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Dissemond J, Augustin M, Dietlein M, Faust U, Keuthage W, Lobmann R, Münter KC, Strohal R, Stücker M, Traber J, Vanscheidt W, Läuchli S. Efficacy of MMP-inhibiting wound dressings in the treatment of chronic wounds: a systematic review. J Wound Care 2020; 29:102-118. [PMID: 32058850 DOI: 10.12968/jowc.2020.29.2.102] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Matrix metalloproteinases (MMPs) substantially contribute to the development of chronicity in wounds. Thus, MMP-inhibiting dressings may support healing. A systematic review was performed to determine the existing evidence base for the treatment of hard-to-heal wounds with these dressings. METHODS A systematic literature search in databases and clinical trial registers was conducted to identify randomised controlled trials (RCTs) investigating the efficacy of MMP-inhibiting dressings. Studies were analysed regarding their quality and clinical evidence. RESULTS Of 721 hits, 16 relevant studies were assessed. There were 13 studies performed with collagen and three with technology lipido-colloid nano oligosaccharide factor (TLC-NOSF) dressings. Indications included diabetic foot ulcers, venous leg ulcers, pressure ulcers or wounds of mixed origin. Patient-relevant endpoints comprised wound size reduction, complete wound closure, healing time and rate. Considerable differences in the quality and subsequent clinical evidence exist between the studies identified. Substantial evidence for significant improvement in healing was identified only for some dressings. CONCLUSION Evidence for the superiority of some MMP-inhibiting wound dressings exists regarding wound closure, wound size reduction, healing time and healing rate. More research is required to substantiate the existing evidence for different types of hard-to-heal wounds and to generate evidence for some of the different types of MMP-inhibiting wound dressings.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | | | | | - Uta Faust
- MEDAHCON GmbH, HealthCare Communication, Bonn, Germany
| | - Winfried Keuthage
- Specialist Practice for Diabetology and Nutritional Medicine, Münster, Germany
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Stuttgart, Germany
| | | | - Robert Strohal
- Department of Dermatology and Venerology, State Hospital and Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Markus Stücker
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Jürg Traber
- Department of Surgery, Venenklinik Bellevue, Kreuzlingen, Switzerland
| | | | - Severin Läuchli
- University Hospital Zurich, Department of Dermatology, Zurich, Switzerland
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Kern JS, Schwieger-Briel A, Löwe S, Sumeray M, Davis C, Martinez AE. Oleogel-S10 Phase 3 study "EASE" for epidermolysis bullosa: study design and rationale. Trials 2019; 20:350. [PMID: 31186047 PMCID: PMC6560757 DOI: 10.1186/s13063-019-3362-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Epidermolysis bullosa (EB) is a group of rare, genetic diseases that affect the integrity of epithelial tissues, most notably the skin. Patients experience recurrent skin wounding, with severity depending on type, sub-type, and mutation. Oleogel-S10, a formulation of birch bark extract, has demonstrated efficacy in a Phase 2 trial assessing re-epithelialization of wounds in EB. EASE (NCT03068780, EudraCT 2016–002066-32) is a randomized, Phase 3, placebo-controlled study designed to determine the efficacy of Oleogel-S10 versus placebo in patients with EB. Methods EASE is a Phase 3, two-phase study comprising a 90-day, double-blind, randomized, placebo-controlled phase, followed by 24 months of open-label, single-arm follow-up. Patients with junctional EB, dystrophic EB, or Kindler syndrome and target wounds (10 - 50cm2) present for > 21 days and < 9 months, are randomized in a 1:1 ratio to receive wound dressings according to local standard of care with or without Oleogel-S10. Placebo is based on the Oleogel-S10 vehicle, which is sunflower oil formulated to have a consistency indistinguishable from that of the active product. The primary endpoint of the trial, directed by the US health authority according to the required study endpoints for chronic cutaneous ulcer and burn wounds, is to compare the efficacy of Oleogel-S10 versus placebo according to the proportion of patients with complete closure of the target wound within 45 ± 7 days of treatment. Additional EB-focused endpoints include wound burden, patient-reported outcomes, and safety. Results Results of the primary endpoint are anticipated to be available by H2 2019. Trial registration ClinicalTrials.gov, NCT03068780. EudraCT, 2016–002066-32. Registered on 3 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3362-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes S Kern
