An Evidence-Based Algorithm for Treating Venous Leg Ulcers Utilizing the Cochrane Database of Systematic Reviews

Howard M. Kimmel, DPM, MBA, FACFAS; Angela L. Robin, DPM

Disclosures

Wounds. 2013;25(9):242-250. 

In This Article

Dressings

Wound dressings are usually applied beneath the compression to aid healing, enhance comfort, prevent adherence of the bandage to the ulcer, and control exudate. A wide variety of dressing products and types are available including hydrocolloids, foams, alginates, hydrogels, and others. A Cochrane review of 42 randomized controlled studies with a total of more than 1000 patients found no evidence that any one dressing type was better than others in terms of number of ulcers healed.[35] Furthermore, the more expensive hydrocolloid dressings were not shown to provide healing benefits over the lower-cost simple nonadherent dressings. Without clear evidence to support the use of one dressing over another, the choice of dressings for VLUs can be guided by cost, ease of application, and patient and physician preferences.

Studies have shown that modern dressings, particularly if the wound is < 4 weeks old, do not provide a significant improvement in healing rates of chronic venous ulcerations.[36] Chaby et al[36] concluded that only a weak level of evidence existed for clinic efficacy of products such as hyaluronic acid, hydrogels, and silver-impregnated products when compared to saline or paraffin gauze. Statistical significance in wound healing did not occur in venous ulceration healing until week 6 in a literature review by Kerstein et al.[37] Impregnated gauze, hydrocolloid dressings, and human skin constructs were evaluated, and it was concluded that advanced products may not be cost-effective in early treatment. Cambal et al[38] conducted a small study of 20 patients with chronic venous ulcerations with compressive sclerotherapy and maggot debridement therapy. In these patients, 95% showed a significant clinical improvement. A review conducted by Simms and Ennen[39] determined that no dressing was superior to another, and compression is the necessary gold standard of treatment.

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