therapy at the end of VAC application in the study population. But the results are relatively similar.

DISCUSSION

Wound care remains a significant challenge in medical practice, particularly in managing open infected wounds. Negative pressure wound therapy (NPWT), often referred to as VAC therapy, has revolutionized wound management by promoting faster healing, reducing infection rates, and enhancing the quality of life for patients. However, the high cost associated with conventional VAC systems limits their accessibility, especially in resource-constrained settings. This underscores the urgent need for developing cost-effective alternatives that can deliver comparable therapeutic outcomes.

The conventional VAC therapy involves sophisticated machinery and consumables, which are often prohibitively expensive for widespread use in low-resource environments. Consequently, there is a substantial portion of the global population that cannot benefit from this advanced wound care technique due to financial constraints. Indigenous negative pressure wound therapy (indigenous VAC therapy) presents a promising solution, leveraging locally available materials and simpler mechanisms to achieve similar therapeutic effects at a fraction of the cost.

The study investigated the efficacy and complications of indigenous negative pressure wound therapy (VAC) compared to conventional vacuum-assisted closure therapy in patients with open infected wounds. Results revealed differences in patient demographics, with the indigenous therapy group comprising a higher proportion of younger participants [Table 1], predominantly males [Table 2], and with a higher prevalence of road traffic accident wounds. Anterior aspect of the leg was the most common site of wound in both groups [Table 3] because the extensor surface of leg is more exposed to trauma and bone is deficient in soft-tissue cover. Conventional therapy demonstrated a slightly shorter mean time for complete wound healing [Table 4] and comparable effectiveness in terms of wound reduction and exudate management. Despite differences in wound parameters prior to NPWT application [Table 5], both therapy groups exhibited comparable wound bed score parameters during the first and second VAC applications [Table 6], with slight variations observed in exposed bone/tendon severity during the first VAC application and in several parameters during the second VAC application. Results of therapy in terms of reduction in wound dimensions, exudate reduction, granulation tissue formation and definitive management was similar in both the groups [Table 7]. Complication rates, including bleeding, pain, and treatment failure, were lower yet comparable between the two therapies. In both the groups prior to the application of VAC wound bed parameters were on lower side [Table 8], but after the therapy it improved significantly [Table 9], this shows the efficacy of VAC in wound management.

Table 1.

Distribution of age among the participants

Age categories (years)	Indigenous NPWT (n=43), n (%)	Conventional VAC therapy (n=43), n (%)
≤20	5 (11.6)	1 (2.3)
21–40	22 (51.2)	12 (27.9)
41–60	11 (25.6)	22 (51.2)
>60	5 (11.6)	8 (18.6)

VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

Table 2.

Distribution of sex among the participants

Sex categories	Indigenous NPWT (n=43), n (%)	Conventional VAC therapy (n=43), n (%)
Male	34 (79.1)	28 (65.1)
Female	9 (20.9)	15 (34.9)

VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

Table 3.

Distribution of site of wound among the participants

Wound sites	Indigenous NPWT (n=43), n (%)	Conventional VAC therapy (n=43), n (%)
Anterior leg	13 (30.2)	7 (16.3)
Anterior thigh	5 (11.6)	6 (14)
Dorsum of foot	4 (9.3)	5 (11.6)
Lateral thigh	3 (7)	4 (9.3)
Proximal leg	3 (7)	4 (9.3)
Others	15 (34.9)	17 (39.5)

VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

Table 4.

Comparison of the time taken for complete wound healing across both the groups

Technique used	Mean (SD) time taken (days)	Mean difference (95% CI)	t-statistic	P*
Indigenous NPWT	34.7 (1.6)	3.6 (1.2–4.7)	8.3	0.001
Conventional VAC therapy	31.1 (1.8)

*Independent Student’s t-test, P<0.05 significant. CI=Confidence interval, SD=Standard deviation, VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

Table 5.

