Four-layer Compression Bandaging Research Articles

Venous ulcer healing by four-layer compression bandaging is not influenced by the pattern of venous incompetence.

Previous studies have related deep venous incompetence to reduced venous ulcer healing rates. The aim of this study was to determine the relationship between the pattern of venous incompetence and ulcer healing. A total of 198 legs with venous ulceration were investigated with colour venous duplex imaging to determine the presence and site of venous incompetence. All were treated initially with the four-layer bandage technique. At 6 months, 74 per cent of the venous ulcers had healed using the four-layer bandage technique. There was no significant correlation between the pattern of incompetence and the healing rate of the ulcer. Previous deep vein thrombosis (DVT), increased size of the ulcer and previous episodes of ulceration were associated with a poor healing rate. The four-layer bandage technique achieved an ulcer healing rate of 74 per cent after 6 months, irrespective of the pattern of venous incompetence. Patients with a large ulcer, previous DVT or previous episodes of ulceration had delayed healing, supporting the previous literature.

CORRESPONDENCE: the editors welcome topical correspondence from readers relating to articles published in the journal. Letters should be no more than 250 words in length and should be typed on A4-sized paper in double spacing venous ulcer healing by four-layer compression bandaging is not influenced by the pattern of venous incompetence

Abstract The Editors welcome topical correspondence from readers relating to articles published in the Journal. Letters should be no more than 250 words in length and should be typed on A4-sized paper in double spacing

Preoperative Digital Photoplethysmography Predicts Improvement in Venous Function after Superficial Venous Surgery for Chronically Ulcerated Limbs

Objective: To evaluate digital photoplethysmography (d-PPG) in predicting the influence of superficial surgery on venous function in chronically ulcerated limbs. Design: Prospective case-study. Setting: Vascular Laboratory of a District General Hospital. Patients: Patients with ulcerated limbs referred to a specialized community leg ulcer service were assessed with colour venous duplex ultrasound and ankle–brachial pressure index and offered surgery in cases of superficial venous reflux alone. Interventions: Superficial venous surgery. Four-layer compression bandaging. Main outcome measures: D-PPG derived venous refill time (VRT) and pump power (PP) were measured preoperatively with and without a tourniquet, and again after surgery. Results: Thirty ulcerated limbs in 27 patients were assessed. VRT increased from a median (interquartile range) of 10 s (7–17) preoperatively to 26 s (19–29)* with an above-knee tourniquet, 26 s (18–32)* with a below-knee tourniquet and 19 s (15–25)* after superficial venous surgery (* p < 0.01). PP increased from 2.3% (1.3–3.1) preoperatively to 3.0% (2.0–4.2)* with an above-knee tourniquet, 2.9% (2.1–4.3)** with a below-knee tourniquet and 4.4% (2.3–7.2)* after surgery (* p < 0.01, ** p < 0.05). The increase in VRT with an above-knee tourniquet preoperatively correlated with an increase in VRT after surgery ( r = 0.40, p < 0.05). Conclusion: Superficial venous surgery improves venous function measured by d-PPG in chronically ulcerated limbs. Preoperative assessment with d-PPG and an above-knee tourniquet predicts functional improvement after surgery.

A Cost-Effective Approach to Treating Leg Ulcers.

A variety of therapies for venous leg ulcers have been devised, but information about their comparative effectiveness and costs is scanty. Investigators in England compared two approaches: weekly treatment at a leg ulcer clinic using unique four-layer compression bandages, and …

Leg ulcer management in a nurse-led, hospital-based clinic.

This paper describes the clinical outcomes from a nurse-led leg ulcer clinic over a period of three and a half years. Leg ulcers were assessed in a structured way and venous ulcers were treated with four-layer compression bandaging. The study involved retrospective analysis of 159 patients with 180 venous leg ulcers. Overall healing rates were 64.5% at 12 weeks, 84.1% at 24 weeks and 91.4% at 36 weeks. Healing rates were not affected by a history of previous ulceration or by bilateral limb ulceration. However, healing rates varied with previous ulcer duration, ulcer size and patient mobility.

