. 2019 Nov 25;18(2):625–641. doi: 10.1007/s40200-019-00447-6

Table 2.

Charactristics of included systematic reviews

No	Author/Date Country	databases searched	Objective	Type of intervention	Included Population	Number of included studies and Study designs	Method of risk of bias/quality assessment	outcomes reported in the review	Authors conclusion			Study rating
No	Author/Date Country	databases searched	Objective	Type of intervention	Included Population	Number of included studies and Study designs	Method of risk of bias/quality assessment	outcomes reported in the review	Efficacy	safety	cost	Study rating
1	Samson D./ Spain 2004 [23]	3(medline/embase/cochrane)	“to systematically review and synthesize the available evidence on the effectiveness of vacuum-assisted closure(VAC) for wound healing”	VAC vs. moist gauze dressings	20 people with diabetic foot ulcer	2 RCT [41, 42]	Harris rating system [43]	Change in wound area, incidence of complete wound closure, time to complete closure, adverse events	Inconclusive	N/A	N/A	High
1	Samson D./ Spain 2004 [23]	3(medline/embase/cochrane)		VAC vs. moist gauze dressings	20 people with diabetic foot ulcer	2 RCT [41, 42]	Harris rating system [43]		There was not any significant advantage with regard to VAC therapy. However the evidence from the RCTs were poor			High
2	Pham C. / Australia 2006 [24]	3(medline/embase/cochrane)	“To review the efficacy and safety outcomes of topical negative pressure(TNP) in treating particular wound types”	TNP vs. conventional method	51 people with diabetic foot ulcer	2RCT and 1 case series [41, 42, 44]	N/R	Wound closure, adverse events	Inconclusive	Inconclusive	N/A	Critically Low
2	Pham C. / Australia 2006 [24]	3(medline/embase/cochrane)		TNP vs. conventional method	51 people with diabetic foot ulcer	2RCT and 1 case series [41, 42, 44]	N/R	Wound closure, adverse events	There is a lack of high-quality reports with sufficient sample sizes to detect any differences between NPWT and conventional method
3	Noble-Bell G, et.al UK 2008 [16]	4(the Cochrane register of controlled trials, Medline, Embase and CINHAL,	To systematically review the evidence relating to the effectiveness of NPWT in the management of diabetes foot ulcers	NPWT vs. conventional dressings	206 either type1 or type 2diabetic Patients with, chronic or acute wounds, including postoperative wounds	4 RCT [41, 42, 45, 46]	JADAD criteria	time to wound healing, Treatment related complications, cost-effectiveness	Beneficial	Beneficial	Inconclusive	High
3	Noble-Bell G, et.al UK 2008 [16]			NPWT vs. conventional dressings		4 RCT [41, 42, 45, 46]	JADAD criteria		Negative-pressure wound therapy may be particularly beneficial for diabetic foot ulcer healing without any major adverse events, however the studies quality were weak to moderate			High
4	Vikatmaa, P., et al. Finland 2008 [13]	2 (Cochrane, medline)	To gather the most reliable evidence available on the effectiveness and safety of NPWT in the treatment of acute and chronic wounds	NPWT vs. any other local wound therapy	206 2diabetic Patients with foot ulcer	4 RCT [41, 42, 45, 46]	Harris rating system [43]	time needed to reepithelialization, Second amputation, wound area, reduction,	Beneficial	Beneficial	N/A	Low
4	Vikatmaa, P., et al. Finland 2008 [13]	2 (Cochrane, medline)		NPWT vs. any other local wound therapy	206 2diabetic Patients with foot ulcer	4 RCT [41, 42, 45, 46]	Harris rating system [43]		NPWT was at least as effective and in some cases more effective than the control treatment., however the quality of studies were poor			Low
5	*Gregor S, et al. Germany 2008 [35]	4(MEDLINE, EMBASE, CINAHL, and the Cochrane Library)	To assess the clinical effectiveness and safety of NPWT vs conventional wound therapy	NPWT vs.conventional wound dressing	206 patients with diabetic foot amputations or chronic diabetic wounds	2 RCT, 2 non-RCT [41, 42, 45, 46]	trials were assessed for their quality using IQWiG	Incidence and Time to wound closure, safety	Inconclusive	inconclusive	N/A	High
