Systematic review of topical interventions for the management of odour in patients with chronic wounds or malignant fungating wounds: a study protocol

Background: Chronic wounds including venous, arterial, diabetic and pressure ulcers affect up to 2.21 per 1000 population. Malignant fungating wounds affect up to 6.6% of oncology patients. These wounds impact patients and health care systems significantly. Microbes colonising chronic wounds can produce volatile molecules with unpleasant odours. Wound odour adversely affects quality of life, yet management strategies are inconsistent. Clinicians express uncertainty regarding the current range of odour management agents, which therefore requires evaluation for effectiveness.    Objective: To determine the effects of topical agents in the management of odour in patients with chronic and malignant fungating wounds. Methods: Searches of Embase, Medline, CINAHL, Cochrane CENTRAL, PubMed, Web of Science, Scopus, and the clinicaltrials.gov and WudracT trial registries from inception to present will be conducted without language limits. Randomised controlled trials including adults with venous, arterial, mixed arterio-venous, diabetic, decubitus or malignant fungating wounds, investigating topical agents to manage odour are eligible. Reference lists of included studies and identified systematic reviews will be scanned, and unpublished studies will be sought in the BASE database, in conference proceedings and through contacting authors. Two reviewers will independently scan titles/abstracts and full text articles against predetermined eligibility criteria, with discrepancies resolved by discussion between reviewers or through third-party intervention. Two reviewers will independently extract data from included studies. Disagreements will be resolved by discussion between reviewers or through third-party intervention. Bias risk and evidence quality will be assessed with the Cochrane Risk of Bias Tool 2 and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Meta-analysis will be applied where appropriate. Otherwise, data will be synthesised narratively. Discussion: Wound odour management typically takes a trial-and-error approach. Clinicians are critical of odour management agent effectiveness. This review will evaluate the range of available agents to inform practice and research. PROSPERO registration: CRD42021267668 (14/08/2021)