| 33 |
Oral Abstracts (Session 2 of 5)
|
(Presentation 33.1) A synthesis of level-one evidence from Cochrane systematic reviews on local wound care H Vermeulen; DT Ubbink Background: Patients with open wounds require specific local wound care. The variety in local wound care is huge due to a large variety of wounds, many different preferences among doctors and (district) nurses, and the lack of strong evidence or relevant guidelines on the most appropriate local wound care. This study was initiated to gather Level 1 evidence from systematic reviews (SRs) about local wound care. Methods: The authors searched the Cochrane Database of Systematic Reviews up to Issue 3, 2005, for SRs and protocols on local wound care. The authors reviewed these SRs to determine how many patients and randomized clinical trials (RCTs) they comprised. Furthermore, the authors assessed how strong their recommendations were and which implications were suggested for further research. Results: The authors found 19 SRs on surgical wounds (n = 4), traumatic wounds (n = 1), and ulcers (venous, n = 7; diabetic, n = 2; pressure, n = 2; arterial, n = 1; miscellaneous, n = 2). These SRs comprise 1 to 22 RCTs involving 6 to 817 patients per RCT. Strong evidence was found in only 9 out of 19 SRs. Two SRs showed that tissue adhesives are an acceptable alternative to standard wound closure in traumatic and surgical wounds; high compression bandages aid the healing of venous leg ulcers; EMLA is an effective analgesic in the debridement of venous ulcers; bilayer artificial skin under compression improves healing of venous leg ulcers compared with simple dressings and compression; and hydrogel increases the healing rate of diabetic foot ulcers compared with gauze dressings or standard care. There is no evidence for the effectiveness of electromagnetic therapy in venous or pressure ulcers. Additionally, evidence is lacking for laser therapy in venous ulcers. Conclusion: Although SRs are available and some recommendations can be drawn, more RCTs of high methodological quality, which are the basis for SRs, are needed. The results of such trials will help to guide physicians and nurses in choosing the optimal wound care products. References Coulthard P, Worthington H, Esposito M, van der Elst M, van Waes OJF. Tissue adhesives for closure of surgical incisions. Cochrane Database of Systematic Reviews 2002, Issue 3. Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, et al. Tissue adhesives for traumatic lacerations in children and adults. The Cochrane Database of Systematic Reviews 2001, Issue 4. Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for venous leg ulcers. Cochrane Database of Systematic Reviews 2001, Issue 2. Briggs M, Nelson EA. Topical agents or dressings for pain in venous leg ulcers. Cochrane Database of Systematic Reviews 2003, Issue 1. Jones JE, Nelson EA. Skin grafting for venous leg ulcers. Cochrane Database of Systematic Reviews 2000, Issue 2. Smith J. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2002, Issue 4. Flemming K, Cullum N. Electromagnetic therapy for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2001, Issue 1. Flemming K, Cullum N. Electromagnetic therapy for treating pressure sores. Cochrane Database of Systematic Reviews 2001, Issue 1. Flemming K, Cullum N. Laser therapy for venous leg ulcers. Cochrane Database of Systematic Reviews 1999, Issue 1. |
|