# An Analysis of Intraoperative, Early Postoperative, and Late Postoperative Application of Negative Pressure Wound Therapy in Below-Knee Amputations in a Tertiary Care Center

## TL;DR

This study shows that starting negative pressure wound therapy during surgery improves healing and shortens hospital stays for below-knee amputation patients.

## Contribution

The novel contribution is evaluating the timing of NPWT initiation in BKAs and its impact on healing outcomes and hospitalization duration.

## Key findings

- Intraoperative NPWT resulted in higher granulation tissue (96.8%) and shorter hospital stays (1.24 days) compared to later initiation.
- Late NPWT initiation was associated with lower granulation tissue (69.2%) and longer hospital stays (4.24 days).
- Wound contracture and skin inflammation differences were not statistically significant across groups.

## Abstract

Background: Negative pressure wound therapy (NPWT) has been shown to improve wound healing through enhanced granulation tissue formation and exudate control. However, the timing of NPWT initiation in below-knee amputations (BKA) may significantly affect clinical outcomes, especially in resource-limited settings.

Objective: This study aimed to evaluate the effect of intraoperative, early postoperative (within seven days), and late postoperative (after seven days) initiation of NPWT on wound healing parameters and length of hospital stay in patients undergoing BKA.

Methods: A retrospective observational study was conducted on 75 patients who underwent BKA for diabetic foot complications. Patients were categorized into three groups (n = 25 each) based on the timing of NPWT initiation. Primary outcomes assessed were hospital stay duration and wound bed characteristics post-NPWT removal-granulation tissue percentage, slough percentage, wound contracture, and surrounding skin inflammation.

Results: Intraoperative NPWT led to significantly better outcomes: higher granulation tissue (96.8%), lower slough (2%), and shorter hospital stay (mean 1.24 days) compared to early (84% granulation, 9.6% slough, and 2.2 days stay) and late (69.2% granulation, 17.6% slough, and 4.24 days stay) NPWT. Wound contracture and skin inflammation differences were not statistically significant.

Conclusion: Early application of NPWT, especially intraoperatively, accelerates wound healing and reduces hospitalization time in BKA patients. These findings suggest a cost-effective strategy for improving patient outcomes and optimizing healthcare resource utilization in developing countries.