Andreas Alga, Haweizy R, Bashaireh K, et al. - A pragmatic, multisite, randomized controlled trial was designed to compare the safety and effectiveness of negative pressure wound therapy (NPWT) with that of standard treatment. This trial was conducted at two civilian hospitals in Jordan and Iraq including a total of 174 patients aged 18 years or older, presenting with a conflict-related extremity wound within 72 h after injury between June 9, 2015, and Oct 24, 2018. Individuals were allocated randomly in a 1:1 ratio to receive either NPWT or standard treatment. They applied a predefined, computer-generated randomization list with three block sizes. Compared with standard treatment, NPWT did not produce superior clinical outcomes for acute conflict-related extremity wounds. The outcomes of this research not only question the application of NPWT but also question the tendency for new and costly treatments to be introduced into resource-limited conflict settings without supporting evidence for their effectiveness. This analysis reveals that high-quality, randomized trials in challenging settings are possible, and the findings support the call for future study that will generate context-specific evidence.