Dressings for healing venous leg ulcers

Palfreyman, Simon; Nelson, E Andrea; Lochiel, Rona; Michaels, J

doi:10.1002/14651858.cd001103.pub3

Cited by 32 publications

(39 citation statements)

References 106 publications

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“…On the whole, current study data do not allow for conclusions on a significant advantage of a certain wound dressing in the healing rate of diabetic or venous ulcers [15,76,78,79,81,87,88]. …”

Section: Moisture Balancementioning

confidence: 88%

“…Edwards et al confirmed this observation for diabetic ulcers [18]. In a further meta-analysis of 42 randomized clinical studies with a comparison of hydrocolloid, foam, alginate and hydrogel dressings in combination with compression for the therapy of venous ulcers, none of the products displayed a significantly higher healing rate [79]. Especially innovative hydrogels that react to wound conditions (for example, pH-dependent release of wound healing factors) may play an increasing role in the topical therapy of chronic wounds [19].…”

Section: Moisture Balancementioning

confidence: 91%

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Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Klein

Schreml

Dolderer

et al. 2013

J Deutsche Derma Gesell

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SummaryThe number of patients suffering from chronic wound healing disorders in Germany alone is estimated to be 2.5-4 million. Therapy related expenses reach 5-8 billion Euros annually. This number is partially caused by costly dressing changes due to non-standardized approaches and the application of non-evidence-based topical wound therapies. The purpose of this paper is to elucidate a straightforward principle for the management of chronic wounds, and to review the available evidence for the particular therapy options. The T.I.M.E.-principle (Tissue management, Inflammation and infection control, Moisture balance, Epithelial [edge] advancement) was chosen as a systematic strategy for wound bed preparation. Literature was retrieved from the PubMed and Cochrane Library databases and subjected to selective analysis.Topical wound management should be carried out according to a standardized principle and should further be synchronized to the phases of wound healing. Despite the broad implementation of these products in clinical practice, often no benefit exists in the rate of healing, when evaluated in meta-analyses or systematic reviews. This insufficient evidence is additionally limited by varying study designs. In case of non-superiority, the results suggest to prefer relatively inexpensive wound dressings over expensive alternatives. Arbitrary endpoints to prove the effectiveness of wound dressings, contribute to the random use of such therapies. Defining rational endpoints for future studies as well as the deployment of structured therapy strategies will be essential for the economical and evidence-based management of chronic wounds.

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Section: Moisture Balancementioning

confidence: 88%

Section: Moisture Balancementioning

confidence: 91%

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Klein

Schreml

Dolderer

et al. 2013

J Deutsche Derma Gesell

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“…Moreover, the follow-up times for the majority of the RCTs were 8 or 12 weeks. Diabetic foot ulcers and venous leg ulcers are chronic wounds that usually take longer than two-three months to heal [31,32], so RCTs with short follow-up times in which complete ulcer healing is assessed will have low event rates and consequently low power [19]. Therefore, pooling data from RCTs with different follow-up times may have increased clinical heterogeneity and consequently reduced the validity of our results.…”

Section: Discussionmentioning

confidence: 99%

“…Synthetic active dressings, such as acrylic, alginate, film, foam, hydrocolloid, hydrofiber, and hydrogel dressings, have purportedly improved outcomes in many situations and have been slowly replacing gauze and other traditional dressings. Although synthetic active dressings are advertised to make gauze and other traditional dressings appear antiquated by comparison, their supposed superiority remains questionable in the context of diabetic foot ulcer and venous leg ulcer treatment [12][13][14][15][16][17][18][19]. The purpose of our systematic review and meta-analysis is to critically assess the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in diabetic foot ulcer and venous leg ulcer healing and then make clinical practice recommendations based on our findings.…”

Section: Introductionmentioning

confidence: 99%

Comparing the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of diabetic foot ulcers and venous leg ulcers: A systematic review and metaanalysis examining how to dress for success

