NPC Archive Item: Modern wound care dressings: where is the evidence for their effectiveness?

NOTE – This is an archive post from the NPC and has not been updated since first publication. Therefore, some hyperlinks may no longer be working.
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Chaby G, Senet P, Vaneau M, et al. Dressings for acute and chronic wounds. A systematic review. Arch Dermatol 2007; 143: 1297–1304. Accessed on 17/10/07

Whats the story here?
Despite the widespread use of modern wound care dressings, there are few robust randomised controlled trials showing evidence for improved patient-oriented outcomes (POOs) compared to traditional, usually cheaper dressings. A recent systematic review has been published to try and address this.

What did the study say?
The review included 99 studies published between 1990 and 2006. Unfortunately, it could not identify one single, high-quality study, indeed 80% of the studies were considered to have at least one major shortcoming. The only findings of note in the review, bearing in mind the weak evidence, were:

For chronic wounds:

  • Hydrocolloid dressings were better than saline gauze or paraffin gauze for complete healing
  • Alginates, singly or in sequential treatment with hydrocolloid dressings, were better than other modern dressings for debriding necrotic wounds and reducing wound area.

For acute wounds:

  • Hydrofibre and foam dressings reduced time to healing in comparison with traditional dressings (paraffin gauze or wet-to-dry gauze dressings)
  • Hydrofibre and foam dressings reduced time to healing in comparison when compared with modern silver-coated dressings.

The latter finding is extremely interesting given how much the NHS spends on silver dressings – see later.

No evidence was found supporting specific dressings for haemorrhagic or malodorous wounds, fragile skin, or for prevention and treatment of infection. There was no evidence to show a benefit of modern dressings over traditional dressings with respect to pain or other performance factors e.g. ease of use, avoidance of wound trauma on dressing removal.

What does this mean then?
Wound management products are costly to the NHS. FP10 prescriptions alone accounted for £25 million in the first quarter of 2007, with 25% of these costs for silver dressings. Like all therapeutic interventions, the choice of wound care products should be based on clinical safety, efficacy, cost and patient suitability. Given that there is little good evidence to support our choice in terms of efficacy and safety, cost and patient suitability should largely govern our decision-making here. It may be particularly worthwhile looking at the use of sliver dressings in your practice.

Wound care professionals are encouraged to participate in conducting well-designed and controlled clinical studies of wound dressings, and to resist the routine use of new dressings, that are usually more expensive, in the absence of good quality clinical evidence for their benefit over existing products.

Further information on the selection of wound care products is available on NPC .