Risk Factors for Leg Ulcer Recurrence: A Randomized Trial of Two Types of Compression Stocking

Abstract

Patients with recently healed leg ulceration were entered into a study of leg ulcer recurrence. In all, 188 patients [69% women, mean age = 72 (SD = 12) years] were entered into the study, of whom 166 were considered suitable for ready-made stockings and were randomized to one of two class II below-knee compression stockings and followed for at least 18 months. The remaining patients required either made-to-measure stockings (5) or could not tolerate stockings owing to friable skin and were treated by other methods (17). Overall cumulative recurrence rate was 26% after 1 year and 31% at 18 months. Independent risk factors for (RR = 2.34, p = 0.021) and unsuitability for stockings (RR = 2.52, p = 0.013). The randomized groups had similar stockings, 25 (15%) could not put their stockings on at all and 43 (26%) were only able to put them on with great difficulty. The two stocking types differed significantly in this regard when analysed for trend.

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…Compliance data reported from this trial as summarized in Nelson and Bell-Syer demonstrated that inability to tolerate compression therapy was significantly associated with recurrent ulceration (RR, 2.58; 95% CI, 1.33-5.01; P ¼ .010), although these patients were not included in randomization. 289,291 These RCT data are congruent with 15 years of observational data demonstrating that lack of compliance with compression therapy was significantly associated with ulcer recurrence (16% recurrence with compliance, 100% without; P < .0001). 292 Two studies to date have evaluated the use of moderate (UK class II, 18-24 mm Hg at the ankle) to high (UK class III, 25-35 mm Hg) compression and compliance with these stockings on prevention of ulcer recurrence, with differing results.…”

A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency

“…77 Made to measure hosiery is available and should be offered when fitting is otherwise difficult. Devices are available which may be useful for patients who find the application of stockings difficult.…”

A randomized, investigator-blinded, controlled pilot study to evaluate the safety and efficacy of a poly-N-acetyl glucosamine–derived membrane material in patients with venous leg ulcers

“…5,6 When treated with the current standard of care, about 30% of VLUs remain unhealed at 6 months. 7 Even if healed, approximately 26% to 34% of VLUs recur within 1 year [8][9][10][11] and 56% within 4 years. 12 Given these results, there is a compelling need for new therapies that offer improved efficacy for the management of VLUs.…”