5	*Gregor S, et al. Germany 2008 [35]	4(MEDLINE, EMBASE, CINAHL, and the Cochrane Library)		NPWT vs.conventional wound dressing		2 RCT, 2 non-RCT [41, 42, 45, 46]	trials were assessed for their quality using IQWiG	Incidence and Time to wound closure, safety	Although there is some indication that NPWT may improve wound healing, the body of evidence available is insufficient to clearly prove an additional clinical benefit of NPWT. The large number of prematurely terminated and unpublished trials is reason for concern.			High
6	Hinchliffe RJ/ UK/ 2008 [25]	4 (Medline, Embase, the Cochrane database of systematic reviews, and the Cochrane Central Controlled Trials Register	“to identify interventions for which there is evidence of effectiveness”	NPWT efficacy vs. Saline moistened gauze, standard care	182 people older than 18 with either type 1 or 2 with chronic foot ulcers or post-amputation wounds	3 RCT [41, 42, 45]	Dutch Cochrane Center (www.cochrane.nl/index.html)	Ulcer healing time to healing, reduction in ulcer area	Beneficial	Beneficial	N/A	Low
6	Hinchliffe RJ/ UK/ 2008 [25]			NPWT efficacy vs. Saline moistened gauze, standard care		3 RCT [41, 42, 45]	Dutch Cochrane Center (www.cochrane.nl/index.html)	Ulcer healing time to healing, reduction in ulcer area	NPWT therapy have been shown to improve the rate of healing after post-amputation wounds, however further evidence is required to substantiate the benefit and cost–benefit of TNP therapy after post-amputation wounds, as well as in the non-operated chronic wound.			Low
7	Ubbink/ netherland2008a [22]	4(Cinahl, Embase and Medline and the Cochrane controlled trials register	“to summarize up-to-date, high-level evidence on the effectiveness of TNP on wound healing, in both acute and chronic settings”	TNP effectiveness vs. Saline moistened gauze	206 diabetic patients	4 RCT [41, 42, 45, 46]	Dutch Cochrane Collaboration checklist (www.cochrane.nl).	wound healing adverse events	Inconclusive	N/A	N/A	Low
7	Ubbink/ netherland2008a [22]			TNP effectiveness vs. Saline moistened gauze	206 diabetic patients	4 RCT [41, 42, 45, 46]	Dutch Cochrane Collaboration checklist (www.cochrane.nl).	wound healing adverse events	There is no valuable evidence to support the use of TNP in the treatment of chronic wounds, when compared to MGWD or other topical wounds dressing.			Low
8	Ubbink DT, Netherlands, 2008b [26]	4(Ovid EMBASE, Ovid CINAHL, The Cochrane Library, Ovid MEDLINE)	To determine: if TNP is more effective than alternative wound dressings in terms of healing rates, costs, quality of life, pain management and comfort for people with chronic wounds	effects of TNP vs.	20 people with chronic diabetic foot ulcer	2RCT [41, 42]	Dutch Cochrane Collaboration checklis	Time to complete healing, Rate of change in wound area, Proportion of wounds completely healed, Adverse events., Costs	Inconclusive	N/A	N/A	High
8	Ubbink DT, Netherlands, 2008b [26]			effects of TNP vs.	20 people with chronic diabetic foot ulcer	2RCT [41, 42]	Dutch Cochrane Collaboration checklis		There are methodological flaws regarding with trials comparing TNP with alternative treatments in chronic wounds. Although data demonstrate a beneficial effect of TNP on wound healing, more better quality research is needed.			High
9	Ontario Health Technology Assessment Series, Canada, 2010 [27]	5(PubMed, Embase, CINAHL,the Cochrane Library INAHT)	to review the NPWT technique regarding efficacy and safety in the management of skin ulcers	NPWT vs. moist wound therapy or AMWT	504 people who had diabetic ulcer and amputation wounds	2RCT [8, 46]	Pedro Scale	complete wound closure, Granulation tissue formation, time to granulation tissue formation, rate of secondary amputation and other adverse events, cost-effectiveness	Beneficial	N/A	Inconclusive	High
