Dressings and Topical Agents for Chronic Wounds - NIHR Health ...

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ResultsMoffatt et al., 1992 88Comparison: Traditional vs. Alginate dressing (Tegagel ® )Median baseline area (cm 2 ): 6.4 3.6(range, 1.1–9.9) (range, 0.9–9.8)Sample size (N): 30 30No. of wounds healed (n/N): 24/30 26/30 1.62 (0.4, 6.5)Traditional dressing: Knitted viscose dressing (N-A ® )Wound type: Venous leg ulcersFollow-up time: 12 weeksWunderlich & Orfanos, 1991 87Comparison: Traditional vs. Activated charcoal andsilver dressing (Actisorb ® )Mean baseline area (cm 2 ): 2 3Sample size (N): 19 19 3.9 (0.67, 22.7)No. of wounds healed (n/N): 2/19 6/19 10% reduction in wound area: 65 75Traditional dressing:Wound type:Follow-up time:Paraffin gauzeVenous leg ulcers6 weeksStacey et al., 1992 89Comparison: Zinc bandage vs. Zinc stockinetteMean baseline area (cm 2 ): 10.8 9.9(range, 1.5–57.5) (range, 3.6–61.3)Sample size (N): 43 44 1.83 (0.78, 4.28)No. of wounds healed (n/N): 25/43 19/44Wound type:Follow-up time:Venous leg ulcers9 monthsComparison: Zinc bandage vs. AlginateMean baseline area (cm 2 ): 10.8 10.7(range, 1.5–57.5) (range, 2.4–75.4)Sample size (N): 43 46 2.6 (1.1, 6.14)No. of wounds healed (n/N): 25/43 16/46Wound type:Follow-up time:Venous leg ulcers9 monthsComparison: Zinc vs. AlginatestockinetteMean baseline area (cm 2 ): 9.9 10.7(range, 3.6–61.3) (range, 2.4–75.4)Sample size (N): 44 46 1.42 (0.61, 3.34)No. of wounds healed (n/N): 19/44 16/46Wound type:Follow-up time:Venous leg ulcers9 monthsTegagel ® , 3M LtdN-A ® , Johnson & Johnson Medical LtdActisorb ® , Johnson & Johnson Medical Ltd0.01 0.1 1 10 100 OR(95% CI)ES–40 –20 0 20 40 (95% CI)Favours traditional dressingFavours modern dressing24FIGURE 12 Modern compared with traditional dressings for venous leg ulcers
Health Technology Assessment 1999; Vol. 3: No. 17 (Pt 2)Pessenhoffer & Stangl, 1989; 91 1992 92Comparison: Traditional vs. Foam (Lyomousse ® )Median baseline area (cm 2 ): 11.7 (24.24 SD) 10.8 (17.4 SD)Sample size (N): 23 25Mean % change in woundarea (no. of wounds remaining): +78.3 (17) –65.6 (24) 144 (48.8, 239)Traditional dressing: Sterile gauze compressWound type: Venous leg ulcersFollow-up time: Up to 281 daysCallam et al., 1992 90Comparison: Traditional vs. Foam (Allevyn)Mean baseline area (cm 2 ): 8.35 10.87Sample size (N): 66 66No. of wounds healed: 23/66 (35%) 31/66 (47%) 1.67 (0.8, 3.3)Traditional therapy: Knitted viscose dressingWound type: Venous leg ulcersFollow-up time: 12 weeksDavis et al., 1992 93Comparison: Traditional vs. Film (Tegaderm/Bioclusive ® )Mean baseline area (cm 2 ): Not stated Not statedSample size (N): 6 patients 5 patientsMean % reduction in wound area: 7.1 (n = 7) 39.26 (n = 5) 32.15 (10.18, 54.12)Traditional dressing: Unna’s BootWound type: Venous leg ulcersFollow-up time: 6 monthsBanerjee et al., 1990 94Comparison: Traditional vs. Film (Synthaderm ® )Mean baseline area (cm 2 ): Not stated Not statedSample size (N): 35 36No. of wounds healed (n/N): 8/35 11/36 1.48 (0.5, 4.3)Traditional dressing: Saline-soaked gauzeWound type: Venous leg ulcersFollow-up time: 17 weeksLyomousse ® , (not distributed in the UK)Bioclusive ® , Johnson & Johnson Medical LtdSynthaderm ® , (not currently distributed)0.01 0.1 1 10 100 OR(95% CI)ES–400 –200 0 200 400 (95% CI)Favours traditionaldressingFavours semi-occlusivedressingFIGURE 13 Foam or film compared with control for venous leg ulcersallocated to the control group. The eight studiesthat provided data on the proportion of ulcerscompletely healed during the trial period werepooled using a random effects model. Therewas no significant difference in the proportionof ulcers healed at follow-up (pooled OR, 1.4;95% CI, 0.83–2.34) (Figure 14; appendix 10,Table 21). A random effects model was used toestimate the overall ES, as it assumes that variationin the meta-analysis is a combination of randomerror within studies and variation between studies.Random effects models are more conservativethan fixed effects models, giving estimates withwider CIs. As there was significant statisticalheterogeneity in this meta-analysis (χ 2 forheterogeneity, 16.72; df = 7; p = 0.019),a random effects model is appropriate.Sensitivity analysis was undertaken by furthermeta-analyses to explore what influence certainstudies had on the overall analysis. Excluding thetrial by Moffatt and co-workers, 97 in which theulcers were more chronic (inclusion criteriaincluded failure to heal with a four-layer regimenafter 24 weeks, or failure to reduce ulcer size bya minimum of 20% in 12 weeks), yielded an OR25
Page 1 and 2: Health Technology Assessment 1999;
Page 3 and 4: Systematic reviews of wound careman
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Page 10 and 11: Executive summarythan either an alg
Page 12 and 13: Introduction2sores) or due to under
Page 14 and 15: Introduction4healing rates are low
Page 22 and 23: ResultsMacfie & McMahon, 1980 34Com
Page 24 and 25: ResultsLe Vasseur & Helme, 1991 40C
Page 26 and 27: ResultsMustoe et al., 1994 43Compar
Page 28 and 29: ResultsSayag et al., 1996 49Compari
Page 30 and 31: ResultsOleske et al., 1986 57Compar
Page 32 and 33: ResultsBrod et al., 1990 66Comparis
Page 36 and 37: ResultsArnold et al., 1994 99Compar
Page 38 and 39: Results28healed under a lyophilised
Page 40 and 41: ResultsZuccarelli, 1993 113Comparis
Page 42 and 43: ResultsHolzinger et al., 1994 70Com
Page 44 and 45: ResultsWerner-Schlenzka & Kuhlmann,
Page 46 and 47: ResultsTosti & Veronesi, 1983 132Co
Page 48 and 49: ResultsSix trials evaluated cost-ef
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Appendix 6TABLE 7 contd Dressings c
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Appendix 8TABLE 16 Topical preparat
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Appendix 11124TABLE 27 Summary of c
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Appendix 11TABLE 28 Differences in
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HTA Commissioning BoardCurrent memb
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