Comparing Advanced Wound Technologies

     The authors randomized 42 patients with venous stasis ulcers who were divided to receive either a nonadherent silver-based foam dressing or a nonadherent foam. The authors reported faster healing in the silver foam group. The authors are to be commended on comparing newer, “advanced” wound technologies in a randomized trial. The vast majority of trials seem to compare an “advanced” method to moist gauze. Additionally, there are added complexities in performing a randomized clinical study.      Despite these accolades, there are many issues with the study design that should cause readers pause before attempting to extrapolate these findings to their own clinical cases. Although the study was a prospective, randomized study, there are still many flaws in the study design where bias can result. Some of these can be corrected, but others are more difficult to address. These are described in detail by the CONSORT group (https://www.consort-statement.org/). This is an excellent site for researchers to reference before designing clinical trials.      Clearly, issues including describing how randomization occurred, power calculation, primary endpoints, and trial registration are important aspects of clinical trials. Ideally, in this case, the authors should have used the same dressing with and without silver that was blinded to the person applying the material.      I congratulate the authors on taking this important first step and hope that this article will spur interest in other investigators to pursue additional randomized clinical trials to provide a higher level of evidence to guide our choices in wound care products. Address correspondence to: Dennis P. Orgill, MD, PhD Professor of Surgery, Harvard Medical School and Associate Chief, Plastic Surgery, Brigham and Women’s Hospital 75 Francis St. Boston, MA 02115 Phone: 617-732-5456 E-mail: dorgill@partners.org