9		5(PubMed, Embase, CINAHL,the Cochrane Library INAHT)		NPWT vs. moist wound therapy or AMWT	504 people who had diabetic ulcer and amputation wounds	2RCT [8, 46]	Pedro Scale		Time to complete healing was significantly shorter in NPWT groups vs. controls Proportion of patients who achieved complete ulcer closure in NPWT was significantly greater than in controls in both studies			High
10	Xie X. et al./Canada/ 2010 [12]	2 (PubMed and Embase,)	to estimate the efficacy of negative pressure wound therapy (NPWT)	NPWT compared to any standardwound dressing	580 people who had diabetic ulcer	7RCT [8, 41, 42, 45–48]	PEDro Scale	rate of wound healing	Beneficial	N/A	N/A	Critical low
10	Xie X. et al./Canada/ 2010 [12]	2 (PubMed and Embase,)		NPWT compared to any standardwound dressing	580 people who had diabetic ulcer	7RCT [8, 41, 42, 45–48]	PEDro Scale	rate of wound healing	There is now sufficient evidence to show that NPWT will accelerate healing of diabetes-associated chronic lower extremity wounds.			Critical low
11	C.A. Fries, et al. United Kingdom 2011 [28]	5(Cinahl, Embase, Medline, ProQuest and the Cochrane Library)	to conduct a review of the evidence supporting the effectiveness use of TNP in trauma patients	N/A	206 Patients with diabetic foot ulcers	4 RCT [41, 42, 45, 46]	N/R	Rate of time healing, rate of complete closure, wound depth	Beneficial	N/A	N/A	Critical low
11	C.A. Fries, et al. United Kingdom 2011 [28]			N/A	206 Patients with diabetic foot ulcers	4 RCT [41, 42, 45, 46]	N/R	Rate of time healing, rate of complete closure, wound depth	All trials suggest that wound healing rates and reduction of wound surface area is improved by TNP			Critical low
12	F.L. game / / UK 2012 [11]	3(Medline, Embase, clinical trials registries)	N/A	NPWT vs. standard wound care	chronic foot ulcers in diabetic people older than 18 with either type 1 or 2	3 RCT included 375diabetic foot patients and 1 cohort included 16,319 diabetic foot patients [8, 47–49]	Scottish Intercollegiate Guidelines Network criteria.	Wound healing, time to healing, reduction in ulcer area or amputation	Beneficial	Beneficial	N/A	Low
12	F.L. game / / UK 2012 [11]	3(Medline, Embase, clinical trials registries)	N/A	NPWT vs. standard wound care			Scottish Intercollegiate Guidelines Network criteria.		Weakly significant benefit of NPWT in reduced healing time, increased incidence of healing and reduced risk of minor amputation is for diabetic foot ulcers.			Low
13	Yarwood L UK, 2012 [29]	3(CINAHL, MEDLINE and the Cochrane Library	Seeks to review the effectiveness of NPWT and conventional wound_dressings	NPWT vs.conventional wound dressings	640 people with diabetic foot ulcer	4 RCT [8, 41, 46, 50]	N/A	Granulation tissue formation, healing time, wound surface area reduction, adverse events, cost	Beneficial	Beneficial	Beneficial	Low
13	Yarwood L UK, 2012 [29]	3(CINAHL, MEDLINE and the Cochrane Library		NPWT vs.conventional wound dressings	640 people with diabetic foot ulcer	4 RCT [8, 41, 46, 50]	N/A		NPWT has proven to be more effective than conventional Wound dressings. However further studies are needed evaluating cost-effectiveness and patients accessibility.			Low
14	Quecedo L/ Spain/ 2013 [30]	5(medline, ebbase, NHS, HTAD, chocrane library, Aggressive research website)	to analyze the scientific evidence from clinical trials that evaluate the effectiveness and safety of NPWT in the treatment of diabetic wounds	NPWT vs. conventional therapies	570 people aged 18 years or affected by complicated foot injuries or postoperative wounds	6RCT [41, 42, 45, 46, 48, 51]	The Jaddad criteria	healing time, adverse events, costs	Beneficial	Beneficial	Beneficial	Critical low
14	Quecedo L/ Spain/ 2013 [30]			NPWT vs. conventional therapies		6RCT [41, 42, 45, 46, 48, 51]	The Jaddad criteria	healing time, adverse events, costs	It could be possible to make a recommendation for its use given the safety profile and costs and consistency of the results, in spite of the low quality grade of evidence.			Critical low
15	Greer, N, et al. USA 2013 [14]	2 (MEDLINE, Cochrane Library)	to systematically evaluate the efficacy and harms of NPWT	NPWT vs. standard care	342 diabetic patients	1 RCT [8]	modifide Cochrane Approach to determining risk of bias [52]	Percentage of ulcer healed, healing time, adverse events,	Beneficial	N/A	N/A	low
15	Greer, N, et al. USA 2013 [14]	2 (MEDLINE, Cochrane Library)	to systematically evaluate the efficacy and harms of NPWT	NPWT vs. standard care	342 diabetic patients	1 RCT [8]		Percentage of ulcer healed, healing time, adverse events,	This good-quality study found improved healing with NPWT			low
16	Dumville, UK, 2013 [15]	6(Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); The Database of Abstracts of Reviews of Effects (DARE),The NHS Economic Evaluation Database,MEDLINE, EMBASE; and EBSCO CINAHL	To assess the effects of NPWT in the healing of foot wounds in people with diabetes mellitus	NPWT vs. standard care or adjuvant therapies	605 diabetic patients with Type 1 or 2 DM, with foot wounds below the knee, regardless of underlying etiology	5RCT [8, 46, 50, 53, 54]	Cochrane Collaboration tool for assessing risk of bias	Complete wound healing, amputation adverse events,	Inconclusive	Inconclusive	Inconclusive	High
16	Dumville, UK, 2013 [15]			NPWT vs. standard care or adjuvant therapies		5RCT [8, 46, 50, 53, 54]	Cochrane Collaboration tool for assessing risk of bias	Complete wound healing, amputation adverse events,	There is some evidence to suggest that NPWT is more effective in healing diabetic post-operative foot wounds compared with moist wound dressing			High
17	Guffani A,USA, 2014 [31]	2(pubmed, OVID)	to address the effectiveness and safety of NPWT for wound healing in patients with a diabetic foot	NPWT vs. SMWT	545 diabetic Patients with chronic or acute diabetic foot ulcers	4 RCT [8, 45, 46, 48]	N/R	wound closure rate, safety and reduction in secondary complications	Beneficial	Beneficial	N/A	Critical low
17	Guffani A,USA, 2014 [31]	2(pubmed, OVID)		NPWT vs. SMWT		4 RCT [8, 45, 46, 48]	N/R		Evidence from 4 randomized controlled trials suggests that NPWT using a VAC system is more effective than Standard Moist Wound Therapy(SMWT) in promoting the healing of diabetic foot wounds and is safe and effective for management of diabetic foot ulcers			Critical low
18	*Zhang, Jian, et al. China 2014 [37]	3(PubMed, EMBASE, and Cochrane Library databases)	To evaluate the effectiveness and safety of negative-pressure wound therapy for diabetic foot ulcers	NPWT Vs. with standard wound care	669 diabetic foot patients with any chronic foot wound and postoperative wounds in type 1 or 2patients diabetic	8 RCT [8, 41, 42, 45, 46, 48, 50, 55]	Cochrane Handbook for Systematic Reviews of Interventions	ulcer healing, time to ulcer healing, adverse events	Beneficial	Beneficial	N/A	low
18	*Zhang, Jian, et al. China 2014 [37]	3(PubMed, EMBASE, and Cochrane Library databases)		NPWT Vs. with standard wound care		8 RCT [8, 41, 42, 45, 46, 48, 50, 55]	Cochrane Handbook for Systematic Reviews of Interventions	ulcer healing, time to ulcer healing, adverse events	Negative-pressure wound therapy appears to be more effective for diabetic foot ulcers compared with non–negative-pressure wound therapy, and has a similar safety profile.			low
19	* Wang R/ China/ 2015 [36]	5(PubMed, Ovid EMBASE and Web of Science, Cochrane library and Chinese biomedicine literatures databases	“To compare the strength and weakness of negative pressure wound therapy (NPWT) with ultrasound debridement (UD) as for diabetic foot ulcers (DFU)”	NPWT vs.standard wound care	2800 Patients with diabetic foot ulcers	8 RCT [8, 42, 45–48, 50, 55]and **22 compared studies	Modified JADAD criteria	full epithelialization, Time to wound closure, decrement in ulcer area, secondary amputation	Beneficial	Beneficial	N/A	Critical low
