Negative Pressure Wound Therapy as a Predictor of Persistent Pain After War-Related Trauma

War-related trauma frequently produces complex soft tissue injuries requiring staged surgical management, repeated debridement procedures, and advanced wound care strategies. Negative Pressure Wound Therapy (NPWT) has become a widely used technique in modern trauma care to improve wound healing, control exudate, reduce edema, and prepare wounds for delayed closure or reconstruction. In patients with severe trauma, NPWT is commonly applied following surgical debridement and may be used for several days or weeks depending on wound severity and healing progress.

Although NPWT has well-established benefits in wound management, its relationship with long-term pain outcomes has not been clearly defined. Patients with severe traumatic injuries are at increased risk of developing persistent post-traumatic pain due to extensive tissue damage, repeated surgical interventions, inflammation, and potential peripheral nerve injury. Early clinical factors such as high acute pain intensity, nerve involvement, and repeated surgical manipulation may contribute to peripheral and central sensitization, ultimately increasing the risk of chronic pain.

In trauma populations, NPWT may represent not only a treatment modality but also a clinical marker of injury severity, prolonged wound healing, and repeated surgical procedures. Therefore, evaluating the relationship between NPWT exposure and long-term pain outcomes may help identify patients at higher risk for persistent post-traumatic pain.

This prospective observational cohort study will enroll adult patients with war-related traumatic injuries requiring surgical wound management. Participants will be classified according to whether they received NPWT during their wound treatment. Clinical data related to injury characteristics, early pain intensity, surgical management, and suspected nerve injury will be recorded.

Participants will be followed for six months after injury to assess the development of persistent pain, neuropathic pain symptoms, paresthesia, and pain interference with daily activities. The study will also explore early clinical predictors of chronic pain, including the use and duration of NPWT, number of surgical procedures, acute pain intensity during the first 72 hours after injury, suspected nerve injury, and mechanism of trauma.

By identifying factors associated with persistent post-traumatic pain, this study may improve risk stratification and support the development of early pain prevention and rehabilitation strategies for patients with severe traumatic injuries.

Inclusion criteria

• age ≥18 years
• war-related trauma (blast injury, fragmentation injury, gunshot wound, burn injury, or crush injury)
• traumatic soft tissue injury requiring surgical management
• ability to provide informed consent
• availability for follow-up assessments

Exclusion criteria

• chronic pain in the same anatomical region prior to injury
• severe cognitive impairment preventing pain assessment
• inability to communicate or complete questionnaires
• refusal to participate
• incomplete baseline data or loss to follow-up