Hanna R, Bohbot S, Connolly N. A comparison of inferface pressures of three compression bandage systems. Br J Nurs. 2008; 17:(20)S16-24

Jünger M, Ladwig A, Bohbot S Comparison of interface pressures of three compression bandaging systems used on healthy volunteers. J Wound Care. 2009; 18:(11)474-480

Benigni JP, Lazareth I, Parpex P Efficacy, safety and acceptability of a new two-layer bandage system for venous leg ulcers. J Wound Care. 2007; 16:(9)385-390

Lazareth I, Moffatt C, Dissemond J Efficacy of two compression systems in the management of VLUs: results of a European RCT. J Wound Care. 2012; 21:(11)553-558

Sen CK, Gordillo GM, Roy S Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009; 17:(6)763-771

Agale SV. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers. 2013; 2013

Palfreyman S. Assessing the impact of venous ulceration on quality of life. Nurs Times. 2008; 104:34-37

Rice JB, Desai U, Cummings AKG Burden of venous leg ulcers in the United States. J Med Econ. 2014; 17:(5)347-356

Xie T, Ye J, Rerkasem K The venous ulcer continues to be a clinical challenge: an update. Burns Trauma. 2018; 6

Simplifying venous leg ulcer management consensus recommendations. Consensus recommendations. 2015. (accessed 31 July 2020)

González-Consuegra RV, Verdú J. Quality of life in people with venous leg ulcers: an integrative review. J Adv Nurs. 2011; 67:(5)926-944

Ma H, O'Donnell TF, Rosen NA The real cost of treating venous ulcers in a contemporary vascular practice. J Vasc Surg Venous Lymphat Disord. 2014; 2:(4)355-361

Farrow W. Phlebolymphedema: a common underdiagnosed and undertreated problem in the wound care clinic. J Am Col Certif Wound Spec. 2010; 2:(1)14-23

Falanga V, Eaglstein WH. The ‘trap’ hypothesis of venous ulceration. Lancet. 1993; 341:(8851)1006-1008

Beidler SK, Douillet CD, Berndt DF Inflammatory cytokine levels in chronic venous insufficiency ulcer tissue before and after compression therapy. J Vasc Surg. 2009; 49:(4)1013-1020

Browse NL, Burnand KG. The cause of venous ulceration. Lancet. 1982; 2:(8292)243-245

Smith PDC, Thomas P, Scurr JH Causes of venous ulceration: a new hypothesis. Br Med J (Clin Res Ed). 1988; 296:(6638)1726-1727

Raffetto JD. Inflammation in chronic venous ulcers. Phlebology. 2013; 28:61-67

Mortimer PS. Evaluation of lymphatic function: abnormal lymph drainage in venous disease. Int Angiol. 1995; 14:(3)32-35

Lee S-J, Park C, Lee JY Generation of pure lymphatic endothelial cells from human pluripotent stem cells and their therapeutic effects on wound repair. Sci Rep. 2015; 5

Ruocco E, Brunetti G, Brancaccio G Phlebolymphedema: disregarded cause of immunocompromised district. Clin Dermatol. 2012; 30:(5)541-543

Rasmussen JC, Aldrich MB, Tan I-C Lymphatic transport in patients with chronic venous insufficiency and venous leg ulcers following sequential pneumatic compression. J Vasc Surg Venous Lymphat Disord. 2016; 4:(1)9-17

Kataru RP, Baik JE, Park HJ Regulation of immune function by the lymphatic system in lymphedema. Front Immunol. 2019; 10

Mortimer PS. Implications of the lymphatic system in CVI-associated edema. Angiology. 2000; 51:(1)3-7

Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014; 130:(4)333-46

The important role of the lymphatics in venous ulcers: chronic wounds may require more than venous intervention. 2019. (accessed July 27, 2020)

Levick JR, Michel CC. Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res. 2010; 87:(2)198-210

Mortimer P, Pearson IC. Lymphatic function in severe chronic venous insufficiency. Phlebolymphology. 2004; 44:253-257

Lerman M, Gaebler JA, Hoy S Health and economic benefits of advanced pneumatic compression devices in patients with phlebolymphedema. J Vasc Surg. 2019; 69:(2)571-580

