Background: Chronic venous and arterial leg ulcers are prevalent, hard-to-heal wounds; this review aimed to assess the comparative effectiveness of modern wound dressings in promoting healing and symptom control.

Methods: A systematic search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus (2000–2022) identified RCTs and systematic reviews assessing modern dressings in adults with CVUs or ALUs. Primary outcomes included wound healing and time to closure. Risk of bias was assessed using Cochrane tools and GRADE.

Results: Ten studies (RCTs/systematic reviews; n = 99–3,001) evaluated modern dressings in CVUs and ALUs. Silver dressings showed short-term wound area reduction (MD 0.23 cm²/day, P = 0.004) and reduced odor but had no significant effect on complete healing (RD 0.00; 95% CI −0.09 to 0.09). Hydrocolloids offered no healing advantage over low-adherent dressings (RR 1.02; 95% CI 0.83–1.25), and hydrogel efficacy remained inconclusive (RR 1.53; 95% CI 0.96–2.42). Foam and hydrocellular dressings improved exudate management but not healing rates (HR 1.48; 95% CI 0.87–2.54). Collagen dressings showed marginal improvement in granulation (RR 1.13; 95% CI 0.86–1.47) in CVUs, with no proven benefit in ALUs. Honey and alginate dressings demonstrated antimicrobial and absorptive benefits, respectively, but lacked large-scale comparative data. Overall, modern dressings provided symptom control and wound environment optimization without significantly accelerating complete ulcer healing.

Conclusion: No modern dressing demonstrated clear superiority in complete ulcer healing. Dressing selection should be guided by ulcer characteristics rather than dressing type. In ALUs, healing remains limited without revascularization. Future trials must prioritize real-world populations, longer follow-up, and cost-effectiveness.

Keywords: chronic leg ulcers, wound dressings, venous leg ulcers, arterial leg ulcers, wound healing.