Cochrane Systematic Review: Venous Ulcer Dressings

[Admin]

Reference

Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA. Dressings for healing venous leg ulcers. Cochrane Database Syst Rev. 2006(3):CD001103.

Rationale

The main treatment for VUs is compression. Primary dressings are usually applied to aid healing, improve patient comfort, or manage exudate.

Objective

This systematic review explored the effects of wound dressings on healing VUs.

Methods

The authors retrospectively reviewed prospective randomized controlled trials (RCTs) in all languages published before 2005 comparing dressing effects on time to healing, proportion healed, or rate of healing of patients with VU. RCTs evaluating topical agents and skin grafting were excluded as subjects of prior Cochrane systematic reviews. Searches included the Cochrane, MEDLINE, EMBASE, and CINAHL databases, derivative references, and queries to authors, wound professionals, and manufacturers. A different author checked data extraction. Study quality was assessed on group comparability at baseline, intent-to-treat analyses, follow-up completeness, allocation concealment and objective, and blinded outcome measures. Meta-analyses were performed on statistically homogeneous data of multiple studies addressing each question reviewed. Subgroup analyses tested for effects of study size, compression use, dressing type, and blinded assignment.

Results

Of 254 citations, 42 RCTs of 4- to 40-week duration involving 3,001 patients with a VU qualified for inclusion in the analyses. There were sufficient data for meta-analyses comparing hydrocolloid dressings with foams (4 trials, 311 patients), alginates (2 trials, 80 patients), other hydrocolloids (3 trials, 98 patients) or low-adhering dressings (9 trials, 928 patients); foam dressings with low-adherent (3 trials; 253 patients) or other foams (2 trials; 136 patients); and hydrogels with low-adherent dressings (2 trials; 134 patients). Many studies were underpowered. None of the meta-analyses revealed significant differences between healing effects of any 2 primary dressing categories. Effects of patient variables, such as ambulation and adherence to compression protocols, were not analyzed owing to insufficient data reporting.

Conclusion

Primary wound dressings applied beneath compression have not been shown to affect VU healing.