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REVIEW
Dressings for Acute and Chronic Wounds
A Systematic Review
Guillaume Chaby, MD; Patricia Senet, MD; Michel Vaneau, PharmD; Philippe Martel, MD;
Jean-Claude Guillaume, MD; Sylvie Meaume, MD; Luc Te´ot, MD, PhD; Cle´lia Debure, MD;
Anne Dompmartin, MD; He´lène Bachelet, PharmD; Herve´ Carsin, MD; Ve´ronique Matz, PharmD;
Jean Louis Richard, MD; Jean Michel Rochet, MD; Nathalie Sales-Aussias, PharmD;
Anne Zagnoli, MD; Catherine Denis, MD; Bernard Guillot, MD; Olivier Chosidow, MD, PhD
Objective: To critically review the literature on the ef-
ficacy of modern dressings in healing chronic and acute
wounds by secondary intention.
Data Sources: Search of 3 databases (MEDLINE,
EMBASE, and the Cochrane Controlled Clinical Trials
Register) from January 1990 to June 2006, completed by
manual research, for articles in English and in French.
Study Selection: The end points for selecting studies
were the rate of complete healing, time to complete heal-
ing, rate of change in wound area, and general perfor-
mance criteria (eg, pain, ease of use, avoidance of wound
trauma on dressing removal, ability to absorb and con-
tain exudates). Studies were selected by a single re-
viewer. Overall, 99 studies met the selection criteria (89
randomized controlled trials [RCTs], 3 meta-analyses [1
of which came from 1 of the selected systematic reviews],
7 systematic reviews, and 1 cost-effectiveness study).
Data Extraction: The RCTs, meta-analyses, and cost-
effectiveness studies were critically appraised by 2 re-
viewers to assess the clinical evidence level according to
a modification of Sackett’s 1989 criteria. Ninety-three ar-
ticles were finally graded.
Data Synthesis: We found no level A studies, 14 level
B studies (11 RCTs and 3 meta-analyses), and 79 level C
studies. Hydrocolloid dressings proved superior to sa-
line gauze or paraffin gauze dressings for the complete
healing of chronic wounds, and alginates were better than
other modern dressings for debriding necrotic wounds.
Hydrofiber and foam dressings, when compared with
other traditional dressings or a silver-coated dressing, re-
spectively, reduced time to healing of acute wounds.
Conclusions: Our systematic review provided only weak
levels of evidence on the clinical efficacy of modern dress-
ings compared with saline or paraffin gauze in terms of
healing, with the exception of hydrocolloids. There was
no evidence that any of the modern dressings was better
than another, or better than saline or paraffin gauze, in
terms of general performance criteria. More wound care
research providing level A evidence is needed.
Arch Dermatol. 2007;143(10):1297-1304
W
OUNDS ARE A MAJOR
cause of morbidity
and impaired qual-
ity of life and take up
substantial health
care resources in developed countries.
1
Each
year in the United States, over 1.25 million
people experience burns, and 6.5 million
have chronic skin ulcers caused by pres-
sure, venous stasis, or diabetes mellitus.
2
Since the 1960s, it has been accepted
that wound healing is optimal when the
wound is kept in a moist environment
rather than air dried.
3,4
Occlusive or semi-
occlusive dressings that promote reepi-
thelialization and wound closure have been
developed for chronic and acute wounds
to reduce pain and healing time, absorb
blood and tissue fluids, and to be pain-
less on application and removal.
5
The main
occlusive or semi-occlusive dressings are
hydrocolloid dressings (HCDs), algi-
nates, hydrogels, foam dressings (FDs), hy-
drofiber dressings (HFDs), and paraffin
gauze and nonadherent dressings. Re-
cent products that are reported to induce
angiogenesis or reduce infection are hy-
aluronic acid (HA) cream or dressings and
dressings supplemented with activated
charcoal or silver.
