Venous leg ulceration: treatment by high compression bandaging

Venous leg ulceration is a major tissue viability problem that is becoming better recognized as clinical wound care practice changes from being anecdotal-based to research-based. The current prevalence of leg ulceration in the UK, Sweden and Australia is approximately 1 percent of the adult population, and approximately half a million in the United States. Between 70 and 90 percent of leg ulcers in the UK are venous in origin. Research has shown that graduated compression bandaging is an appropriate method of managing venous leg ulceration for many patients. Since Stemmer's work showing the usefulness of higher levels of external pressure (40 mmHg), the reliability and predictability of the four layer high compression bandaging system has been demonstrated. The purpose of this article is to introduce the extent of the venous leg ulceration problem, discuss risk factors and other aspects of venous leg ulceration, support the use of graduated compression, and describe the four layer high compression bandage system. The success of the four layer system is linked to the wider issues of using a research-based approach to the assessment and management of venous leg ulcers, and such an approach is integral to cost-effective, high quality patient care.