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October 2007

Dressings for Acute and Chronic Wounds: A Systematic Review

Author Affiliations

Author Affiliations: Department of Dermatology, Centre Hospitalier Universitaire d’Amiens, Amiens, France (Dr Chaby); Department of Geriatrics, Assistance Publique–Hôpitaux de Paris, Hôpital Charles Foix, Ivry-sur-Seine, France (Drs Senet and Meaume); Dermatology Consultations, Assistance Publique–Hôpitaux de Paris, Hôpital Rothschild, Paris, France (Dr Senet); Haute Autorité de Santé, Saint Denis, France (Drs Vaneau, Martel, and Denis); Department of Dermatology, Centre Hospital Général de Colmar, Colmar, France (Dr Guillaume); Department of Orthopedic Surgery and Burn and Plastic Surgery Center, Hôpital Lapeyronie, Montpellier, France (Dr Téot); Department of Vascular Rehabilitation, Assistance Publique–Hôpitaux de Paris, Hôpital Broussais, Paris (Dr Debure); Department of Dermatology, Centre Hospitalier Universitaire de Caen, Caen, France (Dr Dompmartin); Department of Pharmacology, Centre Hospitalier Régional Universitaire Lille, Lille, France (Dr Bachelet); Department of Burns, Hôpital d’Instruction des Armées Percy, Clamart, France (Dr Carsin); Department of Pharmacology, Centre Hospitalier Bar le Duc, Bar le Duc, France (Dr Matz); Department of Nutritional Diseases and Diabetology, Centre Medical, Le Grau du Roi, Centre Hospitalier Universitaire Nîmes, France (Dr Richard); Department of Physical and Rehabilitation Medicine, Centre de Rééducation de Coubert, Coubert, France (Dr Rochet); Department of Pharmacology, Assistance Publique-Hôpitaux de Marseille, Marseille, France (Dr Sales-Aussias); Department of Dermatology, Hôpitaux d’Instruction des Armées Clermont Tonnerre, Brest, France (Dr Zagnoli); Department of Dermatology, Centre Hospitalier Universitaire de Montpellier, Montpellier (Dr Guillot); and Université Pierre-et-Marie-Curie–Paris VI, and Department of Dermatology and Allergy, Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris (Dr Chosidow).

Arch Dermatol. 2007;143(10):1297-1304. doi:10.1001/archderm.143.10.1297

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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