2016

Journal of the American Academy of Dermatology

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Diabetic foot ulcers and venous leg ulcers are chronic wounds frequently encountered by dermatologists. Choosing appropriate wound dressings can effectively promote wound healing and potentially reduce morbidity and financial burden experienced by patients. The objective of our systematic review and meta-analysis was to evaluate wound healing efficacies of synthetic active dressings in diabetic foot ulcer and venous leg ulcer management. For data collection, PubMed, Embase, Cochrane Library, CINAHL, and clinicaltrials.gov online databases were searched from database inception to 10 May 2015. Fixed and random effects modeling were used to calculate pooled risk ratios for complete ulcer healing from pairwise dressing comparisons. The results of our review showed moderate-quality level evidence that hydrogels were more effective in healing diabetic foot ulcers than basic wound contact dressings (RR 1.80 [95% CI, 1.27-2.56]). The other dressing comparisons showed no statistically significant differences between the interventions examined in terms of achieving complete diabetic foot ulcer healing. Nonadherent dressings were more cost-effective than hydrofiber dressings for diabetic foot ulcers in terms of mean total cost per patient of the dressings themselves. All venous leg ulcer pairwise dressing comparisons showed equivalent dressing efficacies in terms of promoting complete ulcer healing. Overall, most synthetic active dressings and traditional wound dressings are equally efficacious in treating diabetic foot ulcers and venous leg ulcers. For treating diabetic foot ulcers, hydrogels are more efficacious than basic wound contact dressings, and non-adherent dressings are more cost-effective than hydrofiber dressings. Ultimately, dressing choice should be tailored to the wound and the patient.

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“…Esses cuidados abrangem, além da terapia tópica, o uso da terapia compressiva, que objetiva o controle da insuficiência venosa crônica associada ao exercício físico, repouso e elevação das pernas para o controle do edema. Não obstante, faz-se, ainda, necessário o controle de doenças crônicas, como obesidade, hipertensão arterial e diabetes; dieta balanceada e, em alguns casos, medicamentos venotônicos 5,6 .…”

Section: Introducãounclassified

A experiência de autocuidado de mulheres que convivem com úlcera venosa crônica

Silva

Jesús

Merighi

et al. 2016

Estima

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RESUMOA úlcera venosa é mais prevalente em mulheres, sobretudo as idosas, sendo que a cronicidade e o caráter recorrente desse tipo de lesão podem trazer implicações para o autocuidado. Neste estudo, fundamentado na fenomenologia social de Alfred Schütz, objetivou-se compreender a experiência de autocuidado de mulheres que convivem com úlcera venosa crônica. Participaram sete mulheres, cujos depoimentos foram obtidos em 2012. Os resultados desvelaram que o autocuidado da mulher acometida pela úlcera venosa crônica inclui dificuldades relacionadas à própria higienização, vestimentas e calçados, repouso e adesão ao tratamento tópico e compressivo da úlcera venosa crônica, além do controle da dor. Ainda que não realizem plenamente o autocuidado orientado pelo profissional, as participantes têm a expectativa de conseguir a cicatrização, ter saúde e retomar suas atividades cotidianas afetadas pela ferida. Conclui-se que o maior desafio posto está em fazer com que as orientações profissionais para o manejo da úlcera venosa crônica se desdobrem em autocuidado efetivo. Tal ação está atrelada ao modo como o profissional percebe a realidade de cada mulher e se propõe a intervir, compartilhando, ajudando-a a transcender suas dificuldades em relação à doença e a encontrar caminhos que a empoderem no cuidado de si mesma. DESCRITORES:Estomaterapia. Úlcera varicosa. Autocuidado. Enfermagem. ABSTRACTThe venous leg ulcers are more prevalent in women, especially among the elderly, and its chronicity and the recurring nature of this type of injury may cause implications in self-care. This study aimed to understand the self-care experience of women who has to deal with chronic venous ulcers. We based our research on the social phenomenology of Alfred Schütz. Seven women participated and their testimonials were collected in 2012. The results unveiled that the self-care of women affected by chronic venous ulcers includes difficulties related to their own hygiene, clothing and footwear, rest and adherence to topic and compressive treatments of chronic venous ulcers, in addition to pain control. Although not fully performing self-care guided by a professional, the participants expect to achieve healing, to recover their health and to continue their daily activities, which are affected by the wound. We concluded that the greatest challenge is to make the professional guidelines for the management of chronic venous ulcers unfold themselves in effective self-care. Such action is linked to the way the professional perceives the reality of every woman and proposes to to make interventions with her consent, helping her to transcend her difficulties related to the disease and to find ways that empower her in self-caring.

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Dressings for healing venous leg ulcers

Cited by 32 publications

References 106 publications

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Comparing the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of diabetic foot ulcers and venous leg ulcers: A systematic review and metaanalysis examining how to dress for success

A experiência de autocuidado de mulheres que convivem com úlcera venosa crônica

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