- Dermatology Department, Royal Melbourne Hospital, Faculy of Medicine, Dentistry and Health Science, The University of Melbourne, Parkville, Victoria, Australia. .,Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Agnes Schwieger-Briel
- Department of Dermatology, University Childrens' Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Anna E Martinez
- Department of Paediatric Dermatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Peinemann F, Labeit A. Negative pressure wound therapy: A systematic review of randomized controlled trials from 2000 to 2017. J Evid Based Med 2019; 12:125-132. [PMID: 30460777 DOI: 10.1111/jebm.12324] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) proposes to provide better wound healing than standard wound management. Evidence quality of randomized controlled trials (RCTs) varies. METHODS We included participants with any kind of wounds and commercial as well as the homemade NPWT system. Comparators were any other wound dressing including variant NPWTs. We included RCTs randomizing patients or wounds in parallel or crossover designs. We searched PubMed and Cochrane Library on January 03, 2018. We assessed the risk of bias according to Cochrane and appropriateness of clinical endpoints according to the Food and Drug Administration (FDA). RESULTS We included 93 RCTs originating in 30 countries, 70 studies on open wounds and 23 studies on closed wounds. With respect to random sequence generation, we judged an unclear or high risk of bias in 50% (47 of 93) studies. With respect to allocation concealment, we judged an unclear or high risk of bias in 90% (84 of 93). We identified 41% (38 of 93) studies that based their conclusion on not appropriate endpoints. CONCLUSIONS High risk of bias concerning random sequence generation and allocation concealment limited the credibility of the majority of 93 included RCTs on NPWT. A low risk of bias can and should be achieved with both items, and we recommend to align future RCTs to Cochrane. Many primary clinical endpoints were deemed not valid for making inferences on the efficacy of NPWT. We recommend using patient-centered endpoints as requested by the FDA and suggested in the present systematic review.
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Affiliation(s)
- Frank Peinemann
- Children's Hospital, University Hospital, Cologne, Germany
- FOM University of Applied Science for Economics & Management, Essen, Germany
| | - Alexander Labeit
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
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Foglia E, Ferrario L, Garagiola E, Signoriello G, Pellino G, Croce D, Canonico S. Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:343-351. [PMID: 28652788 PMCID: PMC5473523 DOI: 10.2147/ceor.s128139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Surgical-site complications (SSCs) affect patients’ clinical pathway, prolonging their hospitalization and incrementing their management costs. The present study aimed to assess the economic and organizational implications of a portable device for negative-pressure wound therapy (NPWT) implementation, compared with the administration of pharmacological therapies alone for preventing surgical complications in patients undergoing general, cardiac, obstetrical–gynecological, or orthopedic surgical procedures. Patients and methods A total of 8,566 hospital procedures, related to the year 2015 from one hospital, were evaluated considering infection risk index, occurrence rates of SSCs, drug therapies, and surgical, diagnostic, and specialist procedures and hematological exams. Activity-based costing and budget impact analyses were implemented for the economic assessment. Results Patients developing an SSC absorbed i) 64.27% more economic resources considering the length of stay (€ 8,269±2,096 versus € 5,034±2,901, p<0.05) and ii) 42.43% more economic resources related to hematological and diagnostic procedures (€ 639±117 versus € 449±72, p<0.05). If the innovative device had been used over the 12-month time period, it would have decreased the risk of developing SSCs; the hospital would have realized an average reduction in health care expenditure equal to −0.69% (−€ 483,787.92) and an organizational saving in terms of length of stay equal to −1.10% (−898 days), thus allowing 95 additional procedures. Conclusion The implementation of a portable device for NPWT would represent an effective and sustainable strategy for reducing the management costs of patients. Economic and organizational savings could be reinvested, thus i) treating a wider population and ii) reducing waiting lists, with a higher effectiveness in terms of a decrease in complications.
