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Meta-Analysis
. 2013 May 31;2013(5):CD009907.
doi: 10.1002/14651858.CD009907.pub2.

Foam dressings for venous leg ulcers

Susan O'Meara  1 , Marrissa Martyn-St James
Affiliations
Meta-Analysis

Foam dressings for venous leg ulcers

Susan O'Meara et al. Cochrane Database Syst Rev. .

Abstract

Background: Venous leg ulcers are a common and recurring type of chronic or complex wound that are associated with considerable cost to patients and to healthcare providers. Primary wound contact dressings are usually applied beneath compression devices with the aim of aiding healing. Foam dressings are used frequently, and a variety of foam products is available on the market. The evidence base to guide dressing choice, however, is sparse.

Objectives: To determine the effects of foam dressings on the healing of venous leg ulcers.

Search methods: In October 2012 we searched The Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); the Economic Evaluation Database (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; EBSCO CINAHL. There were no restrictions based on language or date of publication.

Selection criteria: We included published or unpublished randomised controlled trials (RCTs) that evaluated the effects of any type of foam dressing in the treatment of venous ulcers.

Data collection and analysis: Two review authors independently performed study selection, data extraction and risk of bias assessment. Meta-analysis was undertaken when deemed feasible and appropriate.

Main results: Twelve RCTs (1023 participants) reporting 14 comparisons were included in this review. There was no difference in healing outcomes between hydrocellular foam dressings and polyurethane foam dressings (three RCTs). Pooled data across five RCTs (418 participants) showed no statistically significant difference between foam dressings and hydrocolloid dressings in the proportion of ulcers healed at 12 to 16 weeks (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.81 to 1.22). No statistically significant between-group differences in healing outcomes were detected when foam dressings were compared with: paraffin gauze (two RCTs); hydrocapillary dressing (one RCT); knitted viscose dressing (one RCT); and protease modulating matrix (one RCT). No statistically significant between-group differences in the proportion of participants experiencing adverse events were detected when hydrocellular foam dressings were compared with polyurethane foam dressings, or when foam dressings were compared with hydrocapillary, hydrocolloid, or knitted viscose dressings (one RCT for each comparison). Six RCTs were considered as being at overall high risk of bias, and the remaining six RCTs were considered to be at overall unclear risk of bias. No included RCT had an overall low risk of bias.

Authors' conclusions: The current evidence base does not suggest that foam dressings are more effective in the healing of venous leg ulcers than other wound dressing treatments. The evidence in this area is of low quality. Further evidence is required from well-designed and rigorously-conducted RCTs, that employ methods to minimise bias and report them clearly, before any definitive conclusions can be made regarding the efficacy of foam dressings in the management of venous leg ulcers.

PubMed Disclaimer

Conflict of interest statement

This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP‐PG‐0407‐10428). The views expressed are those of the authors (Susan O'Meara and Marrissa Martyn‐St James) and not necessarily those of the NHS, the NIHR or the Department of Health.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.
3
3
Flow diagram of the study selection process
4
4
Forest plot of comparison: 4 Hydrocolloid compared with foam, outcome: 4.1 Proportion of ulcers completely healed at 12 to 16 weeks.
1.1
1.1. Analysis
Comparison 1 Hydrocellular foam compared with polyurethane foam, Outcome 1 Proportion of ulcers completely healed.
1.2
1.2. Analysis
Comparison 1 Hydrocellular foam compared with polyurethane foam, Outcome 2 Participants experiencing adverse events.
2.1
2.1. Analysis
Comparison 2 Paraffin gauze compared with foam, Outcome 1 Proportion of ulcers healed at 17 weeks.
3.1
3.1. Analysis
Comparison 3 Hydrocapillary compared with foam, Outcome 1 Proportion of ulcers healed at 12 months.
3.2
3.2. Analysis
Comparison 3 Hydrocapillary compared with foam, Outcome 2 Participants experiencing adverse events.
4.1
4.1. Analysis
Comparison 4 Hydrocolloid compared with foam, Outcome 1 Proportion of ulcers completely healed at 12 to 16 weeks.
4.2
4.2. Analysis
Comparison 4 Hydrocolloid compared with foam, Outcome 2 Participants experiencing dressing‐related adverse events.
5.1
5.1. Analysis
Comparison 5 Knitted viscose compared with foam, Outcome 1 Proportion of ulcers healed at 12 weeks.
5.2
5.2. Analysis
Comparison 5 Knitted viscose compared with foam, Outcome 2 Participants experiencing adverse events.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009907

References

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