Firstly, data will be synthesized with a pairwise meta-analysis in a frequentist framework by RevMan (version 5.3, Cochrane). Risk ratio and 95% confidence interval (CI) will be used for dichotomous outcomes, mean differences or standardized mean differences with 95% CI will be used for continuous outcomes. Cochrane Q test and I2 test will be used for heterogeneity assessment.[20] If no significant statistical heterogeneity exists or heterogeneity is small (P ≥ .10 and I2 ≤ 50%), the Mantel-–Haenszel fixed effect model will be employed, otherwise using a random effects model (P < .10 and I2 > 50%).

Then, we will conduct Bayesian NMAs to compare the efficacy of different types of skin grafting in the treatment of VLUs. Markov Chains Monte Carlo method will be conducted in the WinBUGS software (Version 1.43, Medical Research Council Biostatistics Unit, Cambridge, UK). Four chains are used for simulation. We will set the number of iterations to 50,000, use the first 20,000 annealing times to eliminate the influence of the initial value, and set the step length to10.[21] Meanwhile, the potential scale reduction parameter (potential scale reduced factor, PSRF) is used to evaluate the convergence of the results. When the PSRF is close to 1, it indicates that the results have good convergence and the obtained results are highly reliable.[22] We also calculate the relative ranking of the various skin grafting based on the surface under the cumulative ranking curves (SUCRA) percentages range from 0 to 1, with 1 indicating that treatment is sure to be the best and 0 that treatment is certain to be the worst. The area under the curve increases as the SUCRA value increases, indicating that the intervention is more effective.[19]

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