The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis

Anzarut, Alexander; Olson, Jarret; Singh, Prabhjyot; Rowe, Brian H.; Tredget, Edward E.

doi:10.1016/j.bjps.2007.10.052

« Previous Next »Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 62, Issue 1 , Pages 77-84, January 2009

The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis☆

Alexander Anzarut
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- EPICORE Centre, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author. Address: 8215-112 Street, 220 College Plaza, Edmonton, Alberta, Canada T6G 2C8. Tel.: +1 780 989 1271; fax: +1 780 492 6059.
Jarret Olson
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
Prabhjyot Singh
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
Brian H. Rowe
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
Edward E. Tredget
- Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
- Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada

Received 2 January 2007; accepted 19 October 2007. published online 15 January 2008.

Summary

Objectives

This study had three objectives. First, to conduct a systematic review to identify the available evidence for the use of pressure garment therapy (PGT); second, to assess the quality of the available evidence; and third, to conduct a meta-analysis to quantify the effectiveness of PGT for the prevention of abnormal scarring after burn injury.

Background

Standard care for the prevention of abnormal scarring after burn injury includes pressure garment therapy (PGT); however, it is associated with potential patient morbidity and high costs. We hypothesise that an assessment of the available evidence supporting the use of pressure garment therapy will aid in directing clinical care and future research.

Methods

Randomised control trials were identified from CINHAL, EMBASE, MEDLINE, CENTRAL, the ‘grey literature’ and hand searching of the Proceedings of the American Burn Association. Primary authors and pressure garment manufacturers were contacted to identify eligible trials. Bibliographies from included studies and reviews were searched. Study results were pooled to yield weighted mean differences or standardised mean difference and reported using 95% confidence intervals.

Results

The review incorporated six unique trials involving 316 patients. Original data from one unpublished trial were included. Overall, studies were considered to be of high methodological quality. The meta-analysis was unable to demonstrate a difference between global assessments of PGT-treated scars and control scars [weighted mean differences (WMD): −0.46; 95% confidence interval (CI): −1.07 to 0.16]. The meta-analysis for scar height showed a small, but statistically significant, decrease in height for the PGT-treated group standardised mean differences (SMD): −0.31; 95% CI: −0.63, 0.00. Results of meta-analyses of secondary outcome measures of scar vascularity, pliability and colour failed to demonstrate a difference between groups.

Conclusions

PGT does not appear to alter global scar scores. It does appear to improve scar height, although this difference is small and of questionable clinical importance. The beneficial effects of PGT remain unproven, while the potential morbidity and cost are not insignificant. Given current evidence, additional research is required to examine the effectiveness, risks and costs of PGT.

Keywords: Burns, Cicatrix, Hypertrophic, Meta-analysis, Review literature