Current clinical practice guidelines on
the treatment of pressure ulcers, leg ul-
See also page 1291
Author Affiliations are listed at
the end of this article.
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1297
©2007 American Medical Association. All rights reserved.
cers, and diabetic foot lesions and available systematic
reviews on the treatment of arterial leg ulcers or surgical
wounds have not established a care strategy for each type
of wound.
6-12
The choice of ideal dressing remains con-
troversial. We assessed the level of published clinical evi-
dence in support of the efficacy of modern dressings for
the care of chronic and acute wounds in terms of com-
plete healing or aspects such as pain, ease of use, avoid-
ance of wound trauma on dressing removal, ability to ab-
sorb and contain exudates, and prevention of infection.
METHODS
DATA SOURCES AND SELECTION CRITERIA
Three bibliographic databases were searched from January 1990
to June 2006: MEDLINE, EMBASE, and the Cochrane Con-
trolled Clinical Trials Register. The search was restricted to pub-
lications in English and in French. Keywords and selection cri-
teria are given in
Table 1. From the list of retrieved titles and
abstracts, 1 reviewer (G.C.) selected the studies that used these
selection criteria to compare dressings. Case reports and case
series were excluded. The reviewer checked study relevance and
design using the full versions of the articles. Additional refer-
ences were retrieved by manual searches.
Wounds were considered to be chronic if time to healing
was delayed as a result of impaired tissue repair due to poor
oxygenation, malnutrition, or infection.
13
Chronic wounds in-
clude leg ulcers, pressure sores, and diabetic foot ulcers. Acute
wounds, however, tend to undergo an orderly and timely re-
pair process that results in sustained restoration of anatomic
and functional integrity.
14
They include skin graft donor sites,
partial-thickness burns, and posttraumatic and surgical wounds
that heal by secondary intention. Studies on deep partial- and
full-thickness burns were excluded.
CRITICAL APPRAISAL
OF SELECTED STUDIES
Selected studies were distributed among 19 reviewers who were
asked to grade trials using a checklist of items for methodologi-
cal quality based on a modified version of Sackett’s criteria for
clinical evidence.
15,16
Each trial was graded by 2 reviewers (G.C.
and 1 other reviewer). The 2 modifications to Sackett’s crite-
ria
15,16
were as follows: (1) meta-analyses that included level C
randomized controlled trials (RCTs) were downgraded from
level A to level B, and (2) RCTs were as graded level C if they
had 1 or more of the following methodological shortcomings:
evaluation of primary outcome was not blind, randomization
method was performed incorrectly when it was described, pri-
mary and secondary objectives were not clearly defined, objec-
tive or subjective measures of dressing performance were not de-
scribed, and patient groups were not comparable at baseline.
17
The criteria we used for clinical evidence are given in Table 2.
RESULTS
Overall, 2330 studies were retrieved by electronic (n=2305)
and manual (n=25) searching (
Figure). Of these, 141 were
considered relevant on the basis of title and/or abstract.