19	* Wang R/ China/ 2015 [36]			NPWT vs.standard wound care	2800 Patients with diabetic foot ulcers	8 RCT [8, 42, 45–48, 50, 55]and **22 compared studies	Modified JADAD criteria		NPWT significantly improved the proportion of diabetic foot ulcer healing compared with standard wound care			Critical low
20	Peters E.J./ The Netherland/2016 [33]	2(PubMed, Embase)	To review the effectiveness of NPWT on infection control in diabetic foot ulcers	NPWT vs. advanced wound dressing	130 people aged 18 years or older who had diabetes and foot infection	1RCT [56]	Dutch Cochrane Centre	Wound healing, infection control	Inconclusive	Inconclusive	N/A	Critical low
20	Peters E.J./ The Netherland/2016 [33]	2(PubMed, Embase)		NPWT vs. advanced wound dressing		1RCT [56]	Dutch Cochrane Centre	Wound healing, infection control	There is no sufficient conclusions about the usefulness of the NPWT			Critical low
21	Game, F. L., et al. UK & USA2016 [32]	2(MEDLINE, Cochrane Library)	to review the NPWT effectiveness in healing of chronic ulcers of the foot in diabetes	NPWT vs. Standard care or advanced wound dressing	297 chronic foot ulcers in diabetic people older than 18 with either type 1 or 2	3 RCT [50, 55, 56]	Scottish Intercollegiate Guidelines Network criteria [57]	healing, time to healing, and/or reduction in ulcer area, cost	Inconclusive	N/A	Inconclusive	Critical low
21	Game, F. L., et al. UK & USA2016 [32]	2(MEDLINE, Cochrane Library)		NPWT vs. Standard care or advanced wound dressing		3 RCT [50, 55, 56]	Scottish Intercollegiate Guidelines Network criteria [57]		The evidence to support the NPWT effectiveness and cost effectiveness in diabetic foot ulcers is not strong			Critical low
22	*Liu, Si, et al. 2017 China [18]	5(Cochrane Library, MEDLINE, EMBASE, Ovid, and Chinese Biological Medicine databases)	“to assess the clinical efficacy, safety, and cost-effectiveness of NPWT in the treatment of DFUs”	NPWT vs. standard dressing changes	1044 Patients with chronic diabetic foot ulcers	11 RCT [8, 41, 42, 46, 48, 50, 55, 58–61]	Cochrane Collaboration tool for assessing risk of bias	healing time, reduction in ulcer area reduction in ulcer depth,amputations, treatment-related adverse effects, cost-effectiveness	Beneficial	Beneficial	Beneficial	High
22	*Liu, Si, et al. 2017 China [18]			NPWT vs. standard dressing changes	1044 Patients with chronic diabetic foot ulcers	11 RCT [8, 41, 42, 46, 48, 50, 55, 58–61]	Cochrane Collaboration tool for assessing risk of bias		All trials suggested that: Higher rate of complete healing, shorter healing time, and fewer amputations.			High
23	Gonzalez-Ruiz, M Spain 2018 [34] Article in spanish	4(PubMed, CINAHL, SciELO and Web of Science)	To conduct a systematic review for analyze the effectiveness of TNP in ulcers of diabetic patients	TPN Vs.conventional dressing	967 people with diabetic foot ulcer	12 RCT [8, 41, 45, 47, 48, 50, 51, 55, 62–65]	JADAD scale	Wound surface area, time to granulation, quality of life cost	Beneficial	Beneficial	Beneficial	low
23	Gonzalez-Ruiz, M Spain 2018 [34] Article in spanish	4(PubMed, CINAHL, SciELO and Web of Science)		TPN Vs.conventional dressing	967 people with diabetic foot ulcer	12 RCT [8, 41, 45, 47, 48, 50, 51, 55, 62–65]	JADAD scale		TPN achieve a greater surface of granulation tissue and faster healing time. Even so, future studies are needed to evaluate the impact of TPN with the aim of incorporating it into daily clinical practice.			low

VAC vacuum assisted closure, RCT randomized controlled trial, NPWT negative pressure wound therapy, N/A not aplicable, TNP topical negative pressure, N/R not reported, MGWD moist gauze wound dressing, DFU diabetic foot ulcer, SWC standard wound care

*Meta-analyses

**these studies are not mentioned in this overview