Venous leg ulcers are common recurrent conditions, but uncertainty regarding the optimal management of the condition remains. Most treatments are based on local compression using bandaging or hosiery. Fletcher and colleagues conducted a research review to evaluate the effectiveness of the most common compression systems for the treatment of venous leg ulcers.
The authors searched 19 databases (including Medline) and also reviewed data contained in reference material, information provided by authors and manufacturers, and other sources for randomized, controlled trials assessing the effectiveness compression for treating venous leg ulcers. The trials identified were reviewed for inclusion in the study using strict criteria. Data from 24 relevant trials were pooled to provide study results.
Only six trials compared compression and noncompression treatments. Each of these trials involved small numbers of patients (from 30 to 69), and significantly increased healing rates using compression were reported in all but one study. The one exception was a study that showed a nonsignificant increase in healing rates with the use of compression. Net results showed a significantly higher proportion of ulcers healed when compression was used. The remaining studies compared different forms of compression. In spite of differences in the systems and methodology used, high-compression systems performed better than low-compression and single-layer systems. No clear differences could be identified in rates of healing using different compression systems such as boots, hosiery and multiple forms of bandaging. Two small studies that examined the effect of adding intermittent pneumatic compression stockings or Unna's boot found a net benefit in the overall odds of healing.
The authors conclude that any correctly applied compression system appears to improve the healing of uncomplicated venous ulcers. They also comment on the difficulties in standardizing research in this area, particularly the difficulty regarding staff who apply the same compression systems under different circumstances, resulting in widely differing pressures, making comparison difficult. They advise that physicians focus on ensuring that compression systems are used properly rather than focusing on the selection of the compression system itself. The authors call for more well-designed, large clinical trials to discern differences in efficacy and cost among the various compression systems.