However, only 99 full-text articles met our selection cri-
teria (89 RCTs, 3 meta-analyses [1 of the meta-analyses
came from 1 of the selected systematic reviews], 7 sys-
tematic reviews, and 1 cost-effectiveness study). The ref-
Table 1. Keywords and Selection Criteria
Key Words
Selection CriteriaMEDLINE EMBASE
Randomized controlled trials, or meta-analysis, or review,
or review-literature, or guidelines, or consensus, or
consensus-development-conferences or congresses or
recommendation(s) in combination with bandages,
including hydrocolloid dressings, hydrocellular or
polyurethane foams, alginate dressings, hydrogels,
hydrofiber dressings, dextranomer, paraffin dressing,
nonadherent dressings, dressings containing
hyaluronic acid, silver-coated dressing or activated
charcoal dressing, protease-modulating matrix
(Promogran
a
) in combination with wound healing or
vacuum or vacuum-assisted closure or negative
pressure wound therapy, or topical negative pressure
or leg ulcer or therapy, drug therapy, nursing, surgery
or decubitus ulcer or therapy, drug therapy, nursing
and surgery or chronic disease or therapy, drug
therapy, nursing and surgery or surgical-wound-
dehiscence or therapy, drug therapy, nursing and
surgery or surgical wound infection or therapy, drug
therapy, nursing and surgery or skin transplantation or
therapy, drug therapy, nursing and surgery or skin
diseases vesiculobullous or therapy, drug therapy,
nursing, and surgery or nursing or surgery or burns or
skin graft or donor site or skin ulcer or pressure or
diabetic with ulcer or trauma(tism)and wound(ing) or
drug therapy or therapy or nursing
Review or systematic review or meta-analysis
or practice guideline or consensus or
conference-paper or recommendation(s)
or randomized-controlled-trial in
combination with bandages-and-
dressings, or wound-dressing or colloid or
hydrogel or calcium-alginate or
polyurethane or charcoal or silver or
hyaluronic-acid in combination with
leg-ulcer or decubitus or skin-ulcer or
donor-site or bullous-skin-disease or
trauma(tism) with wound(ing) or pressure
or diabetic with ulcer or surgery or drug
therapy or nursing or therapy
Complete healing measured by an
objective method: rate of complete
healing or time to complete healing or
rate of change in wound area and/or
volume; pain or ease of use or
avoidance of wound trauma on
dressing removal or ability to absorb
and contain exudates or prevention of
infection or cost
a
Johnson & Johnson, Issy-les-Moulineaux, France.
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©2007 American Medical Association. All rights reserved.
erences, number of studies by type of dressing, and their
level of evidence are given in Tables 3, 4, and 5.
18-108
There were no large RCTs with definitive conclusions (level
A trials) for any type of dressing. No level B trials were
found for either hydrogels or activated charcoal.
CHRONIC WOUND CARE
Treatment with HCD resulted in a statistically signifi-
cant improvement in the complete healing rate of leg ul-
cers and pressure sores according to 3 meta-analyses
18-20
comparing HCD with paraffin gauze and wet-to-dry gauze
dressings (odds ratio, 2.57 [95% confidence interval, 1.58-
4.18]
18
; odds ratio, 2.45 [95% confidence interval, 1.18-
5.12], P =.02
19
; number needed to treat, 7 [95% confi-
dence interval, 4-16]
20
). However, there was no difference
between the healing rates of HCDs and FDs whether for
pressure sores or leg ulcers.
18,20
An RCT
101
comparing Pro-
mogran (Johnson & Johnson, Issy-les-Moulineaux,
France) with a nonadherent dressing reported no differ-
ence in the complete healing rate of leg ulcers. In brief,
for the complete healing of chronic wounds, HCD seems
to be more effective than paraffin gauze and wet-to-dry
gauze dressings, and there is no difference between FD
and HCD in terms of optimizing complete healing rate.
Alginates considerably reduced chronic wound area in
full-thickness pressure ulcers when used sequentially with
HCD (alginates for the first 4 weeks and HCD for the next
4 weeks compared with HCD alone) and when compared
with dextranomer.
41,80
Pain on removal of a dressing, al-
though never evaluated as a primary outcome, was lower
for a nonadherent dressing than for HCD in a study of leg
ulcers.
53
Maceration and odor were also less marked.
53
Scores
on pain when changing a dressing were lower with an al-
ginate than paraffin dressing in diabetic foot lesions.
