Efficacy and Safety of Negative Pressure Wound Therapy in Diabetic Foot Ulcers: A Cross-Sectional Analysis of Overlapping Meta-Analyses.

Objective: Negative pressure wound therapy (NPWT) is a key intervention for diabetic foot ulcers (DFUs). However, the body of meta-analytic evidence is fraught with conflicting findings, creating significant clinical uncertainty. This study was designed to harmonize the discordant evidence, identify the most methodologically robust meta-analysis, and formulate a clear, evidence-based recommendation for the clinical use of NPWT. Methods: We conducted a comprehensive search of the PubMed, Embase, and Cochrane Library databases to identify all pertinent meta-analyses. The methodological quality of each included review was rigorously assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. The Jadad decision algorithm was then employed to systematically select the most reliable and robust evidence. Results: Eight meta-analyses met the inclusion criteria, with AMSTAR scores ranging from 6 to 9. The formal application of the Jadad decision algorithm identified the meta-analysis by Deng et al as the definitive source of best available evidence. This meta-analysis demonstrated that NPWT significantly improved wound healing rates (risk ratio = 1.46) and decreased amputation rates (risk ratio = 0.69) relative to conventional therapy, while also shortening granulation tissue formation time without increasing adverse events. Conclusion: The highest-quality evidence, harmonized through this appraisal, confirms that NPWT is a safe and effective adjunctive therapy for DFUs. Its demonstrated ability to accelerate healing while reducing amputations provides a strong evidence base for consideration as a key component of standard clinical practice.