A prospective, randomized trial of Unna's boots versus hydroactive dressing in the treatment of venous statis ulcers

Abstract

In many centers the standard treatment for venous stasis ulcers consists of UB dressings. A new dressing, DuoDERM hydroactive dressing (HD), has recently been used extensively for the treatment of venous stasis ulcers. Because of this trend, a prospective, randomized trial of these two dressings was undertaken. Sixty-nine ulcers (39 HD and 30 UB) were randomized. End points were complete healing and development of complications necessitating cessation of treatment. Time to healing, cost of treatment, and patient convenience were also evaluated. Twenty-one of 30 ulcers (70%) healed with UB therapy compared with 15 of 39 ulcers (38%) treated with HD (p less than 0.01, CST). Life-table healing rates at 15 weeks were 64% for UB compared with 35% for HD (p = 0.01, log rank test). Ten of 39 patients (26%) receiving HD had complications compared with no complications in the UB group (p = 0.004, FET). For those patients whose ulcers healed, there was no significant difference (p = 0.51, STT) in the mean time required for healing or the average weekly cost of dressing materials between the HD group (7.0 weeks at +11.50 per week) and the UB group (8.4 weeks at +12.60 per week). Those patients treated with HD reported a significantly greater level of convenience than those patients with UB (p = 0.004, STT). Although treatment with HD led to better patient acceptance, those patients receiving UB therapy had a significantly greater rate of healing and a significantly lesser incidence of complications than those patients treated with HD.

Risk factors related to the failure of venous leg ulcers to heal with compression treatment

“…Patients who possess either or both of these factors are at risk for not healing. 4,13,14 The results of our study do not support these findings. Large and long lasting ulcers could be healed although more time is needed.…”

“…12 Published healing rates of venous ulcers obtained with compression therapy vary widely from 40-95%. [4][5][6][7][8][9][10] Unfortunately, a significant number of venous ulcers remain refractory to compression treatment. A possible way to predict nonhealing venous leg ulcers is to examine prognostic risk factors that are consistently found in a number of published studies (large wound area and wound of long duration).…”

“…2,3 Published healing rates of venous ulcers obtained with compression therapy vary widely from 40-95%. [4][5][6][7][8][9][10] Several risk factors have been identified to be correlated with the failure of venous leg ulcers to heal with compression therapy (longer ulcer duration, large surface area, fibrinous deposition present on Ͼ50% of the wound surface, and an Ankle Brachial Pressure Index [ABPI] of Ͻ0.85). 11 The purpose of this study was to identify possible risk factors related to the failure of venous leg ulcers to heal with compression treatment.…”

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…280 Two of the studies (49 and 84 patients) failed to show a difference in healing rates between treatments at 7 weeks and 6 months of follow-up, respectively. 281,282 Another RCT of 321 patients compared SSB or 4LB with moist wound dressings without compression. The healing rate at 24 weeks was superior in both compression groups (72% SSB and 67% 4LB) compared with the noncompression group (29%; P < .0001).…”

Chronic venous insufficiency

“…Cost/cost effectiveness Many patients report less pain with this dressing. Ulcer healing rates are not better than with Unna's boot [16], however, and cost effectiveness is not clearly superior.…”