***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Comparison of desloughing efficacy after four weeks and healing outcomes after 12 weeks in sloughy venous leg ulcers treated with Manuka honey ( Woundcare 18 + ) vs. st and ard hydrogel therapy ( IntraSite Gel ) . BACKGROUND Expert opinion suggests that Manuka honey is effective as a desloughing agent but clinical evidence in the form of a r and omised controlled trial is not available . There is a paucity of research which uses Manuka honey in venous ulcers . DESIGN Prospect i ve , multicentre , open label r and omised controlled trial . METHOD R and omisation was via remote telephone . One hundred and eight patients with venous leg ulcers having > or=50 % wound area covered in slough , not taking antibiotics or immunosuppressant therapy were recruited from vascular centres , acute and community care hospitals and leg ulcer clinics . The efficacy of WoundCare 18 + to deslough the wounds after four weeks and its impact on healing after 12 weeks when compared with IntraSite Gel control was determined . Treatment was applied weekly for four weeks and follow-up was made at week 12 . RESULTS At week 4 , mean % reduction in slough was 67 % WoundCare 18 + vs. 52.9 % IntraSite Gel ( p = 0.054 ) . Mean wound area covered in slough reduced to 29 % and 43 % , respectively ( p = 0.065 ) . Median reduction in wound size was 34 % vs. 13 % ( p = 0.001 ) . At 12 weeks , 44 % vs. 33 % healed ( p = 0.037 ) . Wounds having > 50 % reduction in slough had greater probability of healing at week 12 ( 95 % confidence interval 1.12 , 9.7 ; risk ratio 3.3 ; p = 0.029 ) . Infection developed in 6 of the WoundCare 18 + group vs. 12 in the IntraSite Gel group . CONCLUSION The WoundCare 18 + group had increased incidence of healing , effective desloughing and a lower incidence of infection than the control . Manuka honey has therapeutic value and further research is required to examine its use in other wound aetiologies . RELEVANCE TO CLINICAL PRACTICE This study confirms that Manuka honey may be considered by clinicians for use in sloughy venous ulcers . Additionally , effective desloughing significantly improves healing outcomes Ninety‐three patients with treatment‐resistant venous ulcers were included in a multicentre r and omized trial to compare cadexomer iodine and the st and ard treatment used in each centre combined with compression b and ages , in healing venous ulcers . The mean duration of ulcers before the trial was more than 2 years . With st and ard treatment the mean ulcer size increased slightly during the 6‐week trial whereas with cadexomer iodine the ulcer size was significantly reduced . Cadexomer iodine was more effective than st and ard treatment for reduction of pain , removal of pus and debris , removal of exu date , stimulation of granulation and reduction of surrounding erythema . Bacterial infection of ulcers increased or did not change during treatment with the st and ard therapy whereas cadexomer iodine significantly reduced infection with Staphylococcus aureus , Pseudomonas aeruginosa and other pathogenic organisms . A correlation was seen between the time taken to reduce or eliminate infection with Staphylococcus aureus and rate of ulcer healing . Four patients complained of transient pain in the ulcer after application of the cadexomer iodine . It is concluded that cadexomer iodine increased the rate of healing of infected chronic venous ulcers The treatment of chronic wounds represents a major cost to society and has a profound effect on the participant 's quality of life . Chronic wounds may have an increased bacterial burden that can impair healing without all the clinical signs of infection . Silver dressings may provide an alternative topical method to control bacterial burden . The primary aim of this study was to evaluate the clinical improvement in chronic wounds through the effect on wound size , maceration , resolution of surface slough and conversion to healthy granulation during a 4-week application of the silver-containing Hydrofiber dressing . This was a single centre , open-label case series study which included a total of 30 evaluable participants : four with diabetic neuropathic foot ulcers , 13 venous stasis ulcers , four pressure ulcers and nine miscellaneous wounds that did not fit any of the previous categories . All participants had adequate vascular supply , indicating the potential to heal . The wounds were stalled or had the signs and symptoms consistent with critical colonisation . The underlying cause of the ulceration was identified and corrected , or the symptoms and signs were