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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.