Debra C. Doherty

Randomized trial of four-layer and two-layer bandage systems in the management of chronic venous ulceration

To compare a four‐layer bandage system with a two‐layer system in the management of chronic venous leg ulceration, a prospective randomized open parallel groups trial was undertaken. In total, 112 patients newly presenting to leg ulcer services with chronic leg ulceration, screened to exclude the presence of arterial disease (ankle brachial pressure index <0.8) and causes of ulceration other than venous disease, were entered into the trial. Patients were randomized to receive either four‐layer (Profore™) or two‐layer (Surepress™) high‐compression elastic bandage systems. In all, 109 out of 112 patients had at least one follow‐up. After 24 weeks, 50 out of 57 (88%) patients randomized to the four‐layer bandage system with follow‐up had ulcer closure (full epithelialization) compared with 40 out of 52 (77%) on the two‐layer bandage, hazard ratio = 1.18 (95% confidence interval 0.69–2.02), p = 0.55. After 12 weeks, 40 out of 57 (70%) patients randomized to the four‐layer bandage system with follow‐up had ulcer closure compared with 30 out of 52 (58%) on the two‐layer bandage, odds ratio = 4.23 (95% confidence interval 1.29–13.86), p = 0.02. Withdrawal rates were significantly greater on the two‐layer bandage (30 out of 54; 56%) compared with the four‐layer bandage system (8 out of 58; 14%), p < 0.001, and the number of patients with at least one device‐related adverse incident was significantly greater on the two‐layer bandaging system (15 out of 54; 28%) compared with four‐layer bandaging (5 out of 54; 9%), p = 0.01. The higher mean cost of treatment in the two‐layer bandaging system arm over 24 weeks (

Clinical predictors of leg ulcer healing

1374 [£916] vs.

Assessment of health-related quality of life in patients with lymphedema of the lower limb.

1314 [£876]) was explained by the increased mean number of bandage changes (1.5 vs. 1.1 per week) with the two‐layer system. In conclusion, the four‐layer bandage offers advantages over the two‐layer bandage in terms of reduced withdrawal from treatment, fewer adverse incidents, and lower treatment cost. (WOUND REP REG 2003;11:166–171)

Sociodemographic factors in chronic leg ulceration

Background  Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic leg ulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes.

Psychological factors in leg ulceration: a case-control study

The purpose of this study was to examine the use of a number of tools in the evaluation of health‐related quality of life in patients with lower limb lymphedema, and to determine the consequences of cancer history and concurrent leg ulceration. Patients in one health trust having lower limb lymphedema were identified and interviewed at entry and after 24 weeks. The short form‐36 (SF‐36), modified Barthel scale, McGill short form pain questionnaire, and Euroqol were administered at both time points. Of the 164 (median age=76.9 years, 70.7% women) patients who comprised the study population, 15.2% had a history of cancer and 30.4% had coexisting current leg ulceration. Internal consistencies were high for all scales (Cronbachs α >0.80). There were high ceiling effects for a number of SF‐36 scores, and high floor effects in these and the McGill short form pain questionaire, scales. Despite these limitations, there was strong evidence that treatment led to significant improvements in six of eight scores of the SF‐36, three of three scores of the McGill short form pain questionnaire and the modified Barthel scale (all p<0.05). The improvement in physical functioning was significantly greater for patients who entered the study with a leg ulcer (mean different=9.1, 95% confidence interval 2.1–16.1, p=0.011). Patients treated with compression bandaging had significantly greater improvements for physical functioning (10.2) than those treated with compression hoisery (−1.5) or no treatment (−2.0), p=0.001. Of the tools assessed, the SF‐36, appears to be the most appropriate for use in this patient group.

Lymphoedema: an underestimated health problem

Background  While there is a commonly held belief that leg ulceration is associated with social factors, the evidence to support this is mainly anecdotal.

Prevalence of leg ulceration in a London population

Summary Background  There is increasing recognition of the role that psychological status plays in the development and outcomes of chronic disease, but little understanding of its importance in chronic leg ulceration.