73
ACUTE WOUND CARE
There was no difference in the efficacy of FD, a paraffin
gauze dressing, polyethane film, or polyurethane film on
Table 2. Criteria for Assessing Clinical Evidence
a
Level Criteria
A Large, randomized, double-blind, controlled studies with low
false-positive (␣) and low false-negative () errors; MAs
of RCTs
B RCTs including a small number of patients, thereby
increasing the likelihood of high false-positive and/or
false-negative errors; MAs that include low-evidence RCTs
(level C)
a
C Trials that lack 1 or more of the following criteria: evaluation
of primary outcome blind, randomization method
performed correctly when described, primary and
secondary objectives clearly defined, objective or
subjective measures of dressing performance described,
and patient groups comparable at baseline
b
; case reports;
case series
Abbreviations: MAs, meta-analyses; RCTs, randomized controlled trials.
a
According to the criteria of Bouvenot and Vray.
17
b
According to modifications to Sackett’s criteria.
15,16
2305
References came
from electronic
search (MEDLINE,
EMBASE, Cochrane
Controlled Clinical
Trials Register)
141
Potentially relevant
articles (according
to title on abstract)
93 Graded articles
†
99 Selected articles25
Potentially relevant
articles came from
manual search
1 Cost-effectiveness
study
7 Systematic reviews,
consensus, and
guidelines
89 RCTs
3 MAs
∗
78 RCTs
1 Cost-effectiveness
study
14 Evidence level B
studies
11 RCTs
3 MAs
79 Evidence level C
studies
0 Evidence level A
studies
Figure. Flowchart describing the selection of studies for analysis. MA
indicates meta-analysis; RCTs, randomized controlled trials. The asterisk
indicates that 1 of the MAs came from a selected systematic review. The
dagger indicates that 6 of the 7 systematic reviews, consensus, and
guidelines did not have any RCTs or MAs and were not critically appraised.
15
Table 3. Selected Studies by Type of Dressing
a
Type of Dressing RCTs
Clinical Evidence
Level
BC
Hydrocolloids
18-54
34⫹ 3
MAs
2
41,53
32
3
18-20
Hydrocellular or polyurethane
foam
18,20,30-37,55-68
22⫹ 2
MAs
2
57,65
20
2
18,19
Alginate
38-40,59,60,69-84
21 4
41,73,78,80
17
Hydrogels
52,85-92
90 9
Hydrofiber
77,78,93-95
53
78,94,95
2
Dextranomer
80,91,93,96,97
51
80
4
Paraffin gauze
21,23,27,29,57,69,71,73,74,92
10 2
57,73
8
Nonadherent
53,82,98-101
62
53,101
4
Hyaluronic acid–impregnated
97,102,103
31
102
2
Silver-coated
65,67,83,84,104,105
61
65
5
Activated charcoal
66
10 1
Protease-modulating matrix
(Promogran
b
)
101,106,107
2⫹ 1 CES 1
101
1
1
Abbreviations: CES, cost-effectiveness study; MAs, meta-analyses;
RCTs, randomized controlled trials.
a
Data are given as number of selected studies (we found no level A
studies); n=99.
b
Johnson & Johnson, Issy-les-Moulineaux, France.
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donor sites of split-thickness skin grafts.
57
However, the
time to complete healing of these sites was lower with
the FD than a silver-coated dressing (SCD), and with an
HFD than with paraffin gauze.
65,94
There was no differ-
ence in the complete healing rates of HFD and wet-to-
dry gauze for surgical wounds.
95
The HA-impregnated
dressings delayed time to complete healing of skin graft
donor sites when compared with a glycerine-impreg-
nated dressing.
102
In brief, FD seems to be more effec-
tive than an SCD in hastening complete healing of acute
wounds, and HFD seems more effective than paraffin
gauze.
Pain on dressing change was the primary outcome in
1 study only, which compared HFDs and alginates in sur-
gical wound care and found no difference between these
2 types of dressing.
78
When pain was a secondary out-
come, HFD was superior to paraffin gauze for pain scores
in split-thickness skin graft donor sites.
94
No difference
Table 4. Level B Clinical Evidence for Chronic Wounds
Source
Study
Design
Type of
Dressing
Type of
Wound
Patients
(Wounds),
No.
