New Review Throws Doubt on Wound Care Treatments

A new systematic review of the treatment of skin ulcers suggests that most studies are so technically flawed that their results cannot be trusted.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) conducted a systematic review of studies examining the comparative effectiveness of advanced wound dressings, antibiotics, and surgical management of chronic venous ulcers. The researchers found that of 10,066 citations identified in the literature search, only 66 (0.06%) met liberal inclusion criteria for providing evidence on the effectiveness of interventions for chronic venous ulcers, while the vast majority of the studies suffered from important research gaps and methodological deficiencies.

From the studies that did meet the criteria, the researchers found that dressings that used living human cells increased wound healing. Another finding was that cadexomer iodine and collagen may also increase healing. The evidence was inconclusive regarding the use of systemic antibiotics, unless demonstrated signs of infection were found. Surgical treatments such as radiofrequency ablation, endovenous laser treatment, and sclerotherapy helped healing, while surgical correction of the underlying pathology did help to decrease recurrence of ulcers. The review was published online ahead of print on October 17, 2013, in Wound Repair and Regeneration.

“There is a critical need for well-designed research studies to compare the current minimally invasive surgical interventions to the gold standard of care, compression therapy,” concluded lead author Gerald Lazarus, MD, and colleagues of the JHU Evidence-Based Practice Center. “The review should serve as a means to bring the wound healing community together to improve the situation.”

Compression therapy is the recognized treatment of choice for recurrent venous leg ulcers, combining two mechanisms of action: a static effect (resting pressure) and a dynamic effect due to the changing circumference of the leg during walking. Effective compression is achieved by accurate application of hosiery, tubular bandages, and bandage systems, which provide some compression at rest, but work effectively during exercise. These systems are intended to provide graduated compression to the lower limb in order to improve venous return and lymphatic drainage, thus also reducing edema.

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