Which dressing is best when used under a pressure bandage for venous leg ulcers?

In this meta-analysis, no type of product -- hydrocolloid, foam, hydrogel, or alginate -- was found to be better than a low-adherent dressing or better than one another with regard to healing. Cost, ease of use, and pain on application or removal based on clinical experience can be used to guide product choice. (LOE = 1a)

Palfreyman S, Nelson EA, Michaels JA. Dressings for venous leg ulcers: systematic review and meta-analysis. BMJ 2007;335:244.  [PMID:17631512]

Meta-analysis (randomized controlled trials)

Government

Various (meta-analysis)

To determine which is the best among the numerous dressings to cover a venous leg ulcer under a compression bandage (eg, Unna boot), these researchers searched 4 databases, examined conference proceedings, checked citations, and contacted experts and dressing manufacturers. Two reviewers independently assessed the trials, identifying 42 studies enrolling a total of almost 1000 patients. They did not include studies of diabetic or arterial ulcers. All of the studies were randomized. Allocation concealment was unclear for most to them, as was the masking of the outcome assessor. These design erors could result in an overestimate of benefit of one treatment or another. Studies compared various dressing types and products within specific types, with no studies demonstrating a benefit of one dressing over another or one product over another in terms of healing. As a result, choice of dressing can be based on other factors, such as cost, ease of use, and pain associated with their use, areas that have been poorly studied to date.