Randomized Controlled Trial of an Improvised Dressing for Remote and Conflict Areas of Tropical Developing Countries

Introduction: The researcher began searching for evidence-based solutions for wound management in remote and conflict areas of tropical developing countries in 1999. A 2013 literature review found no descriptions of suitable solutions. Formal usual practice studies demonstrated that for the poorest in the tropics, no successful wound dressing technique has been advanced. Sickle cell leg ulcers are among the most painful and difficult-to-heal chronic wound types. These disabling wounds are somewhat similar to tropical ulcers and venous leg ulcers, and are relatively common in Jamaica. This randomized controlled trial of a sustainable improvised dressing technique was conducted in Jamaica in 2021. The research questions were: Does a cut-to-fit perforated food-grade-plastic-based improvised dressing with a periwound moisture barrier and an absorbent over the perforations decrease pain and improve quality of life? And, is this improvised dressing safe, effective, and acceptable? Methods: The three-armed 12-week evaluator-blinded randomized controlled trial compared improvised dressings to a negative control (wet-to-moist dressings, which were equal or superior to usual practice), and a positive control (the advanced wound dressings with the strongest evidence supporting use in a tropical climate, which are polymeric membrane dressings). All three dressing protocols were rigorously defined. Dressing changes were conducted by the patients, who WhatsApped wound photos and data forms to the investigators weekly. Results: Participants in all three groups saw improvement compared with their previous usual practice. Improvised dressing participants’ pain and quality of life were improved when compared with their previous dressings, and when compared with the experience of participants randomized to wet-to-moist dressings. Compared with wet-to-moist dressings, participants using improvised dressings were less likely to develop wound infections, and their wounds were far more likely to decrease in size. The improvised dressings were only modestly inferior to the advanced wound dressings, and they were significantly less expensive and more available than the other choices. Participants in all three groups found the improvised dressings acceptable. Discussion: A dressing protocol based upon an inexpensive, readily available in remote areas, clean, semipermeable membrane proved safe and effective on sickle cell leg ulcers in Jamaica, and its use dramatically improved quality of life.