Topical ozone therapy effectiveness in the treatment of venous leg ulcers: systematic review

Background: Topical ozone has been recently used in the treatment of venous leg ulcers due to its immunological, antimicrobial and oxygenation properties, but its efficacy still lacks evidence. Objectives: To determine the effectiveness of topical ozone therapy in the healing rate, healing time reduction and in the decrease of bacterial load in venous leg ulcers. Methods: A systematic literature review with meta-analysis of studies published between January 2000 and November 2016 was carried out on PubMed, EBSCO, Scielo, and grey literature. The methodology proposed by Cochrane was followed. Critical appraisal, data extraction, and data synthesis were performed by two inde-pendent reviewers.results. Among 275 studies screened, three controlled trials (one of which rando-mized) were included, corresponding to a total of 133 participants. All these trials demonstrated that ozone therapy is more effective than conventional therapy in healing rate, as well as in reducing healing time and signs of infection (bacterial load). The meta-analysis confirmed the higher efficacy of ozone therapy in the healing rate (Odds Ratio = 7.28; CI 95% = 3.56 to 14.89; p < 0.001). For the other outcomes it was not possible to perform meta-analysis due to the use of different assessment methods. Conclusions: Topical ozone therapy may be a therapeutic option for the treatment of venous leg ulcers. However, more randomized and controlled studies are ne-eded to evaluate its efficacy in reducing healing time and bacterial load, as well as on the safety of this therapy. It is also important that these studies use uniform therapeutic and assessment methods

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Effectiveness of short-stretch compressive therapy beyond healing of varicose ulcers: systematic review

Context: Compressive therapy, especially with short-stretch bandage (SSB), is re-commended in the treatment of varicose ulcers, with proved effectiveness in the healing rate or reduction of wound size. However, there is still insufficient evidence of the advantages of this type of therapy in terms of pain, quality of life (QoL) and cost of treatment. Objectives: To compare the effectiveness of SSB with other types of treatments (with or without compression) to improve pain, QoL and cost of the treatment of venous ulcers. Methodology: A systematic literature review (Cochrane methodology) was carried out on PubMed, EBSCO, Scielo, Google Academic, and grey literature. Only experi-mental or quasi-experimental studies, with adults with varicose ulcer were inclu-ded. Two independent reviewers performed critical appraisal, data extraction, and data synthesis. Results: Among 3133 hits screened, 4 randomized controlled trials (RCTs) were in-cluded, including a total of 977 patients. From these 4 trials: 2 analyzed the QoL, without significant differences between SSB and multiple layer compression; 2 showed a trend towards greater reduction of pain with SSB, but without statistically significant difference; 2 studies evaluated the cost of treatment, with contradictory results. It was not possible to perform a meta-analysis due to high heterogeneity. Conclusions: There is no evidence that SSB is more effective than other compression systems in terms of pain, QoL and cost of treatment in people with venous ulcers. More RCT's are needed, using uniform assessment tools, to allow for more robust conclusions, namely through meta-analysis

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