Intended for healthcare professionals


Dressings for venous leg ulcers: systematic review and meta-analysis

BMJ 2007; 335 doi: (Published 02 August 2007) Cite this as: BMJ 2007;335:244
  1. Simon Palfreyman, research nurse/Smith and Nephew Foundation doctoral student1,
  2. E Andrea Nelson, reader2,
  3. Jonathan A Michaels, professor of vascular surgery1
  1. 1Sheffield Vascular Institute, Northern General Hospital, Sheffield S5 7AU
  2. 2School of Healthcare, University of Leeds, Leeds LS2 9UT
  1. Correspondence to: S J Palfreyman simon.palfreyman{at}
  • Accepted 11 June 2007


Objective To review the evidence of effectiveness of dressings applied to venous leg ulcers.

Design Systematic review and meta-analysis.

Data sources Hand searches of journals and searches of electronic databases, conference proceedings, and bibliographies up to April 2006; contacts with dressing manufacturers for unpublished studies.

Studies reviewed All randomised controlled trials that evaluated dressings applied to venous leg ulcers were eligible for inclusion. Data from eligible studies were extracted and summarised independently by two reviewers using a data extraction sheet. Methodological quality was assessed independently by two reviewers.

Results The search strategy identified 254 studies; 42 of these fulfilled the inclusion criteria. Hydrocolloids were no more effective than simple low adherent dressings used beneath compression (eight trials; relative risk for healing with hydrocolloid 1.02, 95% confidence interval 0.83 to 1.28). For other comparisons, insufficient evidence was available to allow firm conclusions to be drawn. None of the dressing comparisons showed evidence that a particular class of dressing healed more ulcers. Some differences existed between dressings in terms of subjective outcome measures and ulcer healing rates. The results were not affected by the size or quality of trials or the unit of randomisation. Insufficient data were available to allow conclusions to be drawn about the relative cost effectiveness of different dressings.

Conclusions The type of dressing applied beneath compression was not shown to affect ulcer healing. The results of the meta-analysis showed that applying hydrocolloid dressings beneath compression produced no benefit in terms of ulcer healing compared with applying simple low adherent dressings. No conclusive recommendations can be made as to which type of dressing is most cost effective. Decisions on which dressing to apply should be based on the local costs of dressings and the preferences of the practitioner or patient.


  • Contributors: SP and EAN reviewed articles and extracted and analysed the data. JAM reviewed articles and advised on inclusion. All authors contributed to drafting the article. SP is the guarantor.

  • Funding: NHS HTAP, Sheffield Teaching Hospitals Trust, University of York, University of Leeds. The opinions and conclusions expressed here are those of the authors and do not necessarily reflect those of the UK National Health Service or the Department of Health.

  • Competing interests: A trial by EAN was included in the review.

  • Ethical approval: Not needed.

    Provenance and peer review: Non-commissioned; externally peer reviewed.

  • Accepted 11 June 2007
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