The effect of compression stockings on patients with lower extremity venous ulcers: A meta-analysis

ObjectiveThis study aims to systematically evaluate the efficacy and safety of compression stockings compared with other active compression modalities and surgical interventions in the management of venous leg ulcers, and to explore the impacts of intervention duration, reported compression pressure, and comparator heterogeneity on pooled outcomes.MethodsLiterature searches were conducted in eight databases for randomized controlled trials on the effects of compression stockings in patients with venous leg ulcers. The search period was from the database establishment to April 20, 2026. Two researchers independently screened the literature, extracted data, and evaluated methodological quality according to inclusion and exclusion criteria, and then performed a Meta-analysis.ResultsA total of 12 randomized controlled trials involving 1206 patients were ultimately included. Meta-analysis results demonstrated that the patients in the compression stocking group had higher ulcer healing rates compared to the control group [RR = 1.39, 95%CI (1.11, 1.74), P = .004], a greater reduction in ulcer wound area [MD = 5.10, 95%CI (1.60, 8.60), P < .01], and lower ulcer recurrence rates [RR = 0.56, 95%CI (0.37, 0.84), P < .01]. Subgroup analyses indicated that intervention duration could potentially have a modifying effect: interventions lasting ≤12 weeks showed beneficial outcomes, but longer-duration treatments did not, though the between-subgroup difference test did not yield a significant result. Subgroup analysis stratified by stocking layer type found that two-layer compression stockings delivered significant healing benefits, although the between-subgroup difference test did not return a significant result. Sensitivity analysis, which excluded two studies using atypical comparators, confirmed that the healing-rate result was robust. However, no statistically significant differences were observed in adverse event incidence or ulcer healing time between the compression stocking group and the control group [RR = 0.87, 95%CI (0.63, 1.20), P = .40] and [MD = -1.19, 95%CI (-6.85, 4.47), P = .68], respectively. The evidence quality for the indicators of adverse event incidence was of moderate quality, while the rest were of low quality.ConclusionBased on limited evidence, compared with other compression modalities, compression stockings are associated with higher ulcer healing rates, greater wound area reduction, lower recurrence rates, and have favourable safety profiles. However, compression stockings do not outperform other compression modalities across all measured outcomes, as no significant difference was observed in healing time. These findings should be interpreted with caution, due to substantial heterogeneity among included studies, under-reporting of actual compression pressure, and insufficient documentation of baseline ulcer characteristics and treatment adherence.