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Affiliation(s)
- Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management -LIUC University, Castellanza, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management -LIUC University, Castellanza, Italy
| | - Elisabetta Garagiola
- Centre for Health Economics, Social and Health Care Management -LIUC University, Castellanza, Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianluca Pellino
- School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Croce
- Centre for Health Economics, Social and Health Care Management -LIUC University, Castellanza, Italy.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Silvestro Canonico
- School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Rangaraj A, Ye L, Sanders AJ, Price PE, Harding KG, Jiang WG. Molecular and cellular impact of Psoriasin (S100A7) on the healing of human wounds. Exp Ther Med 2017; 13:2151-2160. [PMID: 28565822 PMCID: PMC5443246 DOI: 10.3892/etm.2017.4275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/21/2016] [Indexed: 12/21/2022] Open
Abstract
Psoriasin, which is also known as S100A7, is a member of the S100 protein family, a group of calcium-responsive signalling proteins. Psoriasin expression remains high in patients with psoriasis, whereas it is downregulated in patients with invasive breast carcinoma. This observation suggests that this protein may be a notable marker of keratinocyte function and differentiation during wound healing. The aim of the present study was to determine the cellular impact of Psoriasin in keratinocytes, which are the primary cell type associated with wound healing. Psoriasin expression in wound tissues was examined using reverse transcription-quantitative polymerase chain reaction and immunochemical staining. Knockdown of Psoriasin in HaCaT cells was performed using anti-Psoriasin ribozyme transgenes and the effect on growth, adhesion and migration of keratinocytes was subsequently determined using in vitro cellular functional assays. Psoriasin expression is upregulated in wounds, particularly at the wound edges. The present study demonstrated that Psoriasin is expressed in keratinocytes and is a fundamental regulator of keratinocyte migration. Significant increases in the rate of keratinocyte adhesion, migration and growth were observed in Psoriasin-deficient cells (P<0.01 vs. control). Application of small inhibitors identified the potential association of neural Wiskott-Aldrich syndrome protein, focal adhesion primase and rho-associated protein kinase signalling pathways with Psoriasin-regulated cell adhesion and motility. In conclusion, Psoriasin serves an important role in the wound healing process, suggesting that it may be utilized as a potential wound healing biomarker.
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Affiliation(s)
- Aravindan Rangaraj
- Cardiff China Medical Research Collaborative, Institute of Cancer and Genetics, Cardiff University School of Medicine, CF14 4XN Cardiff, UK.,Department of Wound Healing, Cardiff University School of Medicine, CF14 4XN Cardiff, UK
| | - Lin Ye
- Cardiff China Medical Research Collaborative, Institute of Cancer and Genetics, Cardiff University School of Medicine, CF14 4XN Cardiff, UK
| | - Andrew James Sanders
- Cardiff China Medical Research Collaborative, Institute of Cancer and Genetics, Cardiff University School of Medicine, CF14 4XN Cardiff, UK
| | - Patricia Elaine Price
- Department of Wound Healing, Cardiff University School of Medicine, CF14 4XN Cardiff, UK
| | - Keith Gordon Harding
- Department of Wound Healing, Cardiff University School of Medicine, CF14 4XN Cardiff, UK
| | - Wen Guo Jiang
- Cardiff China Medical Research Collaborative, Institute of Cancer and Genetics, Cardiff University School of Medicine, CF14 4XN Cardiff, UK
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Brassington NJ, Muldoon J, Hill C, Arrowsmith M. A national survey by the SDMA: use of evidence in nursing practice. J Wound Care 2015; 24:466, 468-76. [PMID: 26488738 DOI: 10.12968/jowc.2015.24.10.466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Recently, two surveys were conducted by the Surgical Dressing Manufacturers Association (SDMA) to investigate the evidence required to support wound care products. These showed very clearly that industry provides significant amounts of evidence in a way that appears to meet the expectations of relevant health professionals and their practice for treating patients with wounds. The responses of health professionals refuted the opinion that evidence may be lacking for wound care products. Hopefully, the results of these surveys also add weight to the argument that the Cochrane Review approach is not always the most appropriate for wound care-where the comorbidities of patients are variable and often plural.
