Effect of different compression bandaging techniques on the healing rate of venous leg ulcers: a literature review

Venous leg ulcers (VLUs) are a common health problem in older adults, for which the widely used method of treatment includes compression therapy. There are various compression bandages and hosiery systems available for use, but it remains unclear as to which types of compression systems are most effective in enabling healing of VLUs. This study aimed to determine which type of the two most commonly used compression bandaging (four-layer and two-layer) is more effective in providing complete ulcer healing of VLUs. Key search terms were identified using the PICO (population, intervention, comparison, outcome) model, with distinct inclusion and exclusion criteria, in a strategic search of electronic databases (e.g. CINAHL and MEDLINE) along with wider sources, including Google Scholar. More studies favoured the four-layer compression system than two-layer for providing better healing rates in the treatment of VLUs, but two-layer bandaging tends to provide a better quality of life and may be more cost-effective, although comorbidities and other factors also need to be considered. In choosing the type of compression bandage for the management of leg ulcers, the healing rate achieved by the chosen bandage needs to be carefully monitored, while also taking into consideration other factors such as the quality of life for the patient.

Download Full-text

Velcro compression wraps as an alternative form of compression therapy for venous leg ulcers: a review

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.sup6.s10 ◽

2021 ◽

Vol 26 (Sup6) ◽

pp. S10-S20

Author(s):

Amy Cox ◽

Chrissie Bousfield

Keyword(s):

Quality Of Life ◽

Compression Therapy ◽

Alternative Form ◽

Leg Ulcers ◽

Nursing Time ◽

Similar Treatment ◽

Venous Leg Ulcers ◽

Compression Bandages ◽

The Impact

The first-line treatment for venous leg ulcers (VLUs) is compression therapy, most commonly, with compression bandages. A similar treatment measure is used for lymphoedema in the form of Velcro compression wraps (VCWs). However, the use of VCWs for VLUs is less evident, and a direct comparison to compression bandaging is not evident. This review explores the evidence to support the use of VCWs for the treatment of VLUs in order to raise awareness of alternative forms of compression therapy. Nine primary research studies were analysed, from which four key themes emerged: quality of life, cost of treatment, ulcer healing time and pressure maintenance. The findings suggest that VCWs decrease material costs by at least 50%, and further savings may be realised by reducing the costs associated with nursing time. The benefits of promoting self-care, maintaining compression, and eliciting greater healing rates are clearly evident, and the impact on quality of life is substantiated.

Download Full-text

The comparative impact of conservative treatment versus superficial venous surgery, for the treatment of venous leg ulcers: A systematic review of the impact on patients’ quality of life

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515581278 ◽

2015 ◽

Vol 31 (2) ◽

pp. 82-93 ◽

Cited By ~ 4

Author(s):

Philippa Tollow ◽

Jane Ogden ◽

Mark S Whiteley

Keyword(s):

Quality Of Life ◽

Future Research ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Psychological Mechanisms ◽

Compression Bandaging ◽

Venous Surgery ◽

The Impact ◽

Positive Effect

Objectives Leg ulcers are known to have a profound effect on patients’ quality of life; however, the influence of different treatment approaches is unclear. This review aims to evaluate the comparative impact of conservative treatments and superficial venous surgery, for venous leg ulcers, on patients’ Quality of Life. Data sources Three electronic databases (PsycInfo, Medline and CINAHL), and reference lists of relevant articles, were searched. A total of 209 articles were initially identified, and 16 articles were included in the review. Results The results lend cautious support to the suggestion that all treatments have a positive effect on quality of life, regardless of type, whilst wound status also appears to be an important factor. Conclusions Some evidence suggests that surgical treatment methods may lead to greater improvements in patients’ quality of life than compression bandaging alone; however, future research may focus on the psychological mechanisms underlying such changes.

Download Full-text

Pilot study investigating the feasibility of an ulcer-specific quality of life questionnaire

Phlebology The Journal of Venous Disease ◽

10.1258/0268355053300839 ◽

2005 ◽

Vol 20 (1) ◽

pp. 14-27 ◽

Cited By ~ 6

Author(s):

P D Venkatraman ◽

S C Anand ◽

C Dean ◽

R Nettleton ◽

A EL Sawi ◽

...

Keyword(s):

