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The Cochrane Database of Systematic... Aug 2015Venous leg ulcers are a common and recurring type of chronic, complex wound associated with considerable cost to patients and healthcare providers. To aid healing,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Venous leg ulcers are a common and recurring type of chronic, complex wound associated with considerable cost to patients and healthcare providers. To aid healing, primary wound contact dressings are usually applied to ulcers beneath compression devices. Alginate dressings are used frequently and there is a variety of alginate products on the market, however, the evidence base to guide dressing choice is sparse.
OBJECTIVES
To determine the effects of alginate dressings compared with alternative dressings, non-dressing treatments or no dressing, with or without concurrent compression therapy, on the healing of venous leg ulcers.
SEARCH METHODS
For this first update, in March 2015, we searched the following databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.
SELECTION CRITERIA
Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of any type of alginate dressing in the treatment of venous ulcers were included.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, data extraction and risk of bias assessment. Meta-analysis was undertaken when deemed feasible and appropriate.
MAIN RESULTS
Five RCTs (295 participants) were included in this review. All were identified during the original review. The overall risk of bias was high for two RCTs and unclear for three. One RCT compared different proprietary alginate dressings (20 participants), three compared alginate and hydrocolloid dressings (215 participants), and one compared alginate and plain non-adherent dressings (60 participants). Follow-up periods were six weeks in three RCTs and 12 weeks in two. No statistically significant between-group differences were detected for any comparison, for any healing outcome. Meta-analysis was feasible for one comparison (alginate and hydrocolloid dressings), with data from two RCTs (84 participants) pooled for complete healing at six weeks: risk ratio 0.42 (95% confidence interval 0.14 to 1.21). Adverse event profiles were generally similar between groups (not assessed for alginate versus plain non-adherent dressings).
AUTHORS' CONCLUSIONS
The current evidence base does not suggest that alginate dressings are more or less effective in the healing of venous leg ulcers than hydrocolloid or plain non-adherent dressings, and there is no evidence to indicate a difference between different proprietary alginate dressings. However, the RCTs in this area are considered to be of low or unclear methodological quality. Further, good quality evidence is required from well designed and rigorously conducted RCTs that employ - and clearly report on - methods to minimise bias, prior to any definitive conclusions being made regarding the efficacy of alginate dressings in the management of venous leg ulcers.
Topics: Aged; Alginates; Bandages, Hydrocolloid; Compression Bandages; Female; Humans; Male; Pain Measurement; Randomized Controlled Trials as Topic; Varicose Ulcer
PubMed: 26286189
DOI: 10.1002/14651858.CD010182.pub3 -
BMJ (Clinical Research Ed.) Feb 1992
Topics: Bandages; Elasticity; Humans; Necrosis; Prescriptions; Varicose Ulcer
PubMed: 1559052
DOI: 10.1136/bmj.304.6826.520 -
Scientific Reports Sep 2020Bandaging is a steadfast but time-consuming component of wound care with limited technical advancements to date. Bandages must be changed and infection risk managed....
Bandaging is a steadfast but time-consuming component of wound care with limited technical advancements to date. Bandages must be changed and infection risk managed. Rapid-set liquid bandages are efficient alternatives but lack durability or inherent infection control. We show here that antibacterial zinc (Zn) and copper (Cu) species greatly enhance the barrier properties of the natural, waterproof, bio-adhesive polymer, shellac. The material demonstrated marked antibacterial contact properties and, in ex-vivo studies, effectively locked-in pre-applied therapeutics. When challenged in vivo with the polybacterial bovine wound infection 'digital dermatitis', Zn/Cu-shellac adhered rapidly and robustly over pre-applied antibiotic. The bandage self-degraded, appropriately, over 7 days despite extreme conditions (faecal slurry). Treatment was well-tolerated and clinical improvement was observed in animal mobility. This new class of bandage has promise for challenging topical situations in humans and other animals, especially away from controlled, sterile clinical settings where wounds urgently require protection from environmental and bacterial contamination.
Topics: Animals; Anti-Bacterial Agents; Bandages; Cattle; Cattle Diseases; Copper; Female; Humans; Surgical Wound Infection; Wound Healing; Zinc
PubMed: 32934279
DOI: 10.1038/s41598-020-71586-7 -
BMJ (Clinical Research Ed.) Apr 2009To compare the effectiveness of two types of compression treatment (four layer bandage and short stretch bandage) in people with venous leg ulceration. (Comparative Study)
Comparative Study Meta-Analysis Review
Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients.
