Is chronic venous ulcer curable? A sample survey of a plastic surgeon

Comparative Efficacy and Cost-Effectiveness of Two-Layer Versus Four-Layer Compression Bandages for Venous Leg Ulcers: A Prospective Study

OBJECTIVE

This study aims to evaluate and compare the efficacy and cost-effectiveness of two-layer versus four-layer compression bandages in the treatment of venous leg ulcers (VLUs).

METHODS

A prospective study was conducted at a tertiary hospital from August 2022 to July 2024. A total of 100 patients with chronic VLUs were sampled. Of the patients, 50 were given two-layer (group A) compression therapy, and the other 50 were given four-layer (group B) compression therapy. Outcomes after both therapies were analyzed.

RESULTS

The mean age of the participants was 45.76 years, with a predominance of males (67%). Both bandaging systems demonstrated similar healing efficacy with no significant difference in ulcer size or healing time between groups. However, the four-layer bandage system required significantly fewer follow-ups (mean = 4.88) compared to the two-layer system (mean = 6.46) (p < 0.001). The mean total cost was higher for the four-layer system (₹3416) compared to the two-layer system (₹2907) (p = 0.004). Complications such as pain and pressure ulcers were comparable, though the four-layer system was associated with slightly higher discomfort and skin irritation.

CONCLUSION

The four-layer bandage system may offer marginal advantages in wound healing and fewer follow-ups, but it is more expensive. The two-layer bandage system is more cost-effective and patient-friendly.

Effect of four-layer dressing on the microbiological profile of venous leg ulcer

OBJECTIVE

Venous leg ulcer (VLU) is a chronic disease and has periods of exacerbation and remission. Various bandage systems-single-layered, double-layered and multiple-layered with elastic and non-elastic components-have been developed. The requirement for sustained pressure brought about the introduction of the four-layer bandage. We studied the bacteriology of VLUs and the effect of four-layer bandages on their healing.

METHOD

Clinical details of all patients, with wound size measurement by gauze piece, wax paper and scale, were recorded. The wounds were initially debrided and photographic records of all patients were maintained. Patients were followed up every week, when the dressings and four-layer bandages were changed.

RESULTS

A total of 60 patients were recruited to the study with four patients having bilateral disease and so a total of 64 VLUs were evaluated. Of these, 60 (93.8%) healed completely, one (1.6%) healed partially and three (4.7%) did not heal. After excluding the four VLUs that did not fully heal, 10 (16.7%) had recurrence while 50 (83.3%) had no recurrence in the follow-up period, which lasted for one year. During the first visit (baseline), meticillin-resistant Staphylococcus aureus (MRSA) was isolated in 29 (45.31%) VLUs and Pseudomonas spp. in 20 (31.25%) VLUs. With subsequent dressing, the VLU size decreased and the culture of the VLU was sterile from the third culture onwards in 45 cases. There was a significant correlation (p<0.001) between VLU size and the number of dressings.

CONCLUSION

Compression therapy is the mainstay of treatment of VLU, with rapid healing and improvement in bacteriological profile. Compression in the range of 30-40mmHg is the most effective treatment for uncomplicated VLUs with adequate arterial competency.

Compression therapy for ulcers: The science and the art

INTRODUCTION

Chronic ulcers are characterized by being resistant to all forms of treatment. Recent improvement in compression techniques, notably use of multilayer bandaging has created a need for a re-look into it's use.

MATERIALS AND METHODS

The authors present two case reports of successful management of chronic ulcers using compression through bandaging where all other forms of treatment had failed. This is followed by a review of literature based on previous articles as well as more recent ones found through Pubmed.

CONCLUSION

It is suggested that, at least in India, compression through proper multilayer bandaging, should be a choice far higher in the treatment ladder than so previously. However, if the technique is improper, it may be harmful so the option is to be exercised with care and only by those who have received adequate training. The need of a team approach, and alongside, wider introduction of more and better training facilities for therapists and nurses is underlined.