Multi-layer compression: comparison of four different four-layer bandage systems applied to the leg

To compare performance of four commercial four-layer bandage systems when applied to the leg.

Four experienced bandagers applied each system: [Profore Regular (Smith and Nephew); Ultra-Four (Robinson); System 4 (Seton) and K Four (Parema)] to the same leg. Bandages were applied as single layers and as completed systems using standard techniques. For each application, 18 pressure measurements were taken using the Borgnis Medical Stocking Tester (MST) at three measuring points (ankle, gaiter and mid-calf) on medial and lateral aspects in three postures: (horizontal, standing and sitting).

In all 2304 observations were made, 576 for each bandager, 576 for each bandaging system, 768 for each measuring point, 1152 for each aspect and 768 for each posture. The increase in pressure produced by each additional layer was 65-75% of the pressure of the same bandage when used as a single layer. There were significant differences in the final pressures achieved by the bandagers (means: 45-54 mmHg, p<0.001) and between bandage systems (means: System 4: 46 mmHg, Profore: 47 mmHg, K Four: 52 mmHg, Ultra-Four: 54 mmHg; p=0.005). The relationships between the final pressures achieved at each of the three measuring points, the three postures and the two aspects were not consistent among the bandage systems (p<0.01).

When a bandage is applied as part of a multi-layered system it exerts approximately 70% of the pressure exerted when applied alone, thus challenging the commonly-held assumption that the final pressure achieved by a multi-layer bandaging system is the sum of the pressures exerted by each individual layer. Each of the four bandaging systems exerted different final pressures and gradients and different changes with posture change. These differences have important implications, which could influence the selection (or avoidance) of a particular bandage system according to a patient's condition and circumstances.