Primary End Point
and Outcome
P
Value
Area Reduction and/or Others
Secondary Outcomes
a
Bradley et al
18
Review
(included MA
of 5 RCTs);
review
(included
MAs of 2
RCTs)
HCD vs SG
or DS;
FD vs
HCD
Pressure sores;
leg ulcers
NA Complete healing, 51%
vs 31%;
complete healing, OR
2.57 (95% CI,
1.58-4.18)
NA NA
Singh et al
19
MA of 12 RCTs HCD vs SG,
PGD
Leg ulcers 693 (819) Complete healing, 51%
vs 31%, P=.02; OR,
2.45 (95% CI,
1.18-5.12)
.02 NA
Bouza et al
20
MA of 6 RCTs;
MA of 5 RCTs
HCD vs SG,
PGD, CD;
FD vs
HCD
Pressures
sores;
pressure
sores
NA Complete healing, HD⬎
TD; NNT, 7;
complete healing
(95% CI, 4-16)
NA NA
Vin et al
101
RCT Pr vs ND Leg ulcers 73 (73) Complete healing, NS .37 Mean (SD) surface decrease:
36.5% (11.4%) (ND) vs
54.4% (10.9%) (Pr),
P⬍ .001 ⱕ20% surface area
reduction: 42% (ND) vs 19%
(Pr), P=.03;
Ease of use, P=.10;
mean dressing acceptability
score, P=.17 (investigators)
and P=.06 (patients)
Belmin et al
41
RCT Alg and HCD
vs HCD
Pressure sores 110 (110) SAR and percentage of
patients with ⱖ40%
SAR at 4 and 8 wk;
mean (SD) SAR:
7.6 (7.1) cm
2
vs
3.1 (7.2) cm
2
at 8 wk;
SAR 40: 74.4% vs
58.5% at 8 wk
.001 Pain during dressing change,
P=.03; ease of use, P =.11
Sayag et al
80
RCT Alg vs D Fibrous
pressure
sores
92 (92) Time to achieve ⱖ40%
SAR, plus granulation
tissue uniformly
covering the wound
bed; median of 4 wk
vs ⬎8 wk)
⬍.001 Mean surface area reduction per
week: 2.39 cm
2
(Alg) vs 0.27
cm
2
(D), P⬍ .001;
minimum 40% reduction in
wound surface: 74% (Alg) vs
42% (D), P=.002
Lalau et al
73
RCT Alg vs PGD Diabetic foot
lesions
77 (77) Percentage of patients
with granulation
tissue over 75% of
wound area and 40%
SAR at 6 wk, NS
NA Pain during dressing change:
lower in Alg group, P=.047
Meaume et al
53
RCT HCD vs ND Leg ulcers 91 (91) SAR at 8 wk, NS NA Pain during dressing removal,
maceration and odor: better
acceptability of ND, P⬍ .001
Abbreviations: Alg, alginate; CD, cotton dressing; CI, confidence interval; D, dextranomer; FD, foam dressing; HCD, hydrocolloid dressing; MA, meta-analysis;
NA, not available; ND, nonadherent dressing; NNT, number needed to treat; NS, not significant; OR, odds ratio; PGD, paraffin gauze dressing; Pr, Promogran
( Johnson & Johnson, Issy-les-Moulineaux, France); RCT, randomized control trial; SAR, surface area reduction; SG, saline gauze; WDG, wet-to-dry gauze.
a
Level B studies were defined as (1) RCTs including few patients but with primary outcomes evaluated blindly, randomization method performed correctly,
primary and secondary objectives clearly defined, and patient groups comparable at baseline or (2) meta-analyses including level C RCTs.
b
General performance criteria are pain, ease of use, avoidance of wound trauma on dressing removal, and ability to absorb and contain exudates.
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between SCD and FD was found in the incidence of posi-
tive bacterial cultures.
