To determine the quantity and quality of current research on the effectiveness of silver-based dressings and topical agents for the treatment of leg ulcers, this paper presents a systematic review of randomized controlled trials (RCTs) looking at the effects of silver-based dressings and topical agents on leg ulcer healing. Electronic databases were searched up to May 2006 for relevant randomized controlled trials. Journals and conference proceedings were also searched. The methodological quality of selected trials was assessed and statistical pooling of the results from similar studies undertaken. Rate of healing, proportion of ulcers completely healed and change in ulcer size were observed. Nine studies were considered eligible for inclusion. These studies varied in terms of the types of leg ulcers treated, interventions used, and outcomes assessed. Studies provided inconsistent evidence regarding the effects of silver-based dressings and topical agents on leg ulcer healing. Studies generally provided poor evidence due to a lack of statistical power, poor study designs, and incomplete reporting. In conclusion, the current evidence base on the use of these silver-based products on leg ulcers is limited, both in terms of the quantity available and the quality of the evidence. This review highlights the need for further, more rigorous research to be carried out before the use of these silver-based interventions in routine leg ulcer management is supported.