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We prospectively compared the effectiveness of foam- and gauze-based negative pressure wound therapy (NPWT) systems on wound healing, pain, cost, and hospital length of stay. We also compare ease of use and time in performing dressing changes reported by nurses.Randomized, controlled clinical trial comparing foam- and gauze-based NPWT systems.Eleven adult subjects with physician orders for NPWT participated in the study. Subjects were middle-aged, white, and male.Six subjects were randomly allocated to foam-based and 5 to gauze-based NPWT systems. Wound healing rates and pain at the first dressing change were measured using a centimeter ruler and a visual analog scale, respectively. Wound care costs were tabulated from a checklist of supplies used and nurse perceptions were measured by responses to Likert-type surveys. Relationships between NPWT system and selected variables were measured using Wilcoxon rank sum tests.Median wound healing rates did not differ significantly between foam-based and gauze-based NPWT systems when measured in centimeters at first dressing change for length (10.6 vs 16.5, P = .58), width (2.7 vs 4.2, P = .41), depth (2.2 vs 2.5, P = .78), and tunneling and undermining (both 0 vs 0, P = .82 and .79, respectively). No differences were detected in pain rating at first dressing change (3.2 vs 2.4, P = .77), cost of wound care ($510.18 vs $333.54 P = .86), or hospital length of stay (26.33 vs 14.8 days; P = .58), respectively. There were no differences in nurses' experiences in ease of performing dressing changes and mean time to perform the first dressing change for foam- or gauze-based NPWT systems: 32.3 vs 38.8 minutes; P = .52, respectively.In a pilot study comparing the effectiveness of foam- and gauze-based NPWT systems, no statistically significant differences were found in patient wound healing, pain, length of stay, or cost of wound care. Nursing time and perceptions about the ease of preparing and completing dressing changes did not differ between systems. Additional research is needed to more definitively determine any differences in wound healing or nurse satisfaction using gauze- versus foam-based NPWT systems.