Effects of compression bandaging on leg pulsatile blood flow.

Leg external compression bandaging is the mainstay of venous ulcer treatment, yet little is known about the impact of therapeutic compression levels on arterial haemodynamics. In this study, the effect of foot-to-knee, four-layer compression bandaging on below-knee arterial pulsatile blood flow was assessed by nuclear magnetic resonance flowmetry. In 14 healthy supine subjects bilateral flow measurements at five below-knee sites without compression, and after compressing one leg to an average malleolar sub-bandage pressure of 40.7 +/- 4.0 mmHg, revealed a potentially important new phenomenon. The forefoot-to-knee compression bandaging caused a highly significant (P < 0.001) increase in the bandaged leg pulsatile blood flow owing to increases in both peak flow and pulse width. It is hypothesized that arteriolar vasodilatation, induced either myogenically by reduced transmural pressure or by vasodilatory substance release triggered by increased venous shear stress, produce the observed compression-related phenomenon. Whatever the mechanism(s), the finding of a compression-associated pulsatile flow increase suggests a previously undiscovered arterial linkage, which may play a role in the well-documented beneficial effects of compression bandaging in venous ulcer treatment. A possible impact of the arterial flow-pulse increase is speculated to effect venous ulcer outcome via a decrease in leucocyte effects in the distal microvasculature, as a consequence of the more vigorous haemodynamic state.

Community Leg Ulcer Clinics: Effect on Quality of Life

Objective: To investigate changes in the quality of life of patients with leg ulcers being treated in community leg ulcer clinics. Design: Patients were interviewed using a standard questionnaire, and then reinterviewed after 12 weeks of compression bandaging to observe changes. Setting: Community ulcer clinics held in health centres within Riverside Health District. Patients: All new patients presenting to community leg ulcer clinics up to 6 months from the start of a clinic and treated with four-layer compression bandaging. Main outcome measures: Changes in quality of life, interference in daily activities caused by leg ulceration and general health after 12 weeks of treatment. Results: Treatment over 12 weeks resulted in a mean reduction in anxiety (2.79 v 1.73, p &lt; 0.001), depression (2.61 v 1.89, p &lt; 0.001), hostility (1.59 v 1.00, p &lt; 0.001) and cognition (1.29 v 0.87, p = 0.015). Pain significantly improved following treatment (χ2 trend = 103.7, 1d.f., p &lt; 0.001). Changes in depression and hostility were related to complete ulcer healing. Conclusions: There were clear changes in quality of life following 12 weeks in a community leg ulcer clinic, which were related to the healing of the ulcer. Systems of care that offer rapid healing and improve patients' well-being must be considered when planning an effective leg ulcer service.

A pilot leg ulcer clinic in a geriatric day hospital.

Twenty-six patients with leg ulcers with a mean age of 80 years were assessed at a day hospital to determine the aetiology and to carry out a trial of four-layer compression bandaging for those suitable. Ten had ankle brachial pressure indices (ABIs) < 0.8. Of nine patients with venous disease who received compression bandaging, only two ulcers healed and have remained healed with fitted below-knee elastic stockings. The remaining patients were unable to tolerate compression or developed deterioration of their ulcers. Nine patients had unhealing arterial ulcers all unsuitable for reconstructive surgery. Five patients presented with pressure sores due to bandages, shoes or heel pressure in bed. All healed slowly with leg elevation and pressure relief. Four patients had extensive non-venous, non-arterial ulceration associated with fluid retention and dependent oedema exacerbated by spending their nights in chairs. Varicose eczema was healed in 12 patients. All the patients had multiple pathology and poorly controlled pain. Although complete healing was achieved in only six patients, the importance of ABI measurement and the gross mixed pathology suggests that every elderly patient with a leg ulcer needs medical assessment and management and that this could form a valuable service of a geriatric day hospital.