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Table 2 Summary of evidence for venous ulcer management

From: Seeking effective interventions to treat complex wounds: an overview of systematic reviews

Outcome

Intervention

Systematic reviews with MA

Systematic reviews without MA

High-quality*

Low/moderate quality

High-quality**

Low/moderate quality

Wound size reduction

(MAs: 2; non-MAs: NA) [36,56]

Cadexomer iodine (topical)

+

NA

NA

NA

Micronized purified flavonoid fraction (MPFF) (oral)

NA

+

NA

NA

Time to healing or rate of healing

(MAs: 5 [34,39,44,45,56];

non-MAs: 1 [77])

Four-layer bandage

+

NA

NA

NA

MPFF (oral)

NA

+

NA

NA

Stockings

NA

+

NA

+/−

Silver-impregnated dressings

NA

–

NA

NA

 

Applied freeze-dried keratinocyte lysate (topical)

NA

NA

NA

–

 

Collagenase (topical)

NA

NA

NA

+/−

 

Compression stockings

NA

NA

NA

+

 

Flavonoids + compression

NA

NA

NA

+/−

 

Intermittent pneumatic compression + compression

NA

NA

NA

+/−

 

Larval therapy

NA

NA

NA

+/−

 

Laser therapy

NA

NA

NA

+/−

 

Leg ulcer clinics, wound care program

NA

NA

NA

+/−

 

Multi-layer elastomeric high-compression

NA

NA

NA

–

 

Platelet-derived growth factor (oral)

NA

NA

NA

+/−

 

Rutosides (oral)

NA

NA

NA

+/−

 

Semi-occlusive dressings: foam, film, hyaluronic acid-derived dressings, collagen, cellulose, or alginate

NA

NA

NA

–

 

Stockings: multi-layer elastic system, multi-layer elastomeric (or non-elastomeric) high-compression regimens

NA

NA

NA

–

 

Sulodexide (oral) + compression

NA

NA

NA

+

 

Thromboxane α2 antagonists (oral)

NA

NA

NA

+/−

 

Topical negative pressure (vacuum-assisted closure)

NA

NA

NA

+

 

Ultrasound

NA

NA

NA

–

Ulcer healing

(MAs: 8 [29,30,39,51,62];

non-MAs: 5 [72,73,77,89,103,119])

Elastic high compression bandages

+

NA

NA

+

Cryopreserved allografts (Skin grafting)

NA

–

NA

+/−

 

Cultured keratinocytes/epidermal grafts (Skin grafting)

NA

–

NA

+/−

 

Fresh allografts (Skin grafting)

NA

–

NA

+/−

 

Granulocyte-macrophage colony stimulating factor (topical)

NA

+

NA

NA

 

Pentoxifylline (oral)

+

NA

NA

NA

 

Stockings

NA

+

NA

 
 

Tissue engineered skin

NA

+

NA

NA

 

Electromagnetic therapy

NA

NA

+

NA

 

Hydrocolloid (occlusive) dressings + compression

NA

NA

NA

–

 

Intermittent pneumatic compression (Flowtron, sequential gradient Jobst extremity pump)

NA

NA

NA

+/−

 

Maggot debridement therapy

NA

NA

NA

+

 

Mesoglycan (topical)

NA

NA

NA

+/−

 

Superficial venous surgery

NA

NA

+

NA

Proportion of patients with healed wounds

(MAs: 39 [21,23,25,30,31,36,40,45,46,48,52,53,55,58,62,64-67];

non-MAs: 2 [77,102])

Four-layer bandage

–

NA

  

Any laser (unspecified low level laser, ultraviolet therapy, non-coherent unpolarized red light)

NA

–

NA

NA

 

Artificial skin graft and standard wound care

NA

–

NA

NA

 

Autologous platelet-rich plasma (topical)

NA

–

NA

–

 

Cadexomer iodine (topical) plus compression therapy

+

NA

NA

NA

 

Systemic ciprofloxacin (oral)

NA

–

NA

NA

 

Skin replacement therapy (Dermagraft)

NA

+

NA

+

 

Elastic high compression bandages

+

NA

NA

NA

 

Foam dressing

–

NA

NA

NA

 

Granulocyte-macrophage colony stimulating factor (perilesional injection)

NA

+

NA

+

 

High frequency ultrasound

–

NA

NA

NA

 

Honey (topical)

–

NA

NA

NA

 

Hydrocolloid dressings

–

NA

NA

NA

 

Hydrogel dressing

–

NA

NA

NA

 

Intermittent pneumatic compression stockings

+/−

–

NA

NA

 

Low frequency ultrasound

–

NA

NA

NA

 

Multi-layer high compression bandages

+/−

NA

NA

+

 

Pentoxifylline (oral) with and without compression

+

NA

NA

+

 

Stockings

+

NA

NA

+/−

 

Two-component (outer elastic) bandages

+/−

NA

NA

NA

 

Ultrasound

NA

–

NA

NA

 

Unna’s boot

NA

–

NA

NA

 

Zinc (oral)

–

NA

NA

NA

 

Antimicrobial (topical)

NA

NA

NA

–

 

Calcitonin gene-related peptide (topical)

NA

NA

NA

–

 

Prostaglandin EI (IV)

NA

NA

NA

+

 

Subfascial endoscopic perforator surgery

NA

NA

NA

+

 

Superficial vein surgery

NA

NA

NA

+/−

 

Systemic mesoglycan (IM, oral) + compression

NA

NA

NA

+

  1. *At least one systematic review with meta-analysis and AMSTAR score ≥8.
  2. **At least one systematic review without meta-analysis and AMSTAR score ≥8.
  3. + Effective (statistically significant difference between interventions and comparators); – No difference (no statistically significant difference between interventions and comparators); +/− Unknown (conflicting evidence between meta-analysis or indeterminate results); NA, No studies available; MA, Meta-analysis.