Persistent edema, impaired lymphatic drainage, and delayed healing are common complications
of chronic venous stasis ulcers (venous leg ulcers or VLUs), which affect roughly 3% of the U.S.
population. Negative pressure wound therapy (NPWT) reduces fluid burden, improves arterial
perfusion, and stimulates granulation tissue formation. Osteopathic manipulative treatment
(OMT), particularly myofascial and lymphatic techniques, enhances lymphatic flow, modulates
inflammation, and supports tissue repair. Although both modalities independently show benefits,
their combined use has not been studied. This review evaluates whether integrating NPWT and
OMT could synergistically improve outcomes in patients with VLUs. A structured search of
PubMed, Google Scholar, and Scopus identified studies that examined the roles of NPWT or
OMT in wound healing, edema reduction, or lymphatic drainage. Evidence from animal models
has shown that NPWT promotes wound closure through mechanical deformation, cytokine
modulation, and optimized wound bed conditions. Additionally, it has demonstrated efficacy in
human clinical trials, where it reduces interstitial fluid burden and promotes granulation tissue
formation. OMT improves fluid redistribution through manual techniques that target
diaphragmatic motion, fascial relationships and pressure gradients, and lymphatic pump
function. Though there are few large-scale, longitudinal clinical trials involving OMT effects on
lymphatics, there are short term studies demonstrating improved lymphatic flow and reduced
interstitial fluid burden after treatment. No studies addressed concurrent use, indicating a notable
research gap. Integrating OMT into NPWT protocols may be a feasible and cost-effective
approach to enhance wound healing, reduce hospital stays and limit devastating complications
for patients, justifying further evaluation in clinical trials.
