What is the aim of this review?

The aim of this review is to find out which dressings and topical agents (gels, ointments and creams) are most effective for treating a type of wound known as venous leg ulcers. These are long-term wounds in the lower leg caused by problems with blood flow back up the leg through the veins. Researchers from Cochrane found 78 relevant studies (randomised controlled trials) to answer this question. Randomised controlled trials are medical studies where patients are chosen at random to receive different treatments. This type of trial provides the most reliable evidence. We evaluated these studies using a method known as network meta-analysis (NMA), which allowed us to compare treatments across different studies and to rank them in terms of complete ulcer healing.

Key messages

We cannot be certain which dressings and topical agents are most effective for healing venous leg ulcers: over all studies there were not enough participants per treatment and there was high risk of bias; this means that many of the studies were conducted or reported in a way that means we cannot be sure if the results are accurate. The main treatment for venous leg ulcers is compression bandages or stockings and the choice of additional dressings or topical treatments should take into account the review findings and their uncertainty, alongside factors such as patient preference and cost.

What was studied in the review?

Venous leg ulcers are open wounds caused by poor blood flow through the veins of the lower leg. Increased pressure in the leg veins may cause damage to the skin and surrounding tissues, leading to an ulcer. Venous leg ulcers can be slow to heal and are painful and costly to treat. The main treatment is compression bandages or stockings but these are often combined with dressings (e.g. foam or nonadherent dressings) and topical creams, gels or ointments. We wished to know which of these additional treatments are most effective when it comes to ulcer healing.

What are the main results of the review?

We found 78 studies relevant to this question, dating from 1985 to 2016. The studies involved 7014 participants (a majority were women, and average age ranged from 46 to 81 where reported). Our NMA included 59 studies (5156 participants) and compared 25 different treatments such as hydrocolloid and silver-impregnated dressings and a variety of creams and gels.

Silver dressings may increase the probability of venous leg ulcer healing compared with nonadherent dressings. However, in the light of the rest of the NMA evidence, we cannot be very confident about any conclusion, and the network as a whole represents low-certainty evidence. This was due to the small numbers of people involved across all included studies, the small number of studies focusing on each treatment, and the high risk of bias. We cannot therefore be certain which are the most effective treatments for venous leg ulcers, or even which treatments it would be best to compare in future trials.

How up to date is this review?

We searched for studies published up to March 2017.