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Which Dressings Are Best for Venous Leg Ulcers?
Am Fam Physician. 2008 Jan 1;77(1):94-95.
Background: Dressings are usually used to cover venous ulcers before compression bandages or supportive hosiery are applied. Evidence of benefit from these dressings is limited, and different types have not been compared for effectiveness. Palfreyman and colleagues reviewed the available evidence on the major types of dressings.
The Study: The authors searched several databases for randomized controlled trials evaluating dressings in the treatment of venous leg ulcers. Studies involving diabetic or arterial ulcers were excluded. Trials were required to report time to complete healing, proportion of ulcers healed, or reduction in ulcer area by the end of the study as outcome measures. Trials were assessed for quality by two reviewers who independently evaluated each trial for suitability, with a third reviewer arbitrating any disagreements. Results were reported by intention to treat.
Results: The meta-analysis included 42 eligible trials involving 3,001 patients. Several trials were funded by manufacturers of the dressings being studied. Most studies were of short duration, involved relatively few patients, and had methodologic problems. Data concerning cost analysis were particularly problematic and no studies conformed to guidelines for reporting cost effectiveness.
Hydrocolloid dressings were compared with low-adherent dressings (nine studies), foam dressings (four studies), alginate dressings (two studies), and other types of dressings (two studies). When compared with low-adherent, foam, and alginate dressings, the relative risks of healing were 1.02, 0.98, and 0.72, respectively. Differences in healing rates did not reach statistical significance. Similarly, two trials comparing different types of hydrocolloid dressings showed no differences among the materials studied.
Foam dressings were compared with low-adherent dressings (two eligible studies), alginate dressings (one study), and silicone dressings (one study). Two additional studies compared different types of foam dressings. None of these studies reported statistically significant differences in ulcer healing rates among the different dressing types.
Similarly, no statistically significant effects on healing were reported in single studies comparing low-adherent dressings with hydrogel or alginate dressings.
Conclusion: The authors conclude that the evidence fails to show any significant difference in healing between any of the types of dressings studied. Although no firm clinical recommendations can be made based on the limited quantity and quality of data, findings from the meta-analysis suggest that a simple low-adherent dressing may be as effective as a more expensive hydrocolloid dressing in multilayer compression bandaging of venous ulcers.
Palfreyman S, et al. Dressings for venous leg ulcers: systematic review and meta-analysis. BMJ. August 4, 2007;335(7613):244–248.
Copyright © 2008 by the American Academy of Family Physicians.
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