A Network Meta-analysis Of Four Kinds Of Treatments For Chronic Refractory Wounds

Objective:Network meta-analys is applied to compare the efficacy of four therapeutic measures for chronic refractory wounds including conventional dressing change,wound negative pressure closure drainage(VSD),self-platelet rich plasma(PRP),wound negative pressure closure drainage(VSD)combined with self-platelet-rich plasma(PRP).Materials and methods:we searched PubMed,EMBASE,the Cochrane,WanFang-CSPD,CNKI,CQVIP,on the appeal of the four treatment methods in treatment of chronic refractory wounds of randomized controlled trials,set the retrieval time for libraries to February 23,2020.Literature screening,quality evaluation and data extraction were carried out by 2 people independently,and data analysis was carried out by Statal4.0 software.The ratio(OR)and 95%CI were used as the effect indexes for the dichotomous variables,and the mean difference(MD)and 95%CI were used as the effect indexes for the continuous variables.Results:A total of 1705 patients were included in 23 studies,involving 4 treatments,all of which were randomized controlled studies.Results of network meta-analysis showed that the wound healing time of VSD+PRP was shorter than that of VSD,PRP and conventional dressing.[VSD+PRP vsVSD:MD=-6.53,95%CI(-12.07,-0.98)],[VSD+PRP vsPRP:MD=-10.65,95%CI(-18.22,-3.09)],[VSD+PRP vsCON:MD=-17.47,95%CI(-23.96,-10.98)];In terms of hospital stay,the wound healing time of VSD+PRP was shorter than that of VSD,PRP and conventional dressing,[VSD+PRP vsVSD:MD=-11.61,95%CI(-17.39,-5.83)],[VSD+PRP vsPRP:MD=-15.11,95%CI(-27.98,-2.24)],[VSD+PRP vsCON:MD=-22.61,95%CI(-34.16,-11.06)];but there was no statistical significance between PRP and VSD.In terms of complications,there was no statistical significance between the four treatments.In terms of total effective rate,VSD+PRP treatment has better effective rate than VSD and conventional dressing.[VSD+PRP vsVSD:OR=3.22,95%CI(1.17,5.24)],[VSD+PRP vsCON:OR=4.73,95%CI(2.14,7.33)];but The other comparisons were not statistically significant.In terms of pain score,VSD+PRP treatment has a lower pain score(VAS pain rating scale)than simple application of VSD,PRP and conventional dressing.[VSD+PRP vsVSD:MD=-2.00,95%CI(-2.78,-1.22)],[VSD+PRP vsPRP:MD=-2.65,95%CI(-3.73.,-1.57)],[VSD+PRP vsCON:MD=-4.60,95%CI(-5.55,-3.65)];but there was no statistical significance between PRP and VSD.According to the results of the SUCRA chart,VSD+PRP ranked first in terms of wound healing time,length of stay,total efficiency,and pain score compared with VSD,PRP alone and conventional dressing,and VSD+PRP treatment may be the best choice among the four measures.Conclusion:1.In this study,VSD,PRP and VSD+PRP are superior to conventional dressing change,and VSD+PRP may have advantages in the aspects of wound healing time,hospitalization time,total cure rate and pain score compared with VSD or PRP alone.2.SUCRA results showed that VSD+PRP ranked first in terms of wound healing time,hospitalization time,total cure rate and pain score compared with other three treatment measures.According to the results of this study,VSD+PRP treatment may be the best choice among the four measures.