treated . This was followed by the application of silver-containing Hydrofiber dressings for a period of 4 weeks . The majority of wounds treated decreased in size ( 70 % ) with decreased exu date , decreased purulence and resolution of surface slough ( 75 % ) . There was an increased quality and quantity of healthy granulation tissue . Unlike some silver dressings , the Hydrofiber and silver combination dressing was unlikely to cause burning and stinging on application . Peri-wound maceration was present in 54 % of participants at baseline , and 85 % of these resolved with this dressing . A desloughing action was seen in those patients with pre-existing slough at baseline and its removal will lower the bacterial burden of the wound Cadexomer iodine ( Iodosorb ) is a hydrophilic starch powder containing iodine , which is a suitable dressing for granulating wounds such as venous ulcers . A total of 61 out patients with chronic venous ulcers participated in a r and omised optional crossover trial using cadexomer iodine or a st and ard dressing for their ulcers . The trial lasted for 24 weeks or until the ulcer had healed . Two patients withdrew during the course of the trial . Both treatments were highly effective , but the epithelium of ulcers dressed with cadexomer iodine grew again significantly faster ( p less than 0.001 ) . At the midpoint of the trial ( 12th week ) 13 of 30 patients receiving st and ard treatment were changed to cadexomer iodine , while only three of 29 receiving cadexomer iodine changed to the st and ard dressing ( p less than 0.02 ) . In most cases ulcers were dressed and reb and aged daily by the patients themselves after instruction and supervision . This may be better than having dressings and b and ages applied by professionals less regularly Recent reports in the literature have indicated that dextranomer ( Debrisan ; Adcock-Ingram ) is an effective cleansing agent for the secreting wound . To evaluate its possible use in the initial cleansing of the infected secreting stasis ulcer , 100 patients were incorporated in a single-blind r and omized trial . The mean cleansing time for the Debrisan-treated ulcers was 5,9 days , compared with 15,4 days for the control group receiving st and ard treatment . The average healing time for ulcers treated with Debrisan and left to heal spontaneously was 4,4 weeks compared with 5,32 weeks for the controls . Debrisan , furthermore , decreased the amount of local tissue oedema and alleviated local pain in the majority of patients . It is feasible to use Debrisan for outpatient treatment and without additional staff in a busy clinic . The cost of Debrisan therapy appeared to be reasonable . A hydrophilic cleansing agent such as Debrisan has a definite place in the early treatment of the secreting infected post-phlebitic stasis ulcer OBJECTIVE To determine the qualitative bacteriological changes that occurred during a four-week treatment period with either manuka honey or a hydrogel dressing . This was the secondary outcome of a r and omised controlled trial ( RCT ) that compared the efficacy of the two treatments in desloughing venous leg ulcers . METHOD This was a prospect i ve open label multicentre RCT with blinded microbiological outcome analysis . R and omisation was conducted via remote telephone . To be included , the wound bed needed to comprise at least 50 % slough . Wound swabs were taken at the start of treatment and after four weeks . RESULTS In all , 108 patients ( 35 males , 73 females ) aged 24 - 89 years ( mean 68 ) enrolled into the study . Both groups were comparable at baseline . Eighteen patients ( 17 % ) were withdrawn due to a wound infection  : six in the honey group and 12 in the hydrogel group . Staphylococcus aureus was the most common isolate , being identified in 41 wounds ( 38 % ) . At baseline , meticillin-resistant Staphylococcus aureus was identified in 16 wounds ( 10 honey versus six hydrogel ) . After four weeks 70 % ( n=7 ) of the manuka-honey treated wounds versus 16 % ( n=1 ) of the hydrogel treated wounds had MRSA eradicated . Pseudomonas aeruginosa was reported in 14 % ( n=16 ) of all wounds at baseline . After four weeks 33 % ( n=2 ) treated with honey and 50 % ( n=5 ) treated with hydrogel had this eliminated . The number of wounds ( n=11 at baseline ; n=15 at week 4 ) with > or =3 bacteria species remained constant over the four weeks . CONCLUSION Manuka honey was effective in eradicating MRSA from 70 % of chronic venous ulcers . The potential to prevent infection is increased when wounds are desloughed and MRSA is eliminated . This can be beneficial to prevent