Robust evidence exists for some wound care interventions, but there are
still gaps in current knowledge requiring international consensus and
further high-level clinical evidence, according to a paper published
online by BJS, the British Journal of Surgery.
Researchers analysed the findings of 44 Cochrane Systematic Reviews
(CSRs) published by the Cochrane Wounds and Peripheral Vascular Disease
Groups up to June 2011. The reviews covered CSRs on acute wounds and
chronic wounds such as venous, pressure, diabetic and arterial ulcers.
This enabled them to identify a number of findings that provide strong
clinical evidence for treating specific wound issues.
“Acute and chronic wounds pose a substantial problem in different
healthcare settings including emergency departments, nursing homes, home
care and family doctor practices,” says co-author Dr Dirk Ubbink, from
the Academic Medical Centre in Amsterdam, The Netherlands.
“Because wounds have a considerable impact on patient health, death,
daily functioning and quality of life, they deserve high-quality local
and systemic treatment.
“Ideally wound treatment decisions should be based on the best available
evidence, integrated with patients’ concerns and priorities and
fine-tuned by the local resources and skills. In reality, however,
treatment decisions are generally based on the personal opinions,
experiences and preferences of healthcare professionals, which can vary
widely. This is partly due to the overwhelming amount of literature
available, which often shows conflicting results.
“Our meta-review of the CSRs aims to help clinicians make evidence-based
decisions by analysing studies of both local and systemic open wound
care.”
The meta-review covered 13 CSRs on venous ulcers, 12 on acute wounds,
seven on pressure ulcers, six on diabetic ulcers, five on arterial
ulcers and five on miscellaneous chronic wounds.
Findings were placed into five categories, based on strong evidence of
effect/no effect, limited evidence of effect/no effect and no evidence
either way.
Strong findings included:
Acute wounds
-
Using antibiotics to prevent infections after dog bites is ineffective
unless the bites are on the hands.
-
Systemic treatment with therapeutic touch does not have any additional
effect on wound healing compared to placebo or non-treatment after
minor surgery.
-
Cleansing pin site wounds using saline, alcohol, hydrogen peroxide or
antibacterial soap to prevent infections is no more effective than no
cleansing.
-
Topical honey reduces wound healing time when compared to film or
gauze-based dressings for burns.
-
Silver sulfadiazine should not be used for burns as trials show this
can delay wound healing and increase pain and infection rates.
-
Drinking quality tap water is better for cleansing lacerations and
acute soft tissue wounds than sterile saline solutions.
Chronic wounds
-
Systemic treatment of venous ulcers with pentoxyfylline increases
complete wound healing and compression therapy, using high
compression, multi-component systems or elastic bandages, is most
effective.
-
Using hyperbaric oxygen therapy decreases major amputations in
diabetic ulcers and local hydrogels should be used after debridement
to promote wound healing.
-
Systemic prostanoids should be used to relieve rest pain and improve
ulcer healing in patients with critical leg ischaemia and spinal cord
stimulation improves limb salvage.
-
Using high-specification foam mattresses and low air loss mattresses
can prevent pressure ulcers on the ward and pressure-relieving
overlays are recommended on operation tables. Using local therapeutic
ultrasound is not recommended for healing pressure ulcers.
“Our meta-review drew 33 conclusions with strong evidence and 18
conclusions with fairly strong evidence from the CSRs we studied,” says
lead author Dr Fleur Brölmann. “Evidence was not available or
insufficient in the remaining 58.”
The paper has been published online early ahead of print publication in
the September issue of BJS. It can be viewed free at: http://onlinelibrary.wiley.com/doi/10.1002/bjs.8810/full
A podcast discussion featuring the author and other clinicians can be
found at http://www.yada-yada.co.uk/Blackwell/BJS/BJS_wound_dressing.mp3