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Affiliation(s)
- N J Brassington
- Surgical Dressing Manufacturers Association (SDMA) Fernbank, 17 The Crescent, Holymoorside, Derbyshire, S42 7EE
| | - J Muldoon
- I Lancaster Park, Newborough Road, Needwood, Burton-on-Trent, Staffordshire DE13 9PD
| | - C Hill
- Aspen Medical Europe Ltd. Redditch, Worcestershire B98 9NL, UK
| | - M Arrowsmith
- Clinical Evidence & Reimbursement Manager; This article was written on behalf of the technical committee of the Surgical Dressing Manufacturers' Association (SDMA), 3M Health Care Ltd, Morley St, Loughborough, Leics, LE11 1EP
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Butcher M. Transparency must prevail. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23 Suppl 20:S3. [PMID: 25382129 DOI: 10.12968/bjon.2014.23.sup20.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martyn Butcher
- Independent Tissue Viability & Wound Care Consultant; Associate Lecturer, University of Plymouth; Research Nurse (Tissue Viability), Northern Devon Healthcare Trust (Honorary post)
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Brölmann FE, Eskes AM, Sumpio BE, Mayer DO, Moore Z, Agren MS, Hermans M, Cutting K, Legemate DA, Vermeulen H, Ubbink DT. Fundamentals of randomized clinical trials in wound care: reporting standards. Wound Repair Regen 2013; 21:641-7. [PMID: 23937172 DOI: 10.1111/wrr.12087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/01/2013] [Indexed: 11/29/2022]
Abstract
In wound care research, available high-level evidence according to the evidence pyramid is rare, and is threatened by a poor study design and reporting. Without comprehensive and transparent reporting, readers will not be able to assess the strengths and limitations of the research performed. Randomized clinical trials (RCTs) are universally acknowledged as the study design of choice for comparing treatment effects. To give high-level evidence the appreciation it deserves in wound care, we propose a step-by-step reporting standard for comprehensive and transparent reporting of RCTs in wound care. Critical reporting issues (e.g., wound care terminology, blinding, predefined outcome measures, and a priori sample size calculation) and wound-specific barriers (e.g., large diversity of etiologies and comorbidities of patients with wounds) that may prevent uniform implementation of reporting standards in wound care research are addressed in this article. The proposed reporting standards can be used as guidance for authors who write their RCT, as well as for peer reviewers of journals. Endorsement and application of these reporting standards may help achieve a higher standard of evidence and allow meta-analysis of reported wound care data. The ultimate goal is to help wound care professionals make better decisions for their patients in clinical practice.
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Affiliation(s)
- Fleur E Brölmann
- Department of Quality Assurance and Process Innovation, Amsterdam, The Netherlands
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Leaper D, Münter C, Meaume S, Scalise A, Mompó NB, Jakobsen BP, Gottrup F. The use of biatain Ag in hard-to-heal venous leg ulcers: meta-analysis of randomised controlled trials. PLoS One 2013; 8:e67083. [PMID: 23843984 PMCID: PMC3699549 DOI: 10.1371/journal.pone.0067083] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 05/15/2013] [Indexed: 01/01/2023] Open
Abstract
Background Venous leg ulcers are common, troublesome, and their failure to heal is often related to a heavy bio-burden. Ionized silver has both anti-inflammatory and antimicrobial properties. The ulcer healing properties of the silver releasing foam dressing Biatain Ag has been examined in 4 randomized controlled trials (RCTs). Aim To evaluate ulcer healing through a meta-analytic approach after treatment with either Biatain Ag or a non-active dressing. Patients and Methods 685 subjects with pure or mixed hard-to-heal venous leg ulcers were included in the meta-analysis. Results Biatain Ag showed a significant treatment effect (p<0.0001), responder rate (p<0.001), and healing rate (p = 0.002). Conclusion The meta-analysis of the 4 RCTs provided statistical significant evidence to support the use of Biatain Ag dressing in treatment of hard-to-heal venous leg ulcers.
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Affiliation(s)
- David Leaper
- Wound Healing Research Unit, Cardiff University, Cardiff, United Kingdom
| | | | | | | | | | | | - Finn Gottrup
- Copenhagen Wound Healing Center, Bispebjerg University Hospital, Copenhagen, Denmark
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What Is New in the Understanding of Non Healing Wounds Epidemiology, Pathophysiology, and Therapies. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/625934] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic wounds are a growing socioeconomic problem in the western world. Knowledge on recalcitrant wounds relies on in vitro studies or clinical observations, and there is emerging evidence on the clinical impact of bacterial biofilm on skin healing. Chronic wounds are locked in the inflammatory state of wound healing, and there are multiple explanations for this arrest with the theory of exaggerated proteolysis as the most commonly accepted. Previously, there has not been enough focus on the different etiologies of chronic wounds compared to acute, healing wounds. There is an urgent need to group chronic wounds by its cause when searching for possible diagnostic or therapeutic targets. Good wound management should therefore consist of recognition of basic wound etiology, irrigation, and debridement in order to reduce microbial and necrotic load, frequently changed dressings, and appropriate antimicrobial and antibiofilm strategies based on precise diagnosis. Representative sampling is required for diagnosis and antimicrobial treatment of wounds. The present review aims at describing the impact of biofilm infections on wounds in relation to diagnosing, treatment strategies, including experimentally adjuvant approaches and animal models.
