References

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 https://doi.org/10.1016/j.jvs.2014.04.049

Hellström A, Nilsson C, Nilsson A, Fagerström C. Leg ulcers in older people: a national study addressing variation in diagnosis, pain and sleep disturbance. BMC Geriatr. 2016; 16:(1) https://doi.org/10.1186/s12877-016-0198-1

Franks PJ, Barker J, Collier M Management of patients with venous leg ulcers: challenges and current best practice. J Wound Care. 2016; 25:S1-S67 https://doi.org/10.12968/jowc.2016.25.Sup6.S1

Barnsbee L, Cheng Q, Tulleners R Measuring costs and quality of life for venous leg ulcers. Int Wound J. 2019; 16:(1)112-121 https://doi.org/10.1111/iwj.13000

Chaby G, Senet P, Ganry O Prognostic factors associated with healing of venous leg ulcers: a multi-centre, prospective, cohort study. Br J Dermatol. 2013; 169:(5)1106-1113 https://doi.org/10.1111/bjd.12570

Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018; 15:(1)29-37 https://doi.org/10.1111/iwj.12814

Lal BK. Venous ulcers of the lower extremity: definition, epidemiology, and economic and social burdens. Semin Vasc Surg. 2015; 28:(1)3-5 https://doi.org/10.1053/j.semvascsurg.2015.05.002

Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. J Wound Care. 2014; 23:(12)601-612 https://doi.org/10.12968/jowc.2014.23.12.601

Alavi A, Sibbald RG, Phillips TJ What's new: management of venous leg ulcers. J Am Acad Dermatol. 2016; 74:(4)643-664 https://doi.org/10.1016/j.jaad.2015.03.059

Labropoulos N, Wang ED, Lanier ST, Khan SU. Factors associated with poor healing and recurrence of venous ulceration. Plast Reconstr Surg. 2012; 129:(1)179-186 https://doi.org/10.1097/PRS.0b013e3182362a53

Mauck KF, Asi N, Elraiyah TA Comparative systematic review and meta-analysis of compression modalities for the promotion of venous ulcer healing and reducing ulcer recurrence. J Vasc Surg. 2014; 60:71S-90S.e1-2

Thomas S. The effect of the weather and other environmental factors on the performance of surgical dressings. Wounds. 2012; 24:(12)335-338

Wound characteristics that affect wound healing. 2012. https://tinyurl.com/523u5j8w (accessed 9 February 2022)

Wong IK, Andriessen A, Charles HE Randomized controlled trial comparing treatment outcome of two compression bandaging systems and standard care without compression in patients with venous leg ulcers. J Eur Acad Dermatol Venereol. 2012; 26:(1)102-110 https://doi.org/10.1111/j.1468-3083.2011.04327.x

Harrison MB, Van-DenKerkhof EG, Hopman WM The Canadian Bandaging Trial: evidence-informed leg ulcer care and the effectiveness of two compression technologies. BMC Nurs. 2011; 10:(1) https://doi.org/10.1186/1472-6955-10-20

Milic DJ, Zivic SS, Bogdanovic DC Risk factors related to the failure of venous leg ulcers to heal with compression treatment. J Vasc Surg. 2009; 49:(5)1242-1247 https://doi.org/10.1016/j.jvs.2008.11.069

Scotton MF, Miot HA, Abbade LP. Factors that influence healing of chronic venous leg ulcers: a retrospective cohort. An Bras Dermatol. 2014; 89:(3)414-422 https://doi.org/10.1590/abd1806-4841.20142687

Karanikolic V, Karanikolic A, Petrovic D, Stanojevic M. Prognostic factors related to delayed healing of venous leg ulcer treated with compression therapy. Zhonghua Pifuke Yixue Zazhi. 2015; 33:(4)206-209 https://doi.org/10.1016/j.dsi.2015.04.005

Weller CD, Evans SM, Staples MP Randomized clinical trial of three-layer tubular bandaging system for venous leg ulcers. Wound Repair Regen. 2012; 20:(6)822-829 https://doi.org/10.1111/j.1524-475X.2012.00839.x

Finlayson KJ, Courtney MD, Gibb MA The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomised controlled trial. Int Wound J. 2014; 11:(1)21-27 https://doi.org/10.1111/j.1742-481X.2012.01033.x

