Systemic wound care: a meta-review of cochrane systematic reviews.
Wound care is a classic example of a surgical realm with a great variation in care. The diversity in wounds and wound treatments, the limited amount of convincing evidence, and the diverging opinions among doctors and nurses involved in wound care contribute to this undesirable variation in care. For chronic wounds, such as arterial or venous ulcers, pressure sores, and diabetic foot ulcers, but also for acute wounds after surgery or trauma, international and national guidelines provide recommendations on diagnostic procedures and treatment options, but rely mostly on expert opinion. We present the available evidence from Cochrane systematic reviews for the systemic treatment (i.e., not prevention) of patients with wounds, as opposed to topical wound treatments. This evidence shows: - Venous ulcers: High-compression therapy is the classic and evidence-based treatment for treating venous ulcers. Oral pentoxifylline promotes ulcer healing with and without compression therapy. Oral zinc is not effective to heal venous ulcers. - Acute wounds: Recombinant human growth hormone accelerates healing of large burn wounds and donor sites, while high-carbohydrate feeding might reduce the risk of pneumonia. Linezolid is more effective than vancomycin for treating skin and soft tissue infections. Hyperbaric oxygen may help heal crush wounds and skin grafts. Therapeutic touch does not heal acute wounds. - Pressure sores: Air-fluidized and some low-tech devices appear effective for treating existing pressure ulcers. Oral zinc, protein, or vitamin C supplements seem ineffective. Also, evidence is lacking on the effectiveness of repositioning regimes as a treatment option. - Diabetic ulcers: Hyperbaric oxygen therapy and pressure-relieving devices may improve healing rates. - Arterial ulcers: Prostanoids and spinal cord stimulation may be effective in healing ischemic ulcers. Thus, fortunately, some high-level evidence exists for various local and systemic interventions in wound care. Caregivers should be aware of, and apply, the strongest evidence available. Only when all stakeholders (patients, physicians, wound care nurses, but also manufacturers and buyers) implement this available evidence will optimum quality of care for patients with wounds be ensured.
Department of Surgery Academic Medical Center Amsterdam, The Netherlands.
Dirk T
DT
Ubbink
Department of Surgery Academic Medical Center Amsterdam, The Netherlands.
Trientje B
TB
Santema
Department of Surgery Academic Medical Center Amsterdam, The Netherlands.
Robert M
RM
Stoekenbroek
D001205:Ascorbic Acid / Q000627:therapeutic use; D058128:Compression Bandages; D006801:Humans; D006931:Hyperbaric Oxygenation; D012883:Skin Ulcer / Q000503:physiopathology* / Q000628:therapy*; D062187:Spinal Cord Stimulation; D000078202:Systematic Reviews as Topic; D014945:Wound Healing / Q000502:physiology*; D015032:Zinc / Q000627:therapeutic use
D015032:Zinc; D001205:Ascorbic Acid