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Ousey K, Edward KL, Lui S. Identifying and exploring physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery: a systematic review. Int Wound J 2013; 12:63-9. [PMID: 23489286 DOI: 10.1111/iwj.12054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/16/2013] [Accepted: 01/28/2013] [Indexed: 11/29/2022] Open
Abstract
The aim of this article was to identify the literature that examined and explored physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. A systematic review of the literature using the databases MEDLINE, CINAHL and EMBASE was undertaken. The papers were examined using title and abstract for relevance to the primary and secondary outcomes. The primary outcome of interest was family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. The search yielded 275 records after removing any duplicates; eight studies were considered eligible and were reviewed as full text. Following full review, none of the studies was included in this article. To conclude, there were no papers that investigated or examined the concept of resilience in relation to the management of acute post-surgical orthopaedic wounds. Four of the papers identified, following the review process, did discuss quality of life outcomes and how these may be improved following wound development; most papers focused on the management of chronic wounds. It is apparent from the review that there is no evidence currently available that explores patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery.
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Affiliation(s)
- Karen Ousey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Affiliation(s)
- W.J. Jeffcoate
- Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, Nottingham University Hospitals Trust, City Hospital Unit, UK
| | - C.D. Weller
- School of Public Health & Preventive Medicine, Department of Epidemiology & Preventive Medicine, The Alfred Centre, Melbourne, Australia
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Does evidence permeate all surgical areas equally? Publication trends in wound care compared to breast cancer care: a longitudinal trend analysis. World J Surg 2012; 36:2021-7. [PMID: 22526043 PMCID: PMC3414698 DOI: 10.1007/s00268-012-1599-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Evidence-based decision making has permeated the daily practice of healthcare professionals. However, in wound care this seems more difficult than in other medical areas, such as breast cancer, which has a similar incidence, variety of etiologies, financial burden, and diversity of treatment options. This incongruence could be due to a lack in quantity and quality of available evidence. We therefore compared worldwide publication trends to answer whether research in wound care lags behind that in breast cancer. METHODS In order to assess the trends in quantity and methodological quality of publications as to wound care and breast cancer treatments, we examined relevant publications over the last five decades. Publications in MEDLINE were classified into seven study design categories: (1) guidelines, (2) systematic reviews (SR), (3) randomized (RCT), and controlled clinical trials (CCT), (4) cohort studies, (5) case-control studies, (6) case series and case reports, and (7) other publications. RESULTS We found a 30-fold rise in publications on wound care, versus a 70-fold increase in those on breast cancer. High-quality study designs like SR, RCT, or CCT were less frequent in wound care (difference 1.9, 95 % CI 1.8-2.0 %) as were guidelines; 76 on wound care versus 231 for breast cancer. CONCLUSIONS Publications on wound care fall behind in quantity and quality as compared to breast cancer. Nevertheless, SR, RCT, and CCT in wound care are becoming more numerous. These high-quality study designs could motivate clinicians to make evidence-based decisions and researchers to perform proper research in wound care.
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Sweeney IR, Miraftab M, Collyer G. A critical review of modern and emerging absorbent dressings used to treat exuding wounds. Int Wound J 2012; 9:601-12. [PMID: 22248337 PMCID: PMC7950558 DOI: 10.1111/j.1742-481x.2011.00923.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Wound management has progressed significantly over the last five decades. This emanates from a greater understanding of wound healing, technological progression and improved clinical and scientific research. There are currently a plethora of absorbent dressings on the wound care market which claim to have the ability to manage exudates whilst encouraging healing. However, it is becoming clear, from analysing randomised controlled trials, that some of these absorbent dressings are not meeting their expectations when applied in a clinical setting. Many clinicians now feel that there should be more focus, not only on a dressing's ability to manage exudate efficiently, but on a dressing's ability to proactively encourage healing and thus exudate reduction will ensue. This paper proposes to critically review modern and emerging absorbent wound care dressings used to manage exuding wounds and discuses some advances in this area.
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Affiliation(s)
- India R Sweeney
- Insitute for Materials Research and Innovation, University of Bolton, Deane Road, Bolton, UK.
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16
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Evidence-based decisions for local and systemic wound care. Br J Surg 2012; 99:1172-83. [DOI: 10.1002/bjs.8810] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2012] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Decisions on local and systemic wound treatment vary among surgeons and are frequently based on expert opinion. The aim of this meta-review was to compile best available evidence from systematic reviews in order to formulate conclusions to support evidence-based decisions in clinical practice.