Wound parameters prior to therapy

Parameters	Indigenous NPWT (n=43)	Conventional VAC therapy (n=43)
Mean wound area (cm2)	96.5 (2.8)	89.3 (3.3)
Mean wound depth (cm)	2.2 (0.5)	2.1 (0.4)
Mean wound granulation tissue area (cm2)	37.5 (2.5)	35.4 (1.9)
Mean exudate from the wound (mL/day)	246.4 (5.8)	266.9 (5.1)

VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

Table 6.

Wound parameters after 2 cycle of vacuum assisted closure therapy

Parameters	Indigenous NPWT (n=43)	Conventional VAC therapy (n=43)
Mean wound area (cm2)	54.9 (2.2)	49.3 (2.6)
Mean wound depth (cm)	1.3 (0.3)	1.2 (0.2)
Mean wound granulation tissue area (cm2)	48.0 (1.5)	46.9 (2.0)
Mean exudate from the wound (mL/day)	39.2 (3.5)	34.4 (3.3)
Colour of the exudate, n (%)
Greenish brown	4 (9.3)	1 (2.3)
Greyish brown	11 (25.6)	10 (23.3)
Reddish brown	19 (44.2)	30 (69.8)
Yellowish brown	9 (20.9)	2 (4.7)

VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

Table 7.

Result of negative pressure wound therapy among both the groups

Parameters	Indigenous NPWT (n=43)	Conventional VAC therapy (n=43)
Mean reduction in wound area (%)	43.1	44.8
Mean reduction in wound depth (%)	40.9	42.9
Mean increase in granulation tissue area (%)	28	32.5
Mean exudate reduction (%)	84.1	87.1
Fixation of bone done, n (%)	39 (90.7)	30 (69.8)
Definitive management done, n (%)
Flap coverage	16 (37.2)	5 (11.6)
Healed by secondary intention	0	2 (4.7)
Secondary suturing	8 (18.6)	10 (23.3)
SSG	19 (44.2)	26 (60.5)

SSG=Split thickness skin graft, VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

Table 8.

Comparison of wound bed score prior to the application of vacuum assisted closure

Technique used	Mean (SD) wound bed score (out of 10)	Mean difference (95% CI)	t-statistic	P*
Indigenous NPWT	2.9 (0.7)	−0.5 (−0.76–−0.02)	−2.1	0.03
Conventional VAC therapy	3.4 (1.0)

*Independent Student’s t-test. CI=Confidence interval, SD=Standard deviation, VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

Table 9.

Comparison of mean wound bed score after the 2 cycles of vacuum assisted closure therapy

Technique used	Mean (SD) wound bed score (out of 10)	Mean difference (95% CI)	t-statistic	P*
Indigenous NPWT	7.5 (0.7)	−0.9 (−1.2–−0.6)	−6.15	0.000
Conventional VAC therapy	8.4 (0.7)

*Independent Student’s t-test. CI=Confidence interval, SD=Standard deviation, VAC=Vacuum assisted closure, NPWT=Negative pressure wound therapy

In addition, on an average, it costs around 1000 INR for the Ioban and suction set for the indigenous technique. On the other hand, it costs around 6000 to 8000 INR for the foam and tube set for the conventional technique. These suggest that indigenous negative pressure wound therapy is a feasible alternative to conventional vacuum-assisted closure therapy.

Recommendations for practice

• Adoption in resource-limited settings: Indigenous NPWT should be considered a viable, cost-effective alternative to conventional VAC therapy, particularly in settings with limited financial resources

• Training and protocol development: Healthcare providers should be trained in the application and management of indigenous NPWT, with standardized protocols to ensure consistent treatment

• Further research: Encourage continuous research and participation in larger, multi-center trials to validate and expand upon these findings.

CONCLUSION

The study findings showed that conventional VAC therapy significantly reduced the mean time for complete wound healing. Both therapies exhibited comparable wound reduction and exudate management, with slight variations in wound bed score parameters. However, the conventional therapy group had superior wound healing progress as indicated by higher mean wound bed scores both before and after VAC application. Complications such as bleeding, pain, and infection were slightly lower but comparable in the indigenous group, suggesting that indigenous VAC therapy is a cost-effective and similarly safe alternative to conventional VAC therapy despite minor differences in healing and complication rates.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.