Effectiveness of dressings for healing venous leg ulcers

American Family Physician,  March 1, 2007  by Pablo Lopez,  Robert Dachs

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Clinical Question

Is one dressing superior to others when used for healing venous leg ulcers?

Evidence-Based Answer

No single dressing or type of dressing appears to be superior to others in the complete healing of ulcers or in healing rate.

Practice Pointers

Family physicians commonly encounter patients with venous leg ulcerations. A previous Cochrane review on the management of these ulcers noted that compression bandages or stockings improve ulcer healing. (1) However, the best dressing to place directly on the ulcer before applying a compression dressing is unclear. The ideal dressing would keep the wound moist, allowing cells to proliferate and migrate while excess drainage is absorbed. Many types of dressings are available. This Cochrane review evaluated whether one dressing provides superior healing compared with others.

The analysis included 42 prospective randomized controlled trials with 3,001 total patients. The dressings (Table 1) included hydrocolloids, hydrogels, alginates, foam dressings, bead dressings, and dry gauze. Most trials were small, ranging from 13 to 200 participants. The length of trials ranged from four to 40 weeks, with an average of 14 weeks of follow-up. The small sample size and short duration may have limited the ability of the studies to detect clinically important differences.

Thirty-one trials (74 percent) used the total number of healed ulcers as the primary outcome; the remaining studies used rate of healing as the primary outcome. However, healing rates may not correspond with complete healing of the ulcer.

Trials comparing hydrocolloids with low-adherent dressings included the most participants (n = 792). These trials showed that hydrocolloids were not superior to simple, low-adherent dressings. Other dressing comparisons also demonstrated no superiority.

The authors note a number of limitations in many of the studies that may limit the strength of their conclusions: small sample size and limited study duration, unspecified randomization techniques, and researchers who were unblinded to the treatment group. Only five studies were deemed to be of high methodologic quality.

There is insufficient evidence to recommend one type of dressing over another. The need for large, high-quality trials on this topic is evident because a lack of evidence does not necessarily equal a lack of effectiveness.

Source: Palfreyman SJ, et al. Dressings for healing venous leg ulcers. Cochrane Database Syst Rev 2006;(3):CD001103.

REFERENCE

(1.) Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for venous leg ulcers. Cochrane Database Syst Rev 2001;(2):CD000265.

TABLE 1
Dressings Commonly Used for Healing Venous Leg Ulcers

Dressing           Description

Alginates          Fibrous dressing, derived from seaweed, that
                   absorbs fluid; creates gel to keep wound moist;
                   allows gas exchange; prevents contamination
                   (e.g., Kaltostat, Sorbsan)

Bead dressings     Absorbs wound exudates, debris, and bacteria;
                   a separate dressing is required to hold beads in
                   place (e.g., Debrisan)

Foam dressings     Absorbs exudates into foam, keeping the wound
                   moist (e.g., Lyofoam, Allevyn, Cavicare)

Hydrocolloids      Occlusive dressing that absorbs wound exudates and
                   liquefies to keep the wound moist; impervious to
                   gas, bacteria, and liquid (e.g., Coloplast, Duoderm)

Hydrogels          Flat sheets of starch polymer that absorb wound
                   exudates or rehydrate the wound based on wound
                   moisture levels (e.g., Geliperm, Intrasite
                   Gel, Vigilon)

Semipermeable      Transparent film that keeps the wound moist;
  film dressings   allows some gas exchange; impervious to bacteria
                   (e.g., Bioclusive, Opsite, Tegaderm)

Wound dressing     Includes simple nonadherent dressings, knitted
  pads             viscose dressings, and medicated or nonmedicated
                   dressings (e.g., Adaptec, Silvadene, and Betadine
                   impregnated gauze; sterile gauze; Tricotex)

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