Methods
All Cochrane systematic reviews (CSRs), published by the Cochrane Wounds and Peripheral Vascular Diseases Groups, and that investigated therapeutic and preventive interventions, were searched in the Cochrane Database up to June 2011. Two investigators independently categorized each intervention into five levels of evidence of effect, based on size and homogeneity, and the effect size of the outcomes.
Results
After screening 149 CSRs, 44 relevant reviews were included. These contained 109 evidence-based conclusions: 30 on venous ulcers, 30 on acute wounds, 15 on pressure ulcers, 14 on diabetic ulcers, 12 on arterial ulcers and eight on miscellaneous chronic wounds. Strong conclusions could be drawn regarding the effectiveness of: therapeutic ultrasonography, mattresses, cleansing methods, closure of surgical wounds, honey, antibiotic prophylaxis, compression, lidocaine–prilocaine cream, skin grafting, antiseptics, pentoxifylline, debridement, hyperbaric oxygen therapy, granulocyte colony-stimulating factors, prostanoids and spinal cord stimulation.
Conclusion
For some wound care interventions, robust evidence exists upon which clinical decisions should be based.
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Vollenweider D, Ebneter I, Mayer D, Hafner J, Steurer J, Puhan MA. Dealing with heterogeneous populations in randomized wound trials: challenges and potential solutions. Wound Repair Regen 2012; 20:466-72. [PMID: 22672225 DOI: 10.1111/j.1524-475x.2012.00806.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 02/27/2012] [Indexed: 12/19/2022]
Abstract
Chronic wounds have a great variety of etiologies and manifestations that influence wound healing. Such heterogeneity potentially threatens the validity and clinical usefulness of trials if not considered appropriately. In 82 randomized wound trials retrieved from 10 Cochrane reviews, we assessed if and how authors considered wound and other prognostically important characteristics in the conduct and analysis of wound trials. We assessed whether these characteristics were discussed, reflected in the eligibility criteria, used for prestratification or for adjustments to ensure comparability of treatment groups, and whether subgroup analyses were conducted to identify heterogeneity of treatment effects. Nine percent of all trials explicitly discussed characteristics that influence wound healing in the introduction and 43% in the Discussion section. Ninety percent of trials had at least one prognostically important characteristic as eligibility criterion. Only 11% of trials used prestratification, and 6% adjusted the results for imbalances between treatment groups. Twenty-seven percent performed subgroup analyses with prognostically important characteristics defining subgroups. Chronic wound trials use simple randomization, but rarely adapt the study design and analysis to take the heterogeneity of patients into consideration. Collaborative multicenter trials would overcome many of the limitations and provide statistical power to detect important treatment effects both overall and in subgroups.
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Affiliation(s)
- Daniela Vollenweider
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Gottrup F, Apelqvist J. Present and new techniques and devices in the treatment of DFU: a critical review of evidence. Diabetes Metab Res Rev 2012; 28 Suppl 1:64-71. [PMID: 22271726 DOI: 10.1002/dmrr.2242] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Management of foot ulcer in individuals with diabetes remains a major therapeutic challenge throughout the world. We performed a critical review of evidence of present and new techniques and devices in the treatment of diabetic foot ulcer. The golden standard for optimal evidence in the Cochrane system is level I - randomized controlled trials, and meta-analyses of several randomized controlled trials. Available evidence on different types of wound debridement; use of antimicrobials; use of dressings in wounds; topical negative pressure, hyperbaric oxygen treatment; electrical, electromagnetic, laser, shockwave, and ultrasound therapies; growth and cell biology factors; cell products and tissue engineering; bioengineered skin and skin grafts; and adjuvant therapies were evaluated. The results of this review show that there is limited evidence on the highest level to justify a change in routine clinical practice. There is a paucity of high-quality evidence, because the studies are often based on inadequate sample size, short follow-up, nonrandom allocation to treatment arms, nonblinded assessment of outcomes, poor description of control, and concurrent intervention. The heterogeneity of the population (of both people and ulcers), with multiple factors contributing to both ulcer onset and failure to heal, makes the trial design difficult in this field. Another fundamental reason for the lack of evidence is the general use of the outcome measure 'complete healing'. In conclusion, when the results of this updated review are taken together with those of the earlier reports, they provide limited evidence to justify a change in routine clinical practice. For this reason, there is an urgent need to increase the quality of clinical studies. A re-evaluation of which type of research is acceptable for producing evidence in the wound area may be important in the future.
