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Compression bandages and stockings for venous leg ulcers
N Cullum1, E A Nelson, A W Fletcher
1Centre for Evidence Based Nursing, Department of Health Studies, University of York, Genesis 6, York, UK, YO10 5DQ. nac2@york.ac.uk
Objectives:
To assess the effectiveness and cost-effectiveness of compression bandaging and stockings in the treatment of venous leg ulcers.
Search Strategy:
Searches of 19 databases, hand searching of journals, conference proceedings and bibliographies. Manufacturers of compression bandages and stockings and an Advisory Panel were contacted for unpublished studies.
Selection Criteria:
Trials that evaluated compression bandaging or stockings, as a treatment for venous leg ulcers. There was no restriction on date or language. Ulcer healing was the primary endpoint.
Data Collection And Analysis:
Details of eligible studies were extracted and summarised using a data extraction sheet. Data extraction was verified by two reviewers independently.
Main Results:
Twenty two trials reporting 24 comparisons were identified. Compression was more effective than no compression (4/6 trials). When multi-layered systems were compared, elastic compression was more effective than non-elastic compression (5 trials). There was no difference in healing rates between 4-layer bandaging and other high compression multi-layered systems (3 trials). There was no difference in healing rates between elastomeric multi-layered systems (4 trials). Multi-layered high compression was more effective than single layer compression (4 trials). Compression stockings were evaluated in two trials. One found a high compression stocking plus a thrombo stocking to be more effective than a short stretch bandage. The second small trial reported no difference between the compression stockings and Unna's boot. There was insufficient data to draw conclusion about the relative cost-effectiveness of different regimens.
Reviewer'S Conclusions:
Compression increases ulcer healing rates compared with no compression. Multi-layered systems are more effective than single-layered systems. High compression is more effective than low compression but there are no clear differences in the effectiveness of different types of high compression.