OBJECTIVE
To compare the effectiveness of two types of compression treatment (four layer bandage and short stretch bandage) in people with venous leg ulceration.
DESIGN
Systematic review and meta-analysis of patient level data.
DATA SOURCES
Electronic databases (the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register, Medline, Embase, CINAHL, and National Research Register) and reference lists of retrieved articles searched to identify relevant trials and primary investigators. Primary investigators of eligible trials were invited to contribute raw data for re-analysis. Review methods Randomised controlled trials of four layer bandage compared with short stretch bandage in people with venous leg ulceration were eligible for inclusion. The primary outcome for the meta-analysis was time to healing. Cox proportional hazards models were run to compare the methods in terms of time to healing with adjustment for independent predictors of healing. Secondary outcomes included incidence and number of adverse events per patient.
RESULTS
Seven eligible trials were identified (887 patients), and patient level data were retrieved for five (797 patients, 90% of known randomised patients). The four layer bandage was associated with significantly shorter time to healing: hazard ratio (95% confidence interval) from multifactorial model based on five trials was 1.31 (1.09 to 1.58), P=0.005. Larger ulcer area at baseline, more chronic ulceration, and previous ulceration were all independent predictors of delayed healing. Data from two trials showed no evidence of a difference in adverse event profiles between the two bandage types.
CONCLUSIONS
Venous leg ulcers in patients treated with four layer bandages heal faster, on average, than those of people treated with the short stretch bandage. Benefits were consistent across patients with differing prognostic profiles.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Female; Humans; Leg Ulcer; Male; Middle Aged; Occlusive Dressings; Randomized Controlled Trials as Topic; Survival Analysis; Treatment Outcome; Wound Healing
PubMed: 19376798
DOI: 10.1136/bmj.b1344 -
The Cochrane Database of Systematic... May 2014Intermittent pneumatic compression (IPC) is a mechanical method of delivering compression to swollen limbs that can be used to treat venous leg ulcers and limb swelling... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intermittent pneumatic compression (IPC) is a mechanical method of delivering compression to swollen limbs that can be used to treat venous leg ulcers and limb swelling due to lymphoedema.
OBJECTIVES
To determine whether IPC increases the healing of venous leg ulcers. To determine the effects of IPC on health related quality of life of venous leg ulcer patients.
SEARCH METHODS
In April 2014, for this third update, we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that compared the effects of IPC with control (sham IPC or no IPC) or made comparisons between IPC treatment regimens, in venous ulcer management.
DATA COLLECTION AND ANALYSIS
Two review authors reviewed titles and abstracts and agreed on full studies to be retrieved. One review author extracted data and assessed studies for risk of bias and this was checked by a second review author.
MAIN RESULTS
We identified nine randomised controlled trials (including 489 people in total). Only one trial was at low risk of bias overall having reported adequate randomisation, allocation concealment and blinded outcome assessment. In one trial (80 people) more ulcers healed with IPC than with dressings (62% vs 28%; p=0.002). Five trials compared IPC plus compression with compression alone. Two of these (97 people) found increased ulcer healing with IPC plus compression than with compression alone. The remaining three trials (122 people) found no evidence of a benefit for IPC plus compression compared with compression alone.Two trials (86 people) found no difference between IPC (without additional compression) and compression bandages alone.One trial (104 people) compared different ways of delivering IPC and found that rapid IPC healed more ulcers than slow IPC (86% vs 61%).
AUTHORS' CONCLUSIONS
IPC may increase healing compared with no compression. It is unclear whether it can be used instead of compression bandages. There is some limited evidence that IPC may improve healing when added to compression bandages. Rapid IPC was better than slow IPC in one trial. Further trials are required to determine the reliability of current evidence, which patients may benefit from IPC in addition to compression bandages, and the optimum treatment regimen.