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Affiliation(s)
- Finn Gottrup
- Department of Dermatology, D42, Copenhagen Wound Healing Center, Bispebjerg University Hospital, Copenhagen NV, Denmark.
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Harding K, Gottrup F, Jawień A, Mikosiński J, Twardowska-Saucha K, Kaczmarek S, Sopata M, Shearman C, Pieronne A, Kommala D. A prospective, multi-centre, randomised, open label, parallel, comparative study to evaluate effects of AQUACEL® Ag and Urgotul® Silver dressing on healing of chronic venous leg ulcers. Int Wound J 2011; 9:285-94. [PMID: 22066961 DOI: 10.1111/j.1742-481x.2011.00881.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study compared wound healing efficacy of two silver dressings, AQUACEL(®) Ag and Urgotul(®) Silver, against venous ulcers at risk of infection, over 8 weeks of treatment. The primary objective was to show non inferiority of AQUACEL(®) Ag to Urgotul(®) Silver. Patients (281) were randomised into two groups. The AQUACEL(®) Ag group had 145 patients treated with AQUACEL(®) Ag for 4 weeks followed by AQUACEL for another 4 weeks. TheUrgotul(®) Silver group had 136 patients treated with Urgotul(®) Silver for 4 weeks followed by Urgotul(®) for another 4 weeks. In both groups, ulcer size and depth, safety events and ulcer healing were compared. After 8 weeks of treatment, the AQUACEL(®) Ag group had a relative wound size reduction (49·65% ± 52·53%) compared with the Urgotul(®) Silver group (42·81% ± 60·0%). The non inferiority of the AQUACEL(®) Ag group to the Urgotul(®) Silver group was established based on the difference between them (6·84% ± 56·3%, 95% confidence interval -6·56 to 20·2) and the pre-defined non inferiority margin (-15%). Composite wound healing analysis showed that the AQUACEL(®) Ag group had statistically higher percentage of subjects with better wound progression (66·9% versus 51·9%, P = 0·0108). In general, both dressings were effective at promoting healing of venous ulcers.
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Affiliation(s)
- Keith Harding
- Department of Dermatology & Wound Healing, School of Medicine, Cardiff University, Cardiff, UK.
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Eskes AM, Brölmann FE, Gerbens LAA, Ubbink DT, Vermeulen H. Which dressing do donor site wounds need?: study protocol for a randomized controlled trial. Trials 2011; 12:229. [PMID: 21999705 PMCID: PMC3219559 DOI: 10.1186/1745-6215-12-229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/17/2011] [Indexed: 11/13/2022] Open
Abstract
Background Donor site wounds after split-skin grafting are rather 'standard' wounds. At present, lots of dressings and topical agents for donor site wounds are commercially available. This causes large variation in the local care of these wounds, while the optimum 'standard' dressing for local wound care is unclear. This protocol describes a trial in which we investigate the effectiveness of various treatment options for these donor site wounds. Methods A 14-center, six-armed randomized clinical trial is being carried out in the Netherlands. An a-priori power analysis and an anticipated dropout rate of 15% indicates that 50 patients per group are necessary, totaling 300 patients, to be able to detect a 25% quicker mean time to complete wound healing. Randomization has been computerized to ensure allocation concealment. Adult patients who need a split-skin grafting operation for any reason, leaving a donor site wound of at least 10 cm2 are included and receive one of the following dressings: hydrocolloid, alginate, film, hydrofiber, silicone dressing, or paraffin gauze. No combinations of products from other intervention groups in this trial are allowed. Optimum application and changes of these dressings are pursued according to the protocol as supplied by the dressing manufacturers. Primary outcomes are days to complete wound healing and pain (using a Visual Analogue Scale). Secondary outcomes are adverse effects, scarring, patient satisfaction, and costs. Outcome assessors unaware of the treatment allocation will assess whether or not an outcome has occurred. Results will be analyzed according to the intention to treat principle. The first patient was randomized October 1, 2009. Discussion This study will provide comprehensive data on the effectiveness of different treatment options for donor site wounds. The dressing(s) that will prevail in effectiveness, satisfaction and costs will be promoted among clinicians dealing with such patients. Thus, we aim to contribute a well-designed trial, relevant to all clinicians involved in the care for donor site wounds, which will help enhance uniformity and quality of care for these patients. Trial registration http://www.trialregister.nl, NTR1849. Date registered: June 9, 2009
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Affiliation(s)
- Anne M Eskes