65
COMMENT
According to our systematic review, the methodological
quality of most studies of wound dressings is poor (level
C). There is little evidence to indicate which dressings are
the most effective in chronic and acute local wound care
in terms of complete healing, comfort, and prevention of
infection. Most studies had several of the following limi-
tations: (1) the number of patients was not based on a
sample size calculation performed beforehand; (2) the ran-
domization method was not described; (3) assessment of
outcomes was not blinded to treatment or was not com-
pletely objective; (4) an intention-to-treat analysis was not
always used; (5) assessment of objective or subjective mea-
sures of dressing performance was not always clearly de-
scribed; (6) the study population was heterogeneous, par-
ticularly in studies of leg ulcers; (7) whether adjuvant
treatments, such as pressure-relieving surfaces for pres-
sure sores or off-loading devices for neuropathic diabetic
foot ulcers, were used in each treatment group was not
specified; and (8) a small sample size was combined with
multiple outcome measures. There is, however, good (level
B) evidence to suggest that, for chronic wounds, HCD dress-
ings are better than saline gauze or paraffin gauze for com-
plete healing and that alginates, used either singly or in
sequential treatment, are better than other modern dress-
ings in reducing wound area, perhaps because they cause
debridement of necrotic tissue. There was no difference
between HCDs and FDs in terms of an optimizing com-
plete healing rate, but this does not mean that the prod-
ucts are equivalent because no noninferiority trial has been
performed. Only 1 level B study
73
found a statistically sig-
nificant difference for pain reduction in chronic wounds.
However, pain was a secondary outcome measure in this
study, and the result was statistically significant (P =.047).
In the case of acute wounds, the studies (level B) pro-
vided little useful information. Only 1 study reported a
notable difference in healing rate between modern dress-
ings (an HFD) and paraffin gauze or wet-to-dry gauze
dressings (modern dressings included alginate, FD, and
HCD).
95
An HA or SCD, when compared with a glycerine-
impregnated dressing or an FD, respectively, delayed
healing.
No scientific evidence was found for the use of spe-
cific dressings in the following cases: hemorrhagic
wounds, malodorous wounds, fragile skin, and preven-
tion and treatment of infection. Nor was the evidence suf-
ficient to show a benefit of modern dressings on pain or
other performance factors in the dressing of acute or
chronic wounds when compared with saline or paraffin
gauze dressings (eg, ease of use, avoidance of wound
trauma on dressing removal, ability to absorb and con-
tain exudates). In fact, dressing selection by physicians
is more about matching criteria such as absence of pain,
ease of use, avoidance of wound trauma on dressing re-
moval, and ability to absorb and contain exudates rather
than healing properties. Future trials should use vali-
dated and standardized tools to measure pain, quality of
life, and comfort of use. They should assess healing using
clinically relevant objectives, especially the rate of com-
plete healing and time to heal rather than reduction in
wound area. Other performance factors should be evalu-
ated independently of any potential effect on healing. In-
termediate goals in wound management strategy (ie, pri-
mary end points such as complete wound debridement for
hydrogel dressings and lowering of systemic infection and
prescription of antibiotics for SCDs) might be worth test-
Table 5. Level B Clinical Evidence for Acute Wounds
a
Source
Type of
Dressing
Type of
Wound
Patients
(Wounds),
No.
