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Meta-Analysis
. 2015 Aug 19;2015(8):CD010182.
doi: 10.1002/14651858.CD010182.pub3.

Alginate dressings for venous leg ulcers

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

Alginate 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, complex wound associated with considerable cost to patients and healthcare providers. To aid healing, primary wound contact dressings are usually applied to ulcers beneath compression devices. Alginate dressings are used frequently and there is a variety of alginate products on the market, however, the evidence base to guide dressing choice is sparse.

Objectives: To determine the effects of alginate dressings compared with alternative dressings, non-dressing treatments or no dressing, with or without concurrent compression therapy, on the healing of venous leg ulcers.

Search methods: For this first update, in March 2015, we searched the following databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.

Selection criteria: Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of any type of alginate dressing in the treatment of venous ulcers were included.

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: Five RCTs (295 participants) were included in this review. All were identified during the original review. The overall risk of bias was high for two RCTs and unclear for three. One RCT compared different proprietary alginate dressings (20 participants), three compared alginate and hydrocolloid dressings (215 participants), and one compared alginate and plain non-adherent dressings (60 participants). Follow-up periods were six weeks in three RCTs and 12 weeks in two. No statistically significant between-group differences were detected for any comparison, for any healing outcome. Meta-analysis was feasible for one comparison (alginate and hydrocolloid dressings), with data from two RCTs (84 participants) pooled for complete healing at six weeks: risk ratio 0.42 (95% confidence interval 0.14 to 1.21). Adverse event profiles were generally similar between groups (not assessed for alginate versus plain non-adherent dressings).

Authors' conclusions: The current evidence base does not suggest that alginate dressings are more or less effective in the healing of venous leg ulcers than hydrocolloid or plain non-adherent dressings, and there is no evidence to indicate a difference between different proprietary alginate dressings. However, the RCTs in this area are considered to be of low or unclear methodological quality. Further, good quality evidence is required from well designed and rigorously conducted RCTs that employ - and clearly report on - methods to minimise bias, prior to any definitive conclusions being made regarding the efficacy of alginate dressings in the management of venous leg ulcers.

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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 author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Figures

1
1
Flow diagram of the trial selection process.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.
4
4
Forest plot of comparison: 2 Hydrocolloid dressings compared with alginate dressings, outcome: 2.1 Proportion of ulcers healed at 6 and 12 weeks.
1.1
1.1. Analysis
Comparison 1 Tegagen HG alginate dressing compared with Sorbsan alginate dressing, Outcome 1 Proportion of ulcers healed at 6 weeks.
1.2
1.2. Analysis
Comparison 1 Tegagen HG alginate dressing compared with Sorbsan alginate dressing, Outcome 2 Score for comfort of dressing during wear time at 6 weeks.
1.3
1.3. Analysis
Comparison 1 Tegagen HG alginate dressing compared with Sorbsan alginate dressing, Outcome 3 Score for comfort during dressing removal at 6 weeks.
1.4
1.4. Analysis
Comparison 1 Tegagen HG alginate dressing compared with Sorbsan alginate dressing, Outcome 4 Exudate absorption score at 6 weeks.
1.5
1.5. Analysis
Comparison 1 Tegagen HG alginate dressing compared with Sorbsan alginate dressing, Outcome 5 Ease of dressing removal score at 6 weeks.
2.1
2.1. Analysis
Comparison 2 Hydrocolloid dressings compared with alginate dressings, Outcome 1 Proportion of ulcers healed at 6 and 12 weeks.
2.2
2.2. Analysis
Comparison 2 Hydrocolloid dressings compared with alginate dressings, Outcome 2 Change in ulcer area in mm2 at 12 weeks.
2.3
2.3. Analysis
Comparison 2 Hydrocolloid dressings compared with alginate dressings, Outcome 3 Percentage change in ulcer area at 12 weeks.
2.4
2.4. Analysis
Comparison 2 Hydrocolloid dressings compared with alginate dressings, Outcome 4 Mean wear time (days).
2.5
2.5. Analysis
Comparison 2 Hydrocolloid dressings compared with alginate dressings, Outcome 5 Proportion of participants experiencing adverse events.
3.1
3.1. Analysis
Comparison 3 Plain non‐adherent dressings compared with alginate dressings, Outcome 1 Proportion of ulcers healed at 12 weeks.
See this image and copyright information in PMC

Update of

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