- Quality Assurance & Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Arsenault KA, McDonald J, Devereaux PJ, Thorlund K, Tittley JG, Whitlock RP. The use of transcutaneous oximetry to predict complications of chronic wound healing: A systematic review and meta-analysis. Wound Repair Regen 2011; 19:657-63. [DOI: 10.1111/j.1524-475x.2011.00731.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/07/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Kyle A. Arsenault
- Department of Surgery; McMaster University; Hamilton; Ontario; Canada
| | - Joey McDonald
- Department of Surgery; McMaster University; Hamilton; Ontario; Canada
| | | | - Kristian Thorlund
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton; Ontario; Canada
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Udwadia TE. Ghee and honey dressing for infected wounds. Indian J Surg 2011; 73:278-83. [PMID: 22851841 PMCID: PMC3144338 DOI: 10.1007/s12262-011-0240-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 03/16/2011] [Indexed: 10/18/2022] Open
Abstract
Ghee and honey has been advocated and used as dressing for infected wounds by Sushruta (600BC) and since 1991 in four Mumbai Hospitals. The gratifying results observed with the dressing have prompted this study which aims to establish its efficacy in five recalcitrant subset of chronic infected wounds over a three year period 2006-2009. A standardized ghee and honey dressing was used to treat: a) Eight cases of fungating malignant lesions. b) Thirteen chronic venous ulcers. c) Twenty nine diabetic foot ulcers. d) Eleven of infected ventral hernia mesh hernioplasty. e) Eleven patient with post-cesarean wound dehiscence. The dressing markedly reduced the foul odour and discharge, significantly improving the quality of life in malignant lesions. The results were equivocal in cases of venous ulcers. The results were uniformly good in the last three groups. In view of our results, as also result of innumerable Randomized Control Trials (RCTs) reported on honey dressing for infected wounds, there is substantial evidence that ghee and honey dressing has at least comparable results to other modes of treatment. The easy availability and low cost of this treatment makes it significant in developing countries. Further trials seem warranted.
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Affiliation(s)
- Tehemton E. Udwadia
- P.D. Hinduja National Hospital, Cook’s Building, 4th Floor, D.N. Road, Mumbai, 400 001 India
- Breach Candy Hospital, Cook’s Building, 4th Floor, D.N. Road, Mumbai, 400 001 India
- B. D. Petit Parsee General Hospital, Cook’s Building, 4th Floor, D.N. Road, Mumbai, 400 001 India
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Peinemann F, Sauerland S. Negative-pressure wound therapy: systematic review of randomized controlled trials. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:381-9. [PMID: 21712971 PMCID: PMC3123764 DOI: 10.3238/arztebl.2011.0381] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 02/07/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND In negative-pressure wound therapy (NPWT), a wound is covered with an airtight dressing, and negative pressure is applied. This is thought to promote healing. We evaluated NPWT with an updated, systematic review of the literature. METHODS We systematically searched the PubMed and Cochrane Library databases for randomized, controlled trials (RCTs) of NPWT for the treatment of acute or chronic wounds. The primary outcome was complete wound closure. RESULTS We found reports of 9 RCTs in addition to the 12 covered by earlier IQWiG reviews of this topic. Five of the 9 new trials involved NPWT systems that are not on the market. The frequency of complete wound closure is stated in only 5 of the 9 new reports; a statistically significant effect in favor of NPWT was found in only two trials.The results of 8 of the 9 new trials are hard to interpret, both because of apparent bias and because diverse types of wounds were treated. CONCLUSION Although there may be a positive effect of NPWT, we did not find clear evidence that wounds heal any better or worse with NPWT than with conventional treatment. Good RCTs are still needed to evaluate NPWT.
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Affiliation(s)
- Frank Peinemann
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), Köln.
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Koschwanez HE, Broadbent E. The use of wound healing assessment methods in psychological studies: A review and recommendations. Br J Health Psychol 2011; 16:1-32. [DOI: 10.1348/135910710x524633] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Outcomes in controlled and comparative studies on non-healing wounds: recommendations to improve the quality of evidence in wound management. J Wound Care 2010; 19:237-68. [DOI: 10.12968/jowc.2010.19.6.48471] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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