Chaby G, Senet P, Vaneau M, et al. Dressings for acute and chronic wounds: a systematic review. Arch Dermatol. 2007;143(10):1297-1304.
In the United States more than 1.25 million individuals are treated for burns and more than 6.5 million are treated for chronic pressure, venous, or diabetic ulcers. Professionals involved in the wound care medical arena have known for half a century that moisture-retentive dressings promote wound healing and reduce pain and healing time, yet the ideal dressing choice has remained controversial.
Critically review literature on healing efficacy of modern dressings in chronic and acute wounds that heal by secondary intention.
MEDLINE, EMBASE, and Cochrane reference databases were searched from January 1990 through June 2007 for English or French reviews, practice guidelines, meta-analyses, or randomized controlled trials (RCTs) measuring complete healing of acute or chronic wounds dressed with hydrocolloid, foam, alginate, hydrogel, Hydrofiber, bead, protease-modulating, silver, activated charcoal, hyaluronic acid, other nongauze dressings, and all types of gauze dressings. Included studies were reviewed by 2 of 19 independent reviewers and were rated as Level A if the studies were well-conducted, large, randomized, double-blind, controlled RCTs, or meta-analyses (MA) of such RCTs that had low α and β errors. Small, well conducted RCTs or MA including same or including Level C RCT were rated as Level B. RCTs with one or more methodological shortcoming were rated Level C.
No Level A, large, RCT was found among the 89 RCTs and 3 MA selected for analysis. The most evidence was found for hydrocolloid (34 RCTs, 3 MA), foam (22 RCTs, 2 MA), and alginate dressings (21 RCTs).
Five RCTs and one MA on chronic wounds provided Level B evidence supporting the following conclusions: 1) improved complete healing rates of hydrocolloid-dressed (HCD) leg and pressure ulcers as compared to paraffin impregnated or wet-to-dry gauze; 2) No consistent difference in complete healing between HCD and foam-dressed wounds; 3) Alginate dressings reduced pain during dressing changes compared to HCD or paraffin-gauze-dressed wounds; and 4) debrided more fibrous tissue from pressure ulcers than dextranomer beads; 5) A nonadherent dressing evoked less dressing change pain than HCD in one study that did not measure complete healing.
For acute wounds, 4 RCTs provided Level B evidence that: 1) Split-thickness skin graft donor site (SSDS) healing efficacy did not differ between foam, paraffin gauze, or film dressings; 2) SSDS healed faster when dressed with a foam as compared to a silver-coated dressing; and 3) healed faster with less pain during dressing changes when dressed with a Hydrofiber as compared to paraffin gauze dressing; or 4) when dressed with a glycerin-impregnated dressing as compared to a hyaluronic acid dressing. No consistent effects on healing or dressing change pain were observed in the remaining two RCTs both on surgical wounds.
Reviews provide a weak level of evidence on clinical efficacy of different dressing types on wounds. Hydrocolloids and foam dressings have the best evidence for optimizing complete healing of chronic wounds. Alginate dressings have the best evidence for chronic wound necrotic tissue debridement. Hydrofiber dressings have the best evidence for speeding healing of acute wounds. More large, A-Level, RCTs are needed to support wound care dressing decisions.