Abbade LP, Lastória S, Rollo Hde A. Venous ulcer: clinical characteristics and risk factors. Int J Dermatol. 2011; 50:(4)405-11 https://doi.org/10.1111/j.1365-4632.2010.04654.x

DePopas E, Brown M. Varicose veins and lower extremity venous insufficiency. Semin Intervent Radiol. 2018; 35:(01)056-061 https://doi.org/10.1055/s-0038-1636522

Vasudevan B. Venous leg ulcers: pathophysiology and classification. Indian Dermatol Online J. 2014; 5:(3)366-370 https://doi.org/10.4103/2229-5178.137819

Melikian R, O'Donnell TF, Suarez L, Iafrati MD. Risk factors associated with the venous leg ulcer that fails to heal after 1 year of treatment. J Vasc Surg Venous Lymphat Disord. 2019; 7:(1)98-105 https://doi.org/10.1016/j.jvsv.2018.07.014

Health Promotion Board. Obesity. 2016. https://tinyurl.com/497ebacr (accessed 8 February 2021)

Xiang J, Wang S, He Y Reasonable glycemic control would help wound healing during the treatment of diabetic foot ulcers. Diabetes Ther. 2019; 10:(1)95-105 https://doi.org/10.1007/s13300-018-0536-8

Milic DJ, Zivic SS, Bogdanovic DC The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy. J Vasc Surg. 2010; 51:(3)655-661 https://doi.org/10.1016/j.jvs.2009.10.042

Moffatt CJ, Partsch H, Clark M Understanding compression therapy.: MEP; 2003

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 https://doi.org/10.7150/ijms.7548

Szewczyk MT, Jawień A, Migdalski A Predicting time to healing by anatomical assessment of venous pathology. Med Sci Monit. 2009; 15:(2)CR74-CR81

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)553-4

O'Meara S, Tierney J, Cullum N Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients. BMJ. 2009; 338 https://doi.org/10.1136/bmj.b1344

Rezende De Carvalho M, Utzeri Peixoto B, Andrade Silveira I, Baptista de Oliveria B. A meta-analysis to compare four-layer to short-stretch compression bandaging for venous leg ulcer healing. Ostomy Wound Manage. 2018; 64:(5)30-38 https://doi.org/10.25270/owm.2018.5.3038

Dissemond J, Assenheimer B, Bültemann A Compression therapy in patients with venous leg ulcers. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2016; 14:(11)1072-1087 https://doi.org/10.1111/ddg.13091

Vasquez MA, Rabe E, McLafferty RB Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010; 52:(5)1387-1396 https://doi.org/10.1016/j.jvs.2010.06.161

Leaper DJ, Schultz G, Carville K Extending the TIME concept: what have we learned in the past 10 years?(*). Int Wound J. 2012; 9:1-19 https://doi.org/10.1111/j.1742-481X.2012.01097.x

Hjerppe A, Saarinen JP, Venermo MA Prolonged healing of venous leg ulcers: the role of venous reflux, ulcer characteristics and mobility. J Wound Care. 2010; 19:(11)474-484 https://doi.org/10.12968/jowc.2010.19.11.79696

Harding KG, Vanscheidt W, Partsch H Adaptive compression therapy for venous leg ulcers: a clinically effective, patient-centred approach. Int Wound J. 2016; 13:(3)317-325 https://doi.org/10.1111/iwj.12292

Parker CN, Finlayson KJ, Edwards HE. Ulcer area reduction at 2 weeks predicts failure to heal by 24 weeks in the venous leg ulcers of patients living alone. J Wound Care. 2016; 25:(11)626-634 https://doi.org/10.12968/jowc.2016.25.11.626

Escaleira R, Cardoso M, Rego J Efficacy of a two-component compression system for the therapy of venous leg ulcers. J Wound Care. 2010; 19:(3)104-109 https://doi.org/10.12968/jowc.2010.19.3.47279

Ayala Á, Guerra JD, Ulloa JH, Kabnick L. Compliance with compression therapy in primary chronic venous disease: results from a tropical country. Phlebology. 2019; 34:(4)272-277 https://doi.org/10.1177/0268355518798153

Kumar S, Samraj K, Nirujogi V Intermittent pneumatic compression as an adjuvant therapy in venous ulcer disease. J Tissue Viability. 2002; 12:(2)42-50 https://doi.org/10.1016/S0965-206X(02)80013-4

Burgos-Alonso N, Lobato I, Hernández I Adjuvant biological therapies in chronic leg ulcers. Int J Mol Sci. 2017; 18:(12) https://doi.org/10.3390/ijms18122561

Minniti CP, Delaney KM, Gorbach AM Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia. Am J Hematol. 2014; 89:(1)1-6 https://doi.org/10.1002/ajh.23571

Altman IA, Kleinfelder RE, Quigley JG A treatment algorithm to identify therapeutic approaches for leg ulcers in patients with sickle cell disease. Int Wound J. 2016; 13:(6)1315-1324 https://doi.org/10.1111/iwj.12522

Keast DH, Fraser C. Treatment of chronic skin ulcers in individuals with anemia of chronic disease using recombinant human erythropoietin (EPO): a review of four cases. Ostomy Wound Manage. 2004; 50:(10)64-70

Gould L, Abadir P, Brem H Chronic wound repair and healing in older adults: current status and future research. J Am Geriatr Soc. 2015; 63:(3)427-438 https://doi.org/10.1111/jgs.13332

Gethin G, Cowman S, Kolbach DN. Debridement for venous leg ulcers. Cochrane Database Syst Rev. 2015; (9)

Beard JD. ABC of arterial and venous disease: chronic lower limb ischaemia. BMJ. 2000; 320:(7238)854-857 https://doi.org/10.1136/bmj.320.7238.854

Robertson L, Lee AJ, Gallagher K Risk factors for chronic ulceration in patients with varicose veins: a case control study. J Vasc Surg. 2009; 49:(6)1490-1498 https://doi.org/10.1016/j.jvs.2009.02.237

Thomas Hess C. Checklist for factors affecting wound healing. Adv Skin Wound Care. 2011; 24:(4) https://doi.org/10.1097/01.ASW.0000396300.04173.ec

Zarchi K, Jemec GB. Delivery of compression therapy for venous leg ulcers. JAMA Dermatol. 2014; 150:(7)730-736 https://doi.org/10.1001/jamadermatol.2013.7962

European Wound Management Association. Understanding compression therapy: EWMA position document. 2009. https://tinyurl.com/3v57byss (accessed 8 February 2022)

Guest JF, Gerrish A, Ayoub N Clinical outcomes and cost-effectiveness of three alternative compression systems used in the management of venous leg ulcers. J Wound Care. 2015; 24:(7)300-310 https://doi.org/10.12968/jowc.2015.24.7.300

Leg ulcers
Compression therapy

Healing outcomes and predictors among patients with venous leg ulcers treated with compression therapy

02 July 2022
Practice
02 July 2022
Volume 6 · Issue 2

Abstract

Objective:

This study aimed to compare the healing outcomes between three types of compression therapy—two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing

Method:

A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables.

Results:

Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001).

Conclusion:

In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.

Venous leg ulcers (VLUs) are the commonest type of lower extremity ulcers and are closely related to chronic venous insufficiency.1 Older people are particularly at risk of developing them because of age-related conditions, as well as frailty.2 The precise global prevalence of VLUs is difficult to estimate because of the variety of methodologies used in studies and the accuracy of reporting. Nonetheless, it is estimated that approximately 1% of the global population and 4% of older adults aged >65 years old are affected by VLUs.3

VLUs have significant human and economic burdens, at both individual and societal levels, because they take a long time to heal and have a high recurrence rate.4,5 Globally, it is estimated that 93% of VLUs heal in 12 months and that 7% remain unhealed after five years, while the recurrence rate within three months of healing is around 70%.3 In the UK, the reported healing rate of VLUs was 53% within 12 months, and the average time to healing was 30 months.6 In Asia, including in Singapore, the healing rate of VLUs has not been published so a comparison cannot be made.

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

Register
Or continue by

Signing in with your registered email address

compression therapy
nursing
peripheral vascular disease
pressure bandage
ulcer
venous leg ulcer
wound
wound care
wound dressing
wound healing