A Meta-analysis to Compare Four-layer to Short-stretch Compression Bandaging for Venous Leg Ulcer Healing

Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.

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Ankle Motility is a Risk Factor for Healing of Chronic Venous Leg Ulcers

Phlebology The Journal of Venous Disease ◽

10.1177/026835550101600110 ◽

2001 ◽

Vol 16 (1) ◽

pp. 38-40 ◽

Cited By ~ 13

Author(s):

J. R. Barwell ◽

M. Taylor ◽

J. Deacon ◽

C. Davies ◽

M. R. Whyman ◽

...

Keyword(s):

Risk Factor ◽

Pump Power ◽

Ulcer Healing ◽

Independent Risk Factor ◽

Healing Rate ◽

Leg Ulcer ◽

Venous Leg Ulcer ◽

Compression Bandaging ◽

Venous Ulcers ◽

Ulcer Healing Rate

Objective: To investigate the effect of ankle motility on chronic venous leg ulcer healing, and to relate this to calf pump function and muscle bulk. Methods: This was a prospective cohort study undertaken in a leg ulcer clinic. Ankle motility, calf-ankle circumference ratio and calf pump power (derived from digital photoplethysmography) were assessed as to their effect on ulcer healing rate. Thirty consecutive patients undergoing multi-layer compression bandaging for open chronic venous ulcers were included. Results: Ankle motility was an independent risk factor for ulcer healing ( p = 0.001, hazard ratio 1.08, 95% CI 1.03–1.13). Ankle motility correlated with calf-ankle circumference ratio ( r = 0.48, p<0.01). No relationship was found between photoplethysmography-derived calf pump power, ankle motility or ulcer healing rate. Conclusions Ulcers in legs with poor ankle motility are slower to heal and this may be related to reduced calf muscle bulk. Ankle exercises or physiotherapy could be considered in such patients.

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A meta-analysis of venous leg ulcer healing in prospective randomized studies using micronized purified flavonoid fraction

Journal des Maladies Vasculaires ◽

10.1016/s0398-0499(04)96873-4 ◽

2004 ◽

Vol 29 ◽

pp. 43 ◽

Cited By ~ 2

Author(s):

A.A. Ramelet ◽

P.D. Coleridge-Smith ◽

P. Gloviczki

Keyword(s):

Ulcer Healing ◽

Meta Analysis ◽

Leg Ulcer ◽

Venous Leg Ulcer ◽

Randomized Studies ◽

Micronized Purified Flavonoid Fraction ◽

Flavonoid Fraction

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Daflon 500 mg and Venous Leg Ulcer: New Results From a Meta-Analysis

Angiology ◽

10.1177/00033197050560i106 ◽

2005 ◽

Vol 56 (6_suppl) ◽

pp. S33-S39 ◽

Cited By ~ 24

Author(s):

Philip Coleridge Smith

Keyword(s):

Ulcer Healing ◽

Conventional Therapy ◽

Conventional Treatment ◽

Oral Treatment ◽

Meta Analysis ◽

Venous Ulcer ◽

Leg Ulcer ◽

Venous Leg Ulcer ◽

Type 1 Error ◽

Randomized Controlled Studies

The objective of this study was to assess the effect of oral treatment with Daflon 500 mg (micronized purified flavonoid fraction [MPFF]) on leg ulcer healing. This study was conducted as a meta-analysis of randomized prospective studies using Daflon 500 mg as an adjunct to conventional treatment. Medical literature databases and the manufacturer’s records were searched for relevant clinical trials. Five prospective, randomized, controlled studies in which 723 patients with venous ulcers were treated between 1996 and 2001 were identified. Conventional treatment (compression and local care) in addition to Daflon 500 mg 2 tablets daily was compared with conventional treatment plus placebo in two studies (n=309), or with conventional treatment alone in three studies (n=414). The primary end point was complete ulcer healing at 6 months. The results are expressed as a reduction in the relative risk (RRR) of healing with 95% confidence intervals (CI). Since, in the present case, the desired treatment effect is increased ulcer healing, RRR should be positive to indicate a benefit of adjunctive Daflon 500 mg over conventional therapy alone. Type 1 error was set at 5%. At 6 months, the chance of ulcer healing was 32% better in patients treated with adjunctive Daflon 500 mg than in those managed by conventional therapy alone (RRR, 32%; 95% CI, 3% to 70%). This difference was present from month 2 (RRR, 44%; 95% CI, 7% to 94%), and was associated with a shorter time to healing (16 weeks vs 21 weeks; p=0.0034). The benefit of Daflon 500 mg was found in the subgroup of ulcers between 5 and 10 cm2 in area (RRR, 40%; 95% CI, 6% to 87%), as well as in patients with ulcers of 6 to 12 months’ duration (RRR, 44%; 95% CI, 6% to 97%). These results confirm that venous ulcer healing is accelerated by Daflon 500 mg treatment. Daflon 500 mg might be a useful adjunct to conventional therapy in large and longstanding ulcers that might be expected to heal slowly.

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