Supplementary Material for: Effectiveness of Advanced versus Conventional Wound Dressings on Healing of Chronic Wounds: Systematic Review and Meta-Analysis

Background: Wound dressings are essential in the treatment of chronic wounds and should be selected on valid and recent evidence. Objective: Effectiveness of advanced compared to conventional dressings for chronic wound healing. Methods: Comprehensive literature search, systematic review and meta-analyses of the results of advanced dressing studies on chronic wound treatment. Comprehensiveness and coverage of all relevant studies is the most striking difference in relation to other meta-analyses and systematic reviews. Results: The mean odds ratio of complete healing was 1.52 favouring advanced over conventional dressings in 65 controlled trials. In 287 study conditions including uncontrolled studies, mean odds were 0.97 (advanced dressings/controlled studies), 0.77 (conventional/controlled) and 0.47 (advanced/uncontrolled). The overall healing rate was 33%. When causal treatment was applied, a reduced effect was observed. The consideration of all types of chronic wounds, advanced wound dressings and studies resulted in more study effects, more reliable estimates of mean effects and more statistical power. These differences in the design are likely to explain the differences in the meta-analytic results. Conclusion: A general superiority of advanced dressings on complete healing was shown. The generalizability of the results is limited by the methodological and report quality within studies identified, unexplained heterogeneity in study effects and possibly by publication bias.

背景：伤口敷料是慢性创面治疗的关键手段，其选型应基于最新且可靠的循证依据。研究目标：对比高级伤口敷料与传统敷料用于慢性创面愈合的临床疗效。研究方法：针对慢性创面治疗领域的高级敷料相关研究结果开展全面文献检索、系统评价与荟萃分析。本研究与其他同类荟萃分析及系统评价的最显著差异在于，其对所有相关研究均实现了全面检索与完整覆盖。研究结果：在65项对照试验中，慢性创面完全愈合的平均优势比（Odds Ratio, OR）为1.52，提示高级敷料的疗效优于传统敷料。在包含非对照研究在内的287项研究条件中，平均优势比分别为：高级敷料/对照研究组0.97、传统敷料/对照研究组0.77、高级敷料/非对照研究组0.47。整体愈合率为33%。当实施针对性病因治疗时，观察到敷料的疗效有所降低。纳入所有类型的慢性创面、各类高级伤口敷料及相关研究后，本研究可获得更多有效研究效应、更可靠的平均效应估计值与更高的统计效力。研究设计上的上述差异，或可解释不同荟萃分析结果间的分歧。结论：本研究证实高级伤口敷料在慢性创面完全愈合方面具有总体优势。但本研究结果的外推性存在一定局限：纳入研究的方法学质量与报告质量参差不齐、研究效应存在无法解释的异质性，且可能存在发表偏倚。