The quality of evidence is downgraded by study limitations (lack of allocation concealment and blinding).
A Cochrane review [Abstract] 1 included 5 studies with a total of 535 subjects. These compared hydrocolloids with basic wound contact dressings, foam dressings, alginate dressings and a topical treatment. Meta-analysis of two studies indicated no statistically significant difference in ulcer healing between fibrous-hydrocolloids and basic wound contact dressings (RR 1.01; 95% CI 0.74 to 1.38, n = 229). One of these studies found that a basic wound contact dressing was more cost-effective than a fibrous-hydrocolloid dressing. One study compared a hydrocolloid-matrix dressing with a foam dressing and found no statistically significant difference in the number of ulcers healed (n = 40). There was no statistically significant difference in healing between an antimicrobial (silver) fibrous-hydrocolloid dressing and standard alginate dressing (n = 134), an antimicrobial dressing (iodine-impregnated) and a standard fibrous hydrocolloid dressing (n = 211), or a standard fibrous hydrocolloid dressing and a topical cream containing plant extracts (n=24).
A network analysis 2 included 21 RCTs with a total of 2159 patients diabetic foot ulcers. Amniotic membrane dressings were superior to alginate, basic wound contact, foam, honey-impregnated, hydrocolloid, and iodine-impregnated dressings. Hydrogel dressings were better than basic wound contact dressings. Other dressings showed no significant differences.
A systematic review and meta-analysis 3 evaluated synthetic active dressings in diabetic foot ulcer and venous leg ulcer management. Hydrogels were more effective in healing diabetic foot ulcers than basic wound contact dressings (RR 1.80, 95% CI 1.27 to 2.56]. The other dressing comparisons showed no statistically significant differences. Non-adherent dressings were more cost-effective than hydrofiber dressings. All venous leg ulcer pairwise dressing comparisons showed equivalent dressing efficacies in terms of promoting complete ulcer healing.
Another Cochrane review [Abstract] 4 included 4 studies with a total of 272 subjects. The studies compared hydrogel dressings with the following: gauze and saline, alginate dressing, manuka honey and hydrocolloid. Hydrogel compared with gauze and saline was better in complete wound healing (RR 5.33, 95% CI 1.73 to 16.42; 1 trial, n=60) and in change of ulcer size (mean difference (MD) -1.50, 95% CI -1.86 to -1.14; 1 trial, n=60). Hydrogel compared with alginate gel dressing was better (MD -41.80, 95% CI -63.95 to -19.65; 1 trial, n=20). There was no difference between hydrogel and manuka honey in complete wound healing (RR 0.75, 95% CI 0.46 to 1.21; 1 trial, n=108) or incidence of wound infection (RR 2.00, 95% CI 0.81 to 4.94; 1 trial, n=108). The certainty of the evidence was very low in all these results.
Clinicians may wish to consider aspects such as dressing cost and the wound management properties offered by each dressing type.
Date of latest search: 2024-01-15
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