Dolibog P, Franek A, Taradaj J A comparative clinical study on five types of compression therapy in patients with venous leg ulcers. Int J Med Sci. 2014; 11:(1)34-43

O'Donnell TF, Passman MA, Marston WA Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2014; 60:3S-59S

Mosti G, De Maeseneer M, Cavezzi A Society for Vascular Surgery and American Venous Forum Guidelines on the management of venous leg ulcers: the point of view of the International Union of Phlebology. Int Angiol. 2015; 34:(3)202-218

Franks PJ, Barker J, Collier M Management of patients with venous leg ulcers: challenges and current best practice. J Wound Care. 2016; 25:S1-67

O'Meara S, Cullum N, Nelson EA Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012; 11:(11)

Palfreyman SJ, Lochiel R, Michaels JA. A systematic review of compression therapy for venous leg ulcers. Vasc Med. 1998; 3:(4)301-313

Nelson EA, Bell-Syer SEM. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2014:(9)

Partsch H, Mortimer P. Compression for leg wounds. Br J Dermatol. 2015; 173:(2)359-369

Hettrick H. The science of compression therapy for chronic venous insufficiency edema. J Am Col Certif Wound Spec. 2009; 1:(1)20-24

Mosti G. Venous ulcer treatment requires inelastic compression. Phlebologie. 2018; 47:(7–12)

Principles of compression in venous disease: a practitioner's guide to treatment and prevention of venous leg ulcers. 2013. (accessed 31 July 2020)

European Wound Management Association (EWMA). Focus document: lymphoedema bandaging in practice. 2005. (accessed 31 July 2020)

International Lymphedema Framework (ILF). Best practice for the management of lymphoedema. 2012. (accessed 27 July 2020)

Chen AH, Frangos SG, Kilaru S Intermittent pneumatic compression devices: physiological mechanisms of action. Eur J Vasc Endovasc Surg. 2001; 21:(5)383-392

Partsch H. The static stiffness index: a simple method to assess the elastic property of compression material in vivo. Dermatol Surg. 2005; 31:(6)625-630

Partsch H, Schuren J, Mosti G The static stiffness index: an important parameter to characterise compression therapy in vivo. J Wound Care. 2016; 25:S4-10

Partsch H. Compression therapy in leg ulcers. Rev Vasc Med. 2013; 1:9-14

Partsch H, Clark M, Mosti G Classification of compression bandages: practical aspects. Dermatol Surg. 2008; 34:(5)600-609

De Carvalho MR, Peixoto BU, Silveira IA A meta-analysis to compare four-layer to short-stretch compression bandaging for venous leg ulcer healing. Ostomy Wound Manage. 2018; 64:(5)30-37

Ashby RL, Gabe R, Ali S VenUS IV (Venous leg Ulcer Study IV)—compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: a randomised controlled trial, mixedtreatment comparison and decision-analytic model. Health Technol Assess. 2014; 18:(57)1-293

Amsler F, Willenberg T, Blättler W. In search of optimal compression therapy for venous leg ulcers: a meta-analysis of studies comparing divers bandages with specifically designed stockings. J Vasc Surg. 2009; 50:(3)668-674

Mosti G. Elastic stockings versus inelastic bandages for ulcer healing: a fair comparison?. Phlebology. 2012; 27:1-4

Arnoldi CC. Venous pressure in the leg of healthy human subjects at rest and during muscular exercise in the nearly erect position. Acta Chir Scand. 1965; 130:(6)570-583

Partsch B, Partsch H. Calf compression pressure required to achieve venous closure from supine to standing positions. J Vasc Surg. 2005; 42:(4)734-738

Partsch H. The use of pressure change on standing as a surrogate measure of the stiffness of a compression bandage. Eur J Vasc Endovasc Surg. 2005; 30:(4)415-421

Mosti G, Partsch H. Inelastic bandages maintain their hemodynamic effectiveness over time despite significant pressure loss. J Vasc Surg. 2010; 52:(4)925-931

Mosti G, Mattaliano V, Partsch H. Inelastic compression increases venous ejection fraction more than elastic bandages in patients with superficial venous reflux. Phlebology. 2008; 23:(6)287-294

Mosti G, Mattaliano V, Partsch H. Influence of different materials in multicomponent bandages on pressure and stiffness of the final bandage. Dermatol Surg. 2008; 34:(5)631-639