Topics: Air; Bandages; Humans; Intermittent Pneumatic Compression Devices; Randomized Controlled Trials as Topic; Stockings, Compression; Varicose Ulcer; Wound Healing
PubMed: 24820100
DOI: 10.1002/14651858.CD001899.pub4 -
Journal of Vascular Surgery Mar 2009Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers... (Review)
Review
Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers to treat. This brief review highlights effective methods of management. There is level 1 evidence of the efficacy of compression (bandaging or stockings) in healing ulcers as well as maintaining healing. Patients with superficial saphenous reflux, with or without perforating and deep vein incompetence, benefit from superficial venous surgery. This does not speed ulcer healing but is effective at preventing recurrence after healing with compression. Minimally invasive methods of managing incompetence of superficial saphenous trunks, including endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are probably also effective in treating patients with venous leg ulcers. Perforating vein ligation is commonly combined with superficial venous surgery for leg ulcer patients, but no systematic data are available to define the role of this treatment. Some centers use deep vein reconstruction to restore competence to deep vein valves. Insufficient data have been published to allow any general recommendation to be made for this treatment. A limited number of drugs have efficacy in promoting leg ulcer healing. They may be used in combination with compression treatment in patients with ulcers refractory to other methods of management. No particular ulcer dressing has been shown to be effective in speeding ulcer healing.
Topics: Bandages; Cardiovascular Agents; Catheter Ablation; Combined Modality Therapy; Evidence-Based Medicine; Humans; Laser Therapy; Leg Ulcer; Ligation; Practice Guidelines as Topic; Sclerotherapy; Stockings, Compression; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing
PubMed: 19268785
DOI: 10.1016/j.jvs.2009.01.003 -
International Wound Journal Aug 2015
Topics: Bandages, Hydrocolloid; Female; Humans; Middle Aged; Occlusive Dressings; Self-Injurious Behavior; Treatment Outcome; Ulcer
PubMed: 23786299
DOI: 10.1111/iwj.12114 -
Soins; La Revue de Reference Infirmiere 2016For any wound, necrosis is an obstacle to the formation of granulation tissue and creates an environment which is particularly favourable to the proliferation of...
For any wound, necrosis is an obstacle to the formation of granulation tissue and creates an environment which is particularly favourable to the proliferation of bacteria. Mechanical debridement, carried out by a doctor or nurse, or surgical debridement, is usually necessary. It is completed by autolytic debridement using technical dressings. Among the many modern dressings designed on the principle of the moist healing environment, some are more adapted to the debridement phase and are recommended by the French National Authority for Health.
Topics: Bandages, Hydrocolloid; Debridement; Humans; Wound Healing; Wounds and Injuries
PubMed: 26763564
DOI: 10.1016/j.soin.2015.12.004 -
Deutsches Arzteblatt International Mar 2018
Topics: Bandages; Humans; Postoperative Complications; Surgical Wound Infection; Wound Healing
PubMed: 29669675
DOI: 10.3238/arztebl.2018.0211 -
The British Journal of Surgery Jan 2017Surgical-site infection (SSI) occurs in 1-10 per cent of all patients undergoing surgery; rates can be higher depending on the type of surgery. The aim of this review... (Review)
Review
BACKGROUND
Surgical-site infection (SSI) occurs in 1-10 per cent of all patients undergoing surgery; rates can be higher depending on the type of surgery. The aim of this review was to establish whether (or not) surgical hand asepsis, intraoperative skin antisepsis and selected surgical dressings are cost-effective in SSI prevention, and to examine the quality of reporting.
METHODS
The authors searched MEDLINE via Ovid, CINAHL via EBSCO, Cochrane Central and Scopus databases systematically from 1990 to 2016. Included were RCTs and quasi-experimental studies published in English, evaluating the economic impact of interventions to prevent SSI relative to surgical hand and skin antisepsis, and wound dressings. Characteristics and results of included studies were extracted using a standard data collection tool. Study and reporting quality were assessed using SIGN and CHEERS checklists.
RESULTS
Across the three areas of SSI prevention, the combined searches identified 1214 articles. Of these, five health economic studies evaluating the cost-effectiveness of selected surgical dressings were eligible. Study authors concluded that the interventions being assessed were cost-effective, or were potentially cost-saving. Still, there is high uncertainty around the decision to adopt these dressings/devices in practice. The studies' reporting quality was reasonable; three reported at least 15 of the 24 CHEERS items appropriately. Assessment of methodological quality found that two studies were considered to be of high quality.
CONCLUSION
With few economic studies undertaken in this area, the cost-effectiveness of these strategies is unclear. Incorporating economic evaluations alongside RCTs will help towards evidence-informed decisions.
Topics: Bandages; Cost-Benefit Analysis; Humans; Negative-Pressure Wound Therapy; Surgical Wound Infection
PubMed: 28121042
DOI: 10.1002/bjs.10428