Negative Pressure Wound Therapy in Plastic and Reconstructive Surgery: A Contemporary Narrative Review of Current Evidence and Clinical Applications

Negative pressure wound therapy (NPWT) is used as an adjunct in the management of complex wounds and reconstructive procedures, including wound-bed management, skin graft fixation, staged reconstruction, donor-site management, and selected closed surgical incisions.The clinical role of NPWT varies according to wound characteristics, reconstructive objectives, and patient factors.This narrative review evaluates the mechanisms of action, clinical applications, complications, safety considerations, cost-effectiveness, and emerging developments associated with NPWT in plastic and reconstructive surgery.Relevant literature addressing NPWT in reconstructive surgery was reviewed, including randomised controlled trials, systematic reviews, meta-analyses, consensus statements, and economic evaluations, with consideration of study design, methodological limitations, clinical applicability, and indication-specific outcomes.NPWT provides mechanical wound stabilisation, controlled exudate removal, reduction of dead space, and graft immobilisation.Its clinical application varies substantially between reconstructive indications, with some applications having a more established role than others.Potential complications include pain, periwound skin injury, bleeding, infection, seal failure, and tissue injury, emphasising the importance of appropriate patient selection and clinical monitoring.NPWT should be considered a reconstructive adjunct with a defined clinical objective rather than a universal wound-healing treatment.Its use should be integrated with appropriate debridement, assessment of perfusion, infection control, protection of critical structures, and timely definitive reconstruction.Further research is required to establish indication-specific treatment strategies and clarify long-term clinical and economic outcomes.