Dressings for acute and chronic wounds: a systematic review.
OBJECTIVE
To critically review the literature on the efficacy of modern dressings in healing chronic and acute wounds by secondary intention.


METHODS
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.


METHODS
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).


METHODS
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.


RESULTS
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.
Chaby
Guillaume
G
Department of Dermatology, Centre Hospitalier Universitaire d'Amiens, Amiens, France.
Senet
Patricia
P
Vaneau
Michel
M
Martel
Philippe
P
Guillaume
Jean-Claude
JC
Meaume
Sylvie
S
Téot
Luc
L
Debure
Clélia
C
Dompmartin
Anne
A
Bachelet
Hélène
H
Carsin
Hervé
H
Matz
Véronique
V
Richard
Jean Louis
JL
Rochet
Jean Michel
JM
Sales-Aussias
Nathalie
N
Zagnoli
Anne
A
Denis
Catherine
C
Guillot
Bernard
B
Chosidow
Olivier
O
D000208:Acute Disease; D001458:Bandages / Q000592:standards* / Q000639:trends*; D047070:Bandages, Hydrocolloid / Q000592:standards; D002908:Chronic Disease; D006801:Humans; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000503:physiopathology / Q000628:therapy*