Prospective, Multicenter Study of Managing Lower Extremity Venous Ulcers

Abstract

Seventy patients with 90 venous ulcers were randomly assigned to hydrocolloid or conventional dressing and compression therapy at four study centers. The ulcers had been present for a mean of 47.8 in the control and 46.2 weeks in the treatment group and 42% of all patients had recurrent ulcers. Ulcers treated with hydrocolloid dressings reduced 71% and control treated wounds reduced 43% in area after 7.2 weeks of treatment. Thirty-four percent of all ulcers healed. Mean time to healing was 7 weeks for the hydrocolloid dressing group and 8 weeks for the control group. Most ulcers were less painful at final evaluation, but reduction in pain was more pronounced in hydrocolloid-dressed ulcers (p = 0.03). At baseline as well as during follow-up, significant differences between study centers were observed. Ulcers in patients in the United Kingdom were larger and less likely to heal (p = 0.001). Size of the ulcer at baseline was associated with treatment response and time to healing (p = 0.002). Percent reduction in ulcer area after 2 weeks was also correlated with treatment outcome (p = 0.004) and time to healing (p = 0.002). When all treatment outcome predictors were analyzed together, only percent reduction in area after 2 weeks remained statistically significant (p = 0.002), with percent reduction during the first 2 weeks of treatment > 30% predicting healing.

Wounds research for patient benefit: a 5-year programme of research

“…Thus, the final data set included 19 RCTs evaluating 39 unique treatments (Table 69). 227,231,[282][283][284][285][286][287][288][289][290][291][292][293][294][295][296][297][298] The evidence in the final data set was organised in the network, shown in Figure 16.…”

Systematic review of topic treatment for venous ulcers

“…It is affirmed that a reduction of more than 30% in the wound area in the first two weeks of treatment is a prediction of healing (34) .…”

“…In case hydrocolloid coverage is used in association with zinc oxide paste (Unna's boot), at the end, a gradient compression bandage should be applied (34) .…”

“…The study results suggest the use of a simple, non-adherent coverage, of low cost and acceptable by patients. Polyurethane foam, hydrocolloid and calcium alginate are presented as treatment options (30)(31)(32)(33)(34)(35) . Hydrofiber or calcium alginate dressings must be used in intensively exudative (29,34) venous ulcers and polyurethane foam or hydrocolloid in ulcers with a low to moderate volume of exudate (30)(31)(32) .…”

“…hydrocolloid with gauze, both associated to Unna's boot (34) ; hydrofiber with calcium alginate, both associated to class C3 compression bandage (35) ; application of ultrasound with placebo, both associated to hydrocolloid (36) ; topical treatment associated to laser stimulation compared with topical treatment associated to placebo, compared with topical treatment only (37) ; cryopreserved cultured epidermal graft with hydrocolloid dressing (38) ; growth factor with silver sulfadiazine and with placebo (39) ; two studies of essaven gel with placebo (40)(41) ; mupirocine with vehicle (42) .…”