Evaluating 2- and 4-Layer compression bandages at 40 mmHg for chronic venous leg ulcer: A case study

To compare the healing outcomes of two-layer (2LB) and four-layer (4LB) compression bandaging systems, both delivering approximately 40 mmHg, in the management of chronic venous leg ulcers (VLUs) of a single patient.

A patient with recalcitrant VLUs over the right medial malleolar, left medial malleolar, and left foot dorsum recurring since September 2024 over 30 weeks, presented to the outpatient vascular wound clinic. Initially, all wounds were managed with chitosan dressings and bilateral 4LB. From October 2024 (Week 2), compression bandaging was adjusted: the right leg received 2LB and the left leg remained on 4LB, both delivering approximately 40 mmHg pressure over the ankle till Week 30.

At baseline, on week 2, ulcer measurements were as follows: right medial malleolar - 4.3 × 2.4 cm (10.32 cm²), left medial malleolar - 4.5 × 2 cm (9 cm²), and left dorsum of the foot - 1 × 1.2 cm (1.2 cm²). By week 28, the right malleolar ulcer had healed completely and remained closed through week 30. At week 30, the left malleolar ulcer had reduced to 2.4 × 2 cm (4.8 cm²), and the left dorsum ulcer had decreased to 0.7 × 0.5 cm (0.35 cm²).

This case demonstrates effective healing under both 2LB and 4LB systems at 40 mmHg. Complete healing with 2LB suggests comparable efficacy with potential advantages in comfort and ease of application. These findings support individualised compression strategies guided by wound characteristics and patient needs to optimise VLU healing outcomes.