3 layer paste bandages were more effective than 4 layer bandages for healing venous leg ulcers

摘要

Although we know that compression heals venous ulcers, there is insufficient evidence to recommend a specific high compression system.Meyer et al compared 2 high compression, multilayered bandage systems over 12 months. They applied the bandages using a technique to increase ankle pressure: bandages started above the ankle, then encompassed the foot, before proceeding up the leg to the knee.' This is one of few studies to have a sufficient follow up period. The sample appears to be representative of patients with venous ulcers, despite recruiting from a hospital clinic.Meyer et al tried to reduce bias by stratifying randomisation by ulcer area, confirming healing using a third party, doing an intention to treat analysis, and having 2 statisticians independently analyse the data. They also analysed healing by life table, showing not only how many ulcers healed, but also now quickly. Reporting the proportion of ulcers healed at any point can be misleading (eg, Meyer et al found no difference until 20 wks). We now know that stratification should be by both ulcer area and duration, but this evidence was unavailable when this trial started.Stratifying by ulcer duration is unlikely to have changed the results because ulcers in the 3 layer group were of longer duration (mean 20 v 15 mo). Meyer et al reported no relation between ulcer duration and healing, but their study lacked power to detect such an association (ie, it was too small].The key message from this study is that high compression bandaging by trained clinic nurses using a 3 layer paste system healed ulcers more quickly than a 4 layer system. However, it is not clear if nurses were more experienced with a 3 layer system before the trial. Given the learning curve associated with bandage application,an established high compression system may appear to be more effective than a newly introduced system even if no real difference exists in healing rates.Given the relatively modest size of this trial, these results alone should not influence practitioners to stop using a 4 layer system. Practitioners who are currently using either a 3 layer paste or a 4 layer bandage system, and have acceptable healing rates, should continue with that system.