cross-infection The present study was carried out to find out the efficacy and safety of oxum in the treatment of venous ulcers . The oxum ( superoxidised water ) is a pH neutral , non-irritating , aqueous solution that possesses a good antiseptic , antimicrobial activity and wound healing properties . The study was conducted in 30 patients of venous ulcers with a culture examination positive for pathogenic microbial flora . All patients received a gauze dressing impregnated with oxum followed by compression b and age for 28 days . The primary endpoint was the calculation of ulcer size using ulcer tracing . Assessment of periwound oedema , periwound erythema , wound fibrin and wound granulations were considered as secondary endpoints . There was a singificant reduction in ulcer size starting from day 7 of the treatment . Significant improvements in secondary endpoints were observed . This study has demonstrated that oxum improved the clinical status , reduced the signs of inflammation in venous ulcers  in addition to its well confirmed anti-infective properties The study compared the effect of a sustained silver-release foam dressing ( Contreet Foam ) with a foam dressing ( Allevyn Hydrocellular ) without added silver in critically colonised venous leg ulcers with delayed healing .  The study was a multicentre , open , r and omised , controlled study lasting for 4 weeks . Ulcer area and healing were assessed weekly . Odour , maceration , absorption capacity and leakage were evaluated at dressing changes . All adverse events were recorded . One hundred and twenty-nine patients were included ( Contreet Foam : 65 , Allevyn Hydrocellular : 64 ) . The two groups were comparable in all respects . After 4 weeks , there was a significantly greater reduction in ulcer area in the Contreet Foam group ( 45 % ) than in the Allevyn Hydrocellular group ( 25 % ) . After 1 and 4 weeks , odour was present in significantly less of the ulcers in the Contreet Foam group ( 17 % and 19 % , respectively ) compared with the Allevyn Hydrocellular group ( 47 % and 39 % , respectively ) and at the final visit there were significantly fewer leakages in the Contreet Foam group ( 19 % ) compared with the Allevyn Hydrocellular group ( 49 % ) . Also , less maceration was observed after 1 and 4 weeks in the Contreet Foam group ( 34 % and 37 % , respectively ) compared with the Allevyn Hydrocellular group ( 55 % and 48 % , respectively ) . The occurrence and cause of adverse events were equally distributed between the study groups . The present study provides evidence of the superior performance of the silver-releasing dressing , Contreet Foam , compared with a traditional moist foam wound healing dressing in the treatment of critically colonised , chronic venous leg ulcers . The results of this r and omised , controlled study suggest an important role of sustained silver-releasing dressings in the treatment of critically colonised chronic wounds UNLABELLED ﻿ Objective . Clinical interest of silver in the management of  chronic wounds is not fully established . The main objective of this clinical study was to assess the ability of a new silver releasing lipido-colloid contact layer to promote the healing process of  venous leg ulcers ( VLU ) presenting inflammatory signs suggesting a heavy bacteria colonization and then a delayed healing , in comparison to the same wound dressing not impregnated with silver salts . METHODS This was an open-labeled , r and omized , controlled trial . VLU presenting at least 3 out of 5 clinical signs suggesting heavy bacterial colonization were recruited . Patients were treated with contact layer silver dressing ( [ CLS ] , Restore ® Contact Layer , Silver * ( Hollister Wound Care , Libertyville , Ill ) or contact layer dressing ( [ CL ] Restore ® Contact Layer * * , Hollister Wound Care , Libertyville , Ill ) for 4 weeks , then all treated ulcers were treated with CL for the 4 additional weeks . Wound evaluation and area measurements were conducted weekly during the first 4 weeks and then at week 6 and 8 . Main efficacy criterion was absolute wound area decrease ( AD ) at week 4 and week 8 . RESULTS Patients ( N = 1 
    Output:
    
At present , no evidence is available to support the routine use of systemic antibiotics in promoting healing of venous leg ulcers .
However , the lack of reliable evidence means that it is not possible to recommend the discontinuation of any of the agents review ed .
In terms of topical preparations , some evidence supports the use of cadexomer iodine .
Current evidence does not support the routine use of honey- or silver-based products .