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Skin grafting for venous leg ulcersJones JE, Nelson EA
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SummaryApplying bilayered tissue-engineered skin under compression improves healing of venous leg ulcers compared with simple dressings and compression, but the effect of other types of graft is not clear.Approximately 1% of people in industrialised countries have a leg ulcer at some time, mainly caused by poor blood flow back from the legs towards the heart. Skin grafts, either using the patient's own skin or donor skin/cells, have been evaluated to see whether they improve the healing of ulcers. The review of trials found evidence that tissue-engineered skin composed of two layers increases the chance of healing. There was not enough evidence to recommend any other type of graft, and further research is required.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 24. 2000 AbstractBackgroundVenous leg ulceration is a recurrent, chronic, disabling condition. It affects up to one in 100 adults at some time. Standard treatments are simple dressings and compression bandages or stockings. Sometimes, despite treatment, ulcers remain open for months or years. Sometimes skin grafts are used to stimulate healing. These may be taken, or grown into a dressing, from the patient's own uninjured skin (autografts), or applied as a sheet of bioengineered skin grown from donor cells (allograft). Preserved skin from other animals, such as pigs, has also been used (xenografts). ObjectivesTo assess the effect of skin grafts for treating venous leg ulcers. Search strategyWe searched the Cochrane Wounds Group Specialised Register (February 2006) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2006). Selection criteriaRandomised controlled trials (RCTs) of skin grafts in the treatment of venous leg ulcers. Data collection and analysisTwo reviewers independently undertook data extraction and assessment of study quality. Main resultsWe identified 15 trials - generally of poor methodological quality - involving 768 participants. In 11 trials participants also received compression bandaging. One trial (31 participants) compared a dressing with an autograft. Three trials (74 participants) compared frozen allografts with dressings, and three trials (47 participants) compared fresh allografts with dressings. Two trials (345 participants) compared tissue-engineered skin (bilayer artificial skin) with a dressing. In two trials (71 participants) a single-layer dermal replacement was compared with standard care. Four trials compared skin grafting techniques: one trial (92 participants) compared autografts with frozen allograft, a second (51 participants) compared a pinch graft (autograft) with a porcine dermis (xenograft), the third (seven participants, 12 ulcers) compared tissue-engineered skin with a split-thickness graft, the fourth (10 participants) compared a fresh allograft with a frozen allograft. The trials comparing bilayer artificial skin with a dressing reported a significantly higher proportion of ulcers healing with artificial skin. There was not enough evidence from the other trials to determine whether other types of skin grafting increased the healing of venous ulcers. Authors' conclusionsBilayer artificial skin, used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared with compression and a simple dressing. Further research is needed to assess whether other forms of skin grafts increase ulcer healing. |