Quality Of Life ◽

Compression Therapy ◽

Average Score ◽

Life Questionnaire ◽

Leg Ulcers ◽

Venous Leg Ulcer ◽

Survey Tool ◽

Venous Leg Ulcers ◽

Patient Reported

Objective: This study explores the feasibility and reliability of a modified ulcer-specific quality of life (QOL) questionnaire on patients suffering from venous leg ulcers. Methods: A cross-sectional survey was conducted on a cohort of patients suffering from venous leg ulcers who had been registered at Rochdale Infirmary to participate in a clinical trial. A self-administered six-page questionnaire – Freiburger Lebensqualitäts Questionnaire Assessment (FLQA) – on the QOL along with a checklist was used to collect data from March 2002 to June 2003. The feasibility and reliability of the venous leg ulcer specific questionnaire, the patient-reported QOL and their perspective on compression therapy were chosen as the main outcomes of the study. Results: A response rate of 94% was obtained, of which 56% were women and 44% were men with an average age of 63 years. Approximately 72% of respondents reported that the questionnaire was suitable to reflect their perspectives on QOL and compression therapy. The questionnaire took an average of 20 minutes to complete. The average QOL score was 45.27 in all the eight domains, where 0 reflected good QOL and 100 reflected poor QOL, indicating that the respondents' QOL had been adversely affected due to venous leg ulcers. Men had an average score of 52.0 in all the eight domains and women scored 39.0 in a 0–100 scale. Hence, comparatively, men had poorer QOL than women. Reliability was assessed using measures of internal consistency and test–retest analysis. Cronbach's alpha, α = 0.934 indicated that the survey items were highly inter-correlated. Test–retest analysis indicated that there was moderate-to-strong correlation in seven out of eight domains, which meant that the reproducibility of the FLQA questionnaire was consistent. Conclusions: The pilot survey conducted on a representative sample of patients indicated that the questionnaire is suitable and has the potential to reflect the perspective on compression therapy and overall QOL of patients suffering from venous leg ulcers. The survey tool demonstrated the clinical and research utility as a QOL outcome measure for clinical trials evaluating wound care products on patients suffering from venous leg ulcers.

Download Full-text

Updated leg ulcer pathway: improving healing times and reducing costs

British Journal of Nursing ◽

10.12968/bjon.2019.28.20.s21 ◽

2019 ◽

Vol 28 (20) ◽

pp. S21-S26

Author(s):

Leanne Atkin ◽

Alison Schofield ◽

Anita Kilroy-Findley

Keyword(s):

Quality Of Life ◽

Leg Ulcer ◽

Leg Ulcers ◽

Nursing Time ◽

Venous Leg Ulcers ◽

Reduced Costs ◽

Reducing Costs

Regardless of the amount of literature and evidence on leg ulcer management, there are still significant variations in treatment. Implementing a standardised leg ulcer pathway to ensure patients are appropriately and timely assessed could help reduce nursing time and overall costs, while improving healing outcomes and patients' quality of life. Such a pathway was introduced in Lincolnshire and Leicestershire, UK, to treat venous leg ulcers (VLUs). The results showed improved healing times, reduced costs and fewer nurse visits, among other findings.

Download Full-text

Neurovascular changes after four-layer compression bandaging in people with chronic venous leg ulcers

Phlebology The Journal of Venous Disease ◽

10.1258/026835507780346123 ◽

2007 ◽

Vol 22 (2) ◽

pp. 49-55 ◽

Cited By ~ 4

Author(s):

R Ogrin ◽

P Darzins ◽

Z Khalil

Keyword(s):

Wound Healing ◽

Wound Repair ◽

Statistical Significance ◽

Sensory Nerve ◽

Compression Therapy ◽

Clinical Problem ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Perfusion Measurement ◽

Compression Bandaging

Objectives: Venous leg ulcers represent a major clinical problem, with poor rates of healing. Ideal treatment is compression bandaging. The effect of compression on neurovascular tissues involved in wound repair is unclear. This study aims to assess the effect of four-layer compression therapy (40 mmHg) on neurovascular function and wound healing in people with chronic venous leg ulcers – 15 people (55 years or older) with venous leg ulcers for more than six weeks. Methods: Basal microvascular perfusion measurement (MPM), oxygen tension (tc pO2) measured at sensor temperatures of 39°C and 44°C and sensory nerve function using electrical cutaneous perception thresholds (ECPT) at 5, 250 and 2000 Hz (corresponding to C, A δ and A β fibres) were assessed adjacent to the ulcer site, and at a mirror location on the non-ulcerated limb. Testing was undertaken before and after therapy for 5–12 weeks of four-layer compression bandaging. Results: There was significant improvement in tc pO2 at 44°C and ECPT at 2000 Hz ( P<0.05) compared with pre-intervention. Changes in basal MPM, tc pO2 at 39°C and ECPT at 5 and 250 Hz after compression therapy did not reach statistical significance. Conclusion: Four-layer compression bandaging in people with venous leg ulcers improved some components of neurovascularture in people with chronic venous leg ulcers. Whether this improvement has contributed to wound healing in this study requires further investigation.

Download Full-text

Recurrent venous leg ulcers: management in general practice

Practice Nursing ◽

10.12968/pnur.2021.32.6.220 ◽

2021 ◽

Vol 32 (6) ◽

pp. 220-225

Author(s):

Annemarie Brown

Keyword(s):

Quality Of Life ◽

General Practice ◽

Financial Burden ◽

Self Care ◽

Leg Ulcers ◽

Recurrence Rates ◽

Practice Nurses ◽

Venous Leg Ulcers ◽

Primary Prevention Strategy

Venous leg ulcers commonly recur. Annemarie Brown highlights some self-care strategies that patients can use to reduce their risk Chronic venous leg ulcers are commonly seen in general practice and although healing rates for leg ulcers have improved, recurrence rates are high with around 60–70% reported to recur after healing. The primary prevention strategy is the life-long wearing of compression hosiery; however, compliance is low for several reasons including lack of understanding of the need to wear compression hosiery and difficulties applying and removing it. Self-care strategies such as physical exercise and mobility, leg elevation and appropriate skin care, can help to prevent recurrence of venous leg ulcers. Practice nurses are ideally placed to provide this advice, which can help improve patient's quality of life while reducing the financial burden of treating open ulceration for the NHS.

Download Full-text