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Dressings for Acute and Chronic Wounds A Systematic Review

Guillaume Chaby, MD; Patricia Senet, MD; Michel Vaneau, PharmD; Philippe Martel, MD; Jean-Claude Guillaume, MD; Sylvie Meaume, MD; Luc Téot, MD, PhD; Clélia Debure, MD; Anne Dompmartin, MD; Hélène Bachelet, PharmD; Hervé Carsin, MD; Véronique Matz, PharmD; Jean Louis Richard, MD; Jean Michel Rochet, MD; Nathalie Sales-Aussias, PharmD; Anne Zagnoli, MD; Catherine Denis, MD; Bernard Guillot, MD; Olivier Chosidow, MD, PhD
Arch Dermatol. 2007;143(10):1297-1304. doi:10.1001/archderm.143.10.1297.
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Objective  To critically review the literature on the efficacy of modern dressings in healing chronic and acute wounds by secondary intention.

Data Sources  Search of 3 databases (MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register) from January 1990 to June 2006, completed by manual research, for articles in English and in French.

Study Selection  The end points for selecting studies were the rate of complete healing, time to complete healing, rate of change in wound area, and general performance criteria (eg, pain, ease of use, avoidance of wound trauma on dressing removal, ability to absorb and contain exudates). Studies were selected by a single reviewer. Overall, 99 studies met the selection criteria (89 randomized controlled trials [RCTs], 3 meta-analyses [1 of which came from 1 of the selected systematic reviews], 7 systematic reviews, and 1 cost-effectiveness study).

Data Extraction  The RCTs, meta-analyses, and cost-effectiveness studies were critically appraised by 2 reviewers to assess the clinical evidence level according to a modification of Sackett's 1989 criteria. Ninety-three articles were finally graded.

Data Synthesis  We found no level A studies, 14 level B studies (11 RCTs and 3 meta-analyses), and 79 level C studies. Hydrocolloid dressings proved superior to saline gauze or paraffin gauze dressings for the complete healing of chronic wounds, and alginates were better than other modern dressings for debriding necrotic wounds. Hydrofiber and foam dressings, when compared with other traditional dressings or a silver-coated dressing, respectively, reduced time to healing of acute wounds.

Conclusions  Our systematic review provided only weak levels of evidence on the clinical efficacy of modern dressings compared with saline or paraffin gauze in terms of healing, with the exception of hydrocolloids. There was no evidence that any of the modern dressings was better than another, or better than saline or paraffin gauze, in terms of general performance criteria. More wound care research providing level A evidence is needed.

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Flowchart describing the selection of studies for analysis. MA indicates meta-analysis; RCTs, randomized controlled trials. The asterisk indicates that 1 of the MAs came from a selected systematic review. The dagger indicates that 6 of the 7 systematic reviews, consensus, and guidelines did not have any RCTs or MAs and were not critically appraised.15

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