Primary End Point
and Outcome
P
Value
Area Reduction and/or Other
Secondary Outcomes
b
Persson and
Salemark
57
FD vs PGD vs
PF vs PUF
SGDS 80 (80) Complete healing at 14 d, .30 PUF more comfortable (14 d after
surgery), P= .01
Innes et al
65
FD vs SD SGDS 17 (34) Mean (SD) time to complete healing
(⬎90% reepithelialized),
9.1 (1.6) d vs 14.5 (6.7) d
.004 NA
Barnea et al
95
HFD vs PGD SGDS 23 (46) Mean time to complete healing,
7-10 d vs 10-14 d
.02 Pain during dressing change: lower
for HFD, P⬍ .001
Ease of use greater for HF,
P=.003
Cohn et al
94
HFD vs WDG SW 50 (50) Mean (SD) rate of healing (10.3
[2.0] d vs 9.1 [1.6] d)
.08 Ability to absorb and contain
exudates, P not calculated
Bettinger
102
HA vs GD SGDS 11 (22) Mean (SD) time to complete
healing, 10.3 (2) d vs 9.1 (1.6) d
⬍.05 NA
Foster et al
78
HFD vs Alg SW 100 (100) Pain on dressing change, ease of
use
NA NA
Abbreviations: Alg, alginate; FD, foam dressing; GD, glycerine-impregnated dressing; HA, hyaluronic acid–impregnated dressing; HFD, hydrofiber dressing;
NA, not available; PF, polyethane film; PUF, polyurethane film; PGD, paraffin gauze dressing; SGDS, skin graft donor site; SW, surgical wound;
WDG, wet-to-dry gauze.
a
All of these studies were randomized controlled trials (RCTs). Level B studies were defined as (1) RCTs including few patients but with primary outcomes
evaluated blindly, randomization method performed correctly, primary and secondary objectives clearly defined, and patient groups comparable at baseline or (2)
meta-analyses including level C RCTs.
b
Pain, ease of use, avoidance of wound trauma on dressing removal, and ability to absorb and contain exudates.
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©2007 American Medical Association. All rights reserved.
ing. Other end points could be evaluated in specific situ-
ations (eg, when there is a need to control bleeding in hem-
orrhagic wounds or avoid trauma in cases of fragile skin).
In conclusion, available systematic reviews of the value
of different types of dressing in the management of acute
and chronic wounds provide only weak levels of evi-
dence on clinical efficacy.
10-12,18
The review by Palfrey-
man et al
12
identified 42 RCTs that evaluated dressings for
the treatment of venous leg ulcers but found that no dress-
ing was better than any other in terms of number of ul-
cers healed.
12
In our review, the studies with the best level
of evidence underline the potential interest of some mod-
ern dressings (ie, use of HCDs and FDs) in optimizing the
complete healing rate of chronic wounds, of alginates for
the debridement of necrotic tissue from chronic wounds,
and of HFDs for hastening the healing of acute wounds.
However, our review also stresses the need for more wound
care research providing level A evidence. Health care pro-
fessionals require more detailed recommendations on the
use of dressings. A discussion of our review by an expert
panel would be useful in achieving professional agree-
ment on the recommended use of dressings.
Accepted for Publication: June 14, 2007.
Author Affiliations: Department of Dermatology, Cen-
tre Hospitalier Universitaire d’Amiens, Amiens, France
(Dr Chaby); Department of Geriatrics, Assistance Pub-
lique–Hoˆpitaux de Paris, Hoˆ pital Charles Foix, Ivry-sur-
Seine, France (Drs Senet and Meaume); Dermatology Con-
sultations, Assistance Publique–Hoˆpitaux de Paris, Hoˆpital
Rothschild, Paris, France (Dr Senet); Haute Autorite´de
Sante´, Saint Denis, France (Drs Vaneau, Martel, and
Denis); Department of Dermatology, Centre Hospital Ge´n-
e´ral de Colmar, Colmar, France (Dr Guillaume); Depart-
ment of Orthopedic Surgery and Burn and Plastic Sur-
