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Abstract
Four-layer bandaging has been in existence for more than 15 years, during which time it has been used in numerous studies and in many populations throughout the world. This short series reviews the development of the four-layer compression bandage system, together with the evidence that contributes to a greater understanding of why it is effective in promoting healing in venous leg ulcers. This article, the third and final in the series, looks at the evidence base for efficacy in treating venous leg ulcers.
Key Points
A wealth of evidence on the efficacy of four-layer compression bandaging in treating venous leg ulcers has been accumulated over the past decade.
This review of the evidence base confirms the value of four-layer compression bandaging in improving outcomes for patients with venous and lymphatic disorders.
Further cost-effectiveness studies are required to evaluate the many different four-layer bandaging systems in use.
Objective To review the evidence of effectiveness of dressings applied to venous leg ulcers.
Design Systematic review and meta-analysis.
Data sources Hand searches of journals and searches of electronic databases, conference proceedings, and bibliographies up to April 2006; contacts with dressing manufacturers for unpublished studies.
Studies reviewed All randomised controlled trials that evaluated dressings applied to venous leg ulcers were eligible for inclusion. Data from eligible studies were extracted and summarised independently by two reviewers using a data extraction sheet. Methodological quality was assessed independently by two reviewers.
Results The search strategy identified 254 studies; 42 of these fulfilled the inclusion criteria. Hydrocolloids were no more effective than simple low adherent dressings used beneath compression (eight trials; relative risk for healing with hydrocolloid 1.02, 95% confidence interval 0.83 to 1.28). For other comparisons, insufficient evidence was available to allow firm conclusions to be drawn. None of the dressing comparisons showed evidence that a particular class of dressing healed more ulcers. Some differences existed between dressings in terms of subjective outcome measures and ulcer healing rates. The results were not affected by the size or quality of trials or the unit of randomisation. Insufficient data were available to allow conclusions to be drawn about the relative cost effectiveness of different dressings.
Conclusions The type of dressing applied beneath compression was not shown to affect ulcer healing. The results of the meta-analysis showed that applying hydrocolloid dressings beneath compression produced no benefit in terms of ulcer healing compared with applying simple low adherent dressings. No conclusive recommendations can be made as to which type of dressing is most cost effective. Decisions on which dressing to apply should be based on the local costs of dressings and the preferences of the practitioner or patient.
Those with institutional subscriber access to the BMJ, can get the full text here.
Venous reflux surgery promotes venous leg ulcer healing despite reduced ankle brachial pressure index.
Obermayer A, Göstl K, Partsch H, Benesch T. Int Angiol. 2008 Jun;27(3):239-46.
Quote:
AIM: The aim of this study was to demonstrate that venous surgery promotes ulcer healing, even in the presence of peripheral arterial disease.
METHODS: In this retrospective study, 33 patients (49 legs) with venous leg ulcers and reduced arterial ankle brachial pressure index (< or = 0.8) were followed up 3 months to 7 years (median: 3.11 years) after venous surgery (group I). Venous reflux was considered to be the main cause of ulceration, and no attempt was made to restore the arterial circulation. The results were compared with those of patients with ulcers without arterial occlusive disease (n=190) who were treated following the same principles (group II). The surgical procedure consisted of interruption of reflux in the superficial and/or perforating veins. Additionally, shaving, fasciectomy, and mesh grafting was performed in 36 cases.
RESULTS: In group I, 21 legs were lost to follow-up, 16 due to death. The mortality rate was three times higher in group I than in group II. From 28 legs of group I seen after 0.4-6.7 years (median: 2.9 years), 19/28 legs (68%) were healed compared with 123/145 (85%) in group II after 0.2-7.2 years (median: 3.2 years) (not significant [NS]). Group I showed a significantly longer healing time than group II (P<0.05) (P<0.001). Recurrence was observed in 3/28 (11%) from group I and in 6/145 (4%) from group II (NS). The time course of recurrence showed no statistically significant difference between the groups.
CONCLUSION: Venous surgery produces beneficial results not only in pure venous ulcerations, but also in patients with accompanying arterial disease.
Dressings for venous leg ulcers
Linear Mode