Ehmann S, Walker KJ, Bailey CM, DesJardins JD. Experimental simulation study to assess pressure distribution of different compression applications applied over an innovative primary wound dressing.: Wounds; 2020

Bjork R, Ehmann S. S.T.R.I.D.E. Professional guide to compression garment selection for the lower extremity. J Wound Care. 2019; 28:1-44

Chohan A, Haworth L, Sumner S Examination of the effects of a new compression garment on skin tissue oxygenation in healthy volunteers. J Wound Care. 2019; 28:(7)429-435

Franks PJ, Oldroyd MI, Dickson D Risk factors for leg ulcer recurrence: a randomized trial of two types of compression stocking. Age Ageing. 1995; 24:(6)490-494

Raju S, Hollis K, Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy. Ann Vasc Surg. 2007; 21:(6)790-795

Moffatt C, Kommala D, Dourdin N Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence. Int Wound J. 2009; 6:(5)386-393

Van Hecke A, Grypdonck M, Defloor T. A review of why patients with leg ulcers do not adhere to treatment. J Clin Nurs. 2009; 18:(3)337-349

Andriessen A, Apelqvist J, Mosti G Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications: a review of present guidelines. J Eur Acad Dermatol Venereol. 2017; 31:(9)1562-1568

Vin F, Teot L, Meaume S. The healing properties of Promogran in venous leg ulcers. J Wound Care. 2002; 11:(9)335-341

Thomas S, Banks V, Bale S A comparison of two dressings in the management of chronic wounds. J Wound Care. 1997; 6:(8)383-386

Fays S, Schmutz J, Vin F Leg ulcers and the Urgocell Non-Adhesive wound dressing. Br J Nurs. 2005; 14:(11)S15-20

Meaume S, Ourabah Z, Cartier H Evaluation of a lipidocolloid wound dressing in the local management of leg ulcers. J Wound Care. 2005; 14:(7)329-334

A dual compression system: preliminary clinical insights from the US

02 September 2020
Volume 4 · Issue 4


There is growing evidence on an interconnection between the venous and lymphatic systems in venous leg ulceration, and the possible effects of prolonged oedema and lymphatic impairment in delayed wound healing. Compression therapy is a widely accepted treatment for venous and lymphatic disorders, as it decreases recurrence rates and prolongs the interval between recurrences. Compression bandages improve venous return, increase the volume and rate of venous flow, reduce oedema and stimulate anti-inflammatory processes. The pressure at the interface (IP) of the bandage and the skin is related to the elastic recoil of the product used and its resistance to expansion. The pressure difference between the IP in the supine and standing positions is called the static stiffness index (SSI). Elastic materials provide little resistance to muscle expansion during physical activity, resulting in small pressure differences between resting and activity, with an SSI <10mmHg. Stiff, inelastic materials with a stretch of <100% resist the increase of muscle volume during physical activity, producing higher peak pressures, an SSI of >10mmHg and a greater haemodynamic benefit than elastic systems. UrgoK2 is a novel dual-layer high-compression system consisting of an inelastic (short stretch) and elastic (long stretch) bandage, resulting in sustained tolerable resting pressure and elevated working pressures over extended wear times. It is indicated for the treatment of active venous leg ulcers and the reduction of chronic venous oedema. Each bandage layer has a visual aid to enable application at the correct pressure level. Published European studies have assessed this compression system, exploring its consistency of application, tolerability and efficacy. This article presents the first reports of health professionals' clinical experience of using the compression system in the US, where it has been recently launched. Initial feedback is promising.

In December 2019, a panel of wound care experts (the authors) met in Fort Worth, Dallas, US, to examine the attributes of a compression system for venous leg ulcers (VLUs) that has been available in Europe for some time and was launched in the US in 2020. The dual-layer system consists of an inelastic (also known as short stretch) and an elastic (long stretch) layer; its primary purpose is to heal VLUs. The product has already been the subject of a number of clinical studies conducted in Europe to assess its efficacy, tolerability, comfort, ability to maintain pressure over an extended period, ease of use and ability to be applied in a consistent manner.1,2,3,4 The panel reviewed the evidence in the context of other compression systems on the market; here, they share their personal experience of using the product and assess whether it could be effective as a treatment for venous leg ulcers. This report summarises the evidence and discusses their findings.

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month