gery Center, Hoˆpital Lapeyronie, Montpellier, France
(Dr Te´ot); Department of Vascular Rehabilitation, As-
sistance Publique–Hoˆ pitaux de Paris, Hoˆ pital Brous-
sais, Paris (Dr Debure); Department of Dermatology, Cen-
tre Hospitalier Universitaire de Caen, Caen, France
(Dr Dompmartin); Department of Pharmacology, Cen-
tre Hospitalier Re´gional Universitaire Lille, Lille, France
(Dr Bachelet); Department of Burns, Hoˆ pital d’Instruction
des Arme´es Percy, Clamart, France (Dr Carsin); Depart-
ment of Pharmacology, Centre Hospitalier Bar le Duc,
Bar le Duc, France (Dr Matz); Department of Nutri-
tional Diseases and Diabetology, Centre Medical, Le Grau
du Roi, Centre Hospitalier Universitaire Nıˆmes, France
(Dr Richard); Department of Physical and Rehabilitation
Medicine, Centre de Re´e´ducation de Coubert, Coubert,
France (Dr Rochet); Department of Pharmacology, Assis-
tance Publique-Hoˆ pitaux de Marseille, Marseille, France
(Dr Sales-Aussias); Department of Dermatology, Hoˆpi-
taux d’Instruction des Arme´es Clermont Tonnerre, Brest,
France (Dr Zagnoli); Department of Dermatology, Cen-
tre Hospitalier Universitaire de Montpellier, Montpellier
(Dr Guillot); and Universite´ Pierre-et-Marie-Curie–Paris
VI, and Department of Dermatology and Allergy, Assis-
tance Publique–Hoˆpitaux de Paris, Hoˆ pital Tenon, Paris
(Dr Chosidow).
Correspondence: Olivier Chosidow, MD, PhD, Depart-
ment of Dermatology and Allergy, Hoˆ pital Tenon, 4 rue
de la Chine, 75970 Paris, CEDEX 20, France (olivier
.chosidow@tnn.aphp.fr).
Author Contributions: Study concept and design: Chaby,
Senet, Vaneau, Meaume, Te´ot, Dompmartin, Denis, and
Chosidow. Acquisition of data: Chaby, Martel, Guillaume,
Meaume, Debure, Dompmartin, Guillot, and Chosidow.
Analysis and interpretation of data: Chaby, Senet, Martel,
Guillaume, Meaume, Te´ot, Dompmartin, Bachelet, Car-
sin, Matz, Richard, Rochet, Sales-Aussias, Zagnoli, Guil-
lot, and Chosidow. Drafting of the manuscript: Chaby,
Senet, Vaneau, and Guillaume. Critical revision of the
manuscript for important intellectual content: Senet, Va-
neau, Martel, Guillaume, Meaume, Te´ot, Debure,
Dompmartin, Bachelet, Carsin, Matz, Richard, Rochet,
Sales-Aussias, Zagnoli, Denis, Guillot, and Chosidow. Sta-
tistical analysis: Chaby. Obtained funding: Chaby and Va-
neau. Administrative, technical, and material support: Va-
neau, Martel, and Sales-Aussias. Study supervision: Chaby,
Senet, Vaneau, Guillaume, Debure, Dompmartin, Richard,
Rochet, Denis, Guillot, and Chosidow.
Financial Disclosure. Dr Meaume participates in edu-
cational programs on Profore multilayer bandaging manu-
factured by Smith & Nephew and is a co-organizer for
an international study on the epidemiology of pain and
wounds for Mo¨ lnlycke Products. Dr Te´ot is involved in
the following collaborations and partnerships: scientific
collaboration of wound dressings with Braun (random-
ized trial on calgitrol vs alginate in infected wounds) and
Kinetic Concepts Inc (KCI) (and the French Ministry of
Health) on a medical-economic study of the effects of
vacuum-assisted closure (KCI); editorial collaboration
with Mo¨ lnlycke Products (pain and dressing changes for
acute wounds), KCI (on technical considerations of
vacuum-assisted closure [World Union of Wound Heal-
ing Societies statement]), and Coloplast (on pain man-
agement of wounds); and educational partnerships with
Smith & Nephew, Johnson & Johnson, and Urgo. Drs
Senet and Chosidow are presently involved in building
a protocol using Dermagen to treat diabetic foot ulcers;
Dermagen is manufactured by Genevrier, a French com-
pany that also sells HA-associated dressings.
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