For adults with venous leg ulcers, how do different dressings and topical agents compare?

Abstract

Results from a network meta‐analysis that compares treatments directly (from head‐to‐head RCTs) and indirectly (via common comparators, including placebo) show that sucralfate was ranked the best treatment for adults with venous leg ulcers (93% probability of being first). One small comparison between sucralfate and hydrogel showed that 43/50 ulcers healed with sucralfate versus 5/50 with hydrogel, so all indirect comparisons with sucralfate have large but imprecise effects. Consequently, the apparent benefit of sucralfate should be regarded with caution. Silver had a 50% probability of being the second‐best treatment, hyaluronic acid plus povidone iodine a 21% probability of being ranked third, and paste bandage a 22% probability of being ranked fourth. Saline gauze was most likely to be the worst treatment (33% probability of being ranked 24th). Other apparently poorly performing interventions included gentian violet, hyaluronic acid, silver sulfadiazine (SSD), and zinc oxide. Although the certainty of evidence for the comparison between silver and non‐adherent dressings was rated as moderate, overall evidence was of very low to low certainty, so no firm conclusions can be drawn.