Background: To date, medical lore has determined the use of dressings, topical agents or other local treatments for poorly healing wounds. Since history gauze is the classical product used in local wound care. However, a profusion of sophisticated local wound care materials are winning ground. These modern materials are well marketed by the industry, resulting in an enormous quantity of different dressings (probably >800) or devices like topical negative pressure (TNP) used in local wound care. Whether this transition from classical to modern local wound care is based on strong and sufficient evidence, is to be questioned.

Objectives: Can level-one evidence from systematic reviews (SRs) fill the gap in the body of knowledge about local wound management?

Methods: We searched the Cochrane Database of Systematic Reviews up to Issue 1, 2004 for SRs and protocols on dressings, topical agents or other local treatments for wounds of various etiologies (postoperative and traumatic wounds, pressure and diabetic sores, arterial and venous ulcers), which described healing. We reviewed these SRs to find out how many Randomized Clinical Trials (RCTs) they comprised and what their implications for treatment and research were.

Results: We found 5 SRs, 1 on the local treatment of arterial leg ulcers[1], 2 on venous leg ulcers[2,3], 1 on diabetic foot ulcers[4] and 1 on chronic wounds [5]. They comprised 1, 4, 22, 5, and 2 RCTs, respectively, involving 10 to 299 patients (median: 42.5 patients). These 5 SRs described dressings and topical agents for arterial leg ulcers[1], intermittent pneumatic compression[2] and compression[3] for venous leg ulcers, debridement of diabetic foot ulcers[4], and TNP for treating chronic wounds[5]. Two SRs were not conclusive[1,2], 1 SR was circumstantially conclusive[5], and 2 SRs were conclusive[3,4]. The two conclusive SRs showed that hydrogel increases the healing rate of diabetic foot ulcers compared with gauze[3] and compression increases ulcer-healing rate compared with no compression[2]. Conclusions were limited by the small size and poor methodology of the RCTs. Conclusions: Even though SRs are available, evidence is strikingly scarce regarding local wound care, although this is a worldwide problem. In order to fill the gap in the body of knowledge as to local wound care, the development and conduction of good methodological RCTs (which are the basis for SRs) is encouraged. The results of such trials might help to guide physicians and nurses in choosing the optimal wound care products.

References: 1. Nelson EA, Bradley MD. Dressings and topical agents for arterial leg ulcers (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. 2. Mani R, Vowden K, Nelson EA. Intermittent pneumatic compression for treating venous leg ulcers (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. 3. Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for venous leg ulcers (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. 4. Smith J. Debridement of diabetic foot ulcers (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. 5. Evans D, Land L. Topical negative pressure for treating chronic wounds (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd.