Healing venous ulcers with different modalities of leg compression

Abstract

Summary Background: Compression therapy (CT) is the stronghold of treatment of venous leg ulcers. We evaluated 5 modalities of CT in a prospective open pilot study using a unique trial design. Patients and methods: A group of experienced phlebologists assigned 31 consecutive patients with 35 venous ulcers (present for 2 to 24 months with no prior CT) to 5 different modalities of leg compression, 7 ulcers to each group. The challenge was to match the modality of CT with the features of the ulcer in order to achieve as many healings as possible. Wound care used standard techniques and specifically tailored foam pads to increase local pressure. CT modalities were either stockings Sigvaris® 15-20, 20-30, 30-40 mmHg, multi-layer bandages, or CircAid® bandaging. Compression was maintained day and night in all groups and changed at weekly visits. Study endpoints were time to healing and the clinical parameters predicting the outcome. Results: The cumulative healing rates were 71%, 77%, and 83% after 3, 6, and 9 months, respectively. Univariate analysis of variables associated with nonhealing were: previous surgery, presence of insufficient perforating and/or deep veins, older age, recurrence, amount of oedema, time of presence of CVI and the actual ulcer, and ulcer size (p <0.05-<0.001). The initial ulcer size was the best predictor of the healing-time (Pearson r=0.55, p=0.002). The modality of CT played an important role also, as 19 of 21 ulcers (90%) healed with stockings but only 8 of 14 with bandages (57%; p=0.021). Regression analysis allowed to calculate a model to predict the healing time. It compensated for the fact that patients treated with low or moderate compression stockings were at lower risk of non-healing. and revealed that healing with stockings was about twice as rapid as healing with bandages. Conclusion: Three fourths of venous ulcers can be brought to healing within 3 to 6 months. Healing time can be predicted using easy to assess clinical parameters. Irrespective of the initial presentation ulcer healing appeared more rapid with the application of stockings than with bandaging. These unexpected findings contradict current believes and require confirmation in randomised trials.

Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment

“…At present there is a wide variation in the management of venous leg ulcers. In USA, Unna's boots (a noncompliant, plaster-type bandage) are often applied in many crural ulcer patients; in UK, multilayer elastic compression is widely used, while in mainland Europe and Australia, the inelastic, short stretch bandaging is commonly prescribed [3, 17, 18]. According to the recent clinical evidence analysis published in 2011 in the venous ulcer healing, compression bandages and stockings cure more ulcers compared with no compression, but there is still very little evidence-supported data answering the question: which bandaging technique is most effective [4]?…”

Comparison of low-strength compression stockings with bandages for the treatment of recalcitrant venous ulcers

“…A power analysis was performed on the basis of a recent pilot study of our group, 13 where the effect size w (͌ (X 2 /N) was 0.39 regarding healing. This revealed the necessity to include 52 ulcers to ascertain a difference between the two groups with a power of 0.8 at a two-sided P Ͻ .05.…”

“…The clinical notion was generated from data of a non-randomized pilot study that had shown an advantage of low-strength medical compression stockings (MCS) over bandages. 13 Furthermore, the latest randomized trials reported a higher rate of healing with elastic graduated stockings as compared with bandages and a possible advantage when the stockings were removed at night. 14,15 In view of the various potential benefits of low-strength MCS, we performed the present prospective randomized open-label trial.…”

Compression therapy in venous disease

“…Further studies suggested that ulcers treated with stockings providing lower pressures healed faster than those treated with high-pressure bandages. 21,22 The antithetical findings call for more studies to evaluate their use on a wider scale.…”