Topical negative pressure for treating chronic wounds.
BACKGROUND
Chronic wounds mainly affect the elderly and those with multiple health problems. Despite the use of modern dressings, some of these wounds take a long time to heal, fail to heal, or recur, causing significant pain and discomfort to the person and cost to health services. Topical negative pressure (TNP) is used to promote healing of surgical wounds by using suction to drain excess fluid from wounds.


OBJECTIVE
To assess the effects of TNP on chronic wound healing.


METHODS
For this second update of this review we searched the Cochrane Wounds Group Specialised Register (December 2007), The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 4, 2007, Ovid MEDLINE - 1950 to November Week 2 2007, Ovid EMBASE - 1982 to 2007 Week 50 and Ovid CINAHL - 1980 to December Week 1 2007. In addition, we contacted authors, companies, manufacturers, and distributors to identify relevant trials and information.


METHODS
All randomised controlled trials which evaluated the effects of TNP on people with chronic wounds.


METHODS
Selection of the trials, quality assessment, data abstraction, and data synthesis were done by two authors independently. Disagreements were solved by discussion.


RESULTS
Two trials were included in the original review. A further five trials were included in this second update resulting in a total of seven trials involving 205 participants. The seven trials compared TNP with five different comparator treatments. Four trials compared TNP with gauze soaked in either 0.9% saline or Ringer's solution. The other three trials compared TNP with hydrocolloid gel plus gauze, a treatment package comprising papain-urea topical treatment, and cadexomer iodine or hydrocolloid, hydrogels, alginate and foam. These data do not show that TNP significantly increases the healing rate of chronic wounds compared with comparators. Data on secondary outcomes such as infection rate, quality of life, oedema, hospitalisation and bacterial load were not reported.


CONCLUSIONS
Trials comparing TNP with alternative treatments for chronic wounds have methodological flaws and data do demonstrate a beneficial effect of TNP on wound healing however more, better quality research is needed.
Ubbink
Dirk T
DT
Departments of Surgery and Clinical Epidemiology, J1b-215 Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22700, Amsterdam, Netherlands, 1100 DE. d.ubbink@amc.uva.nl
Westerbos
Stijn Joël
SJ
Evans
Debra
D
Land
Lucy
L
Vermeulen
Hester
H
D001458:Bandages; D002908:Chronic Disease; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D014945:Wound Healing