In wound healing, standard treatments may still be best

An analysis of 60 papers related to skin ulcer treatment suggests that the research presented in the majority of the papers is flawed, leading to unreliable results.

The analysis also suggested that those papers that were scientifically rigorous in their research methods pointed to weak or inconclusive evidence that there are more successful treatments than standard procedures.

The analysis was led by researchers from the Johns Hopkins Evidence-Based Practice Center and the Johns Hopkins Wound Healing Center. The research team began the analysis in 2011, after receiving a grant from the Agency for Healthcare Research and Quality.

The study examined treatment options for chronic venous ulcers. The treatments examined were wound dressings, antibiotics and venous surgery. The standard treatments are compression therapy or stockings.

According to the study there was some data that dressings using living cells increased wound healing. Data also suggest that cadexomer iodine and collagen possibly increase healing.

Despite this, compression therapy should still be considered the standard treatment for chronic venous ulcers, according to Gerald Lazarus, M.D., director of Bayview Dermatology and one of the study’s leaders.

“Almost all dressings applied to venous wounds have similar efficacy with the exception that biological dressings containing viable cells demonstrated significantly enhanced wound healing,” Dr. Lazarus tells Dermatology Times. “Iodosorb and collagen/connective tissue component preparations had more efficacy than controls. Venous surgery did not convincingly enhance healing, but did appear to maintain more durable healing after the wound was healed. There was no evidence that routine use of systemic antibiotics was of value in promoting the healing of venous ulcers.

“This does not mean that these interventions do not work; rather, there is insufficient evidence to prove their therapeutic efficacy,” he adds. “Our studies of this easily diagnosable entity of venous ulcers demonstrates the need for better evidence to ensure reimbursement in a growingly cost-conscious financial environment.”

Dr. Lazarus also notes that only 60 of 10,066 papers focusing on therapeutic interventions could be analyzed, because of design or implementation failures.

“This observation should alert all dermatologists to carefully analyze the quality of clinical research,” he says.