A comparative clinical study on five types of compression therapy in patients with venous leg ulcers

Pawel Dolibog, Andrzej Franek, Jakub Taradaj, Patrycja Dolibog, Edward Blaszczak, Anna Polak, Ligia Brzezinska-Wcislo, Antoni Hrycek, Tomasz Urbanek, Jacek Ziaja, Magdalena Kolanko, Pawel Dolibog, Andrzej Franek, Jakub Taradaj, Patrycja Dolibog, Edward Blaszczak, Anna Polak, Ligia Brzezinska-Wcislo, Antoni Hrycek, Tomasz Urbanek, Jacek Ziaja, Magdalena Kolanko

Abstract

The aim of this study was to compare five types of compression therapy in venous leg ulcers (intermittent pneumatic vs. stockings vs. multi layer vs. two layer short stretch bandages vs. Unna boots). Primary study endpoints were analysis of changes of the total ulcer surface area, volume and linear dimensions inside observed groups. The secondary end points were comparisons between all groups the number of completely healed wounds (ulcer healing rates), Gilman index and percentage change of ulcer surface area. In total, 147 patients with unilateral venous leg ulcers were included to this study. Participants were randomly allocated to the groups: A, B, C, D and E. After two months the healing rate was the highest in group A (intermittent pneumatic compression) - 57.14%, 16/28 patients, B (ulcer stocking system) - 56.66%, 17/30 patients and C (multi layer short stretch bandage) - 58.62%, 17/29 patients. Significantly much worse rate found in group D (two layer short stretch bandages) - only 16.66%, 5/30 patients and E (Unna boots) - 20%, 6/30 patients. The analysis of changes of the percentage of Gilman index and wound total surface area confirmed that intermittent pneumatic compression, stockings and multi layer bandages are the most efficient. The two layer short - stretch bandages and Unna boots appeared again much less effective.

Keywords: Unna boots; compression stockings; short stretch bandages; venous leg ulcers; wound healing.

Conflict of interest statement

Competing Interests: The authors would like to certify that have no commercial associations with the manufacturers of the equipment described in the manuscript and other conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram through the study
Figure 2
Figure 2
Comparison between groups in terms of healing rate. *Fisher test. Legends: - groups A and D (57.14% vs. 16.66%, P=0.03), - groups B and D (56.66% vs.16.66%, P=0.03), - groups C and D (58.62% vs. 16.66%, P=0.03), - groups A and E (57.14% vs. 20.00%, P=0.03), - groups B and E (56.66% vs.20.00%, P=0.03), - groups C and E (58.62% vs. 20.00%, P=0.03).
Figure 3
Figure 3
Comparison between groups in terms of Gilman index [cm]. * the Kruskal-Wallis analysis. Legends: - groups A and D (0.52 cm vs. 0.20 cm, P=0.04), - groups B and D (0.49 cm vs. 0.20 cm, P=0.04), - groups C and D (0.51 cm vs. 0.20 cm, P=0.04), - groups A and E (0.52 cm vs. 0.23 cm, P=0.04), - groups B and E (0.49 cm vs. 0.23 cm, P=0.04), - groups C and E (0.51 cm vs. 0.23 cm, P=0.04).
Figure 4
Figure 4
Comparison between groups in terms of change of the percentage ulcer size. * the Kruskal-Wallis analysis. Legends: - groups A and D (48.11% vs. 17.77%, P=0.04), - groups B and D (41.22% vs. 17.77%, P=0.04), - groups C and D (49.02% vs. 17.77%, P=0.04), - groups A and E (48.11% vs. 20.48%, P=0.04), - groups B and E (41.22% vs. 20.48%, P=0.04), - groups C and E (49.02% vs. 20.48%, P=0.04).

References

    1. Carpentier PH, Maricq HR, Biro C. et al. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population based study in France. J Vasc Surg. 2004;40:650–659.
    1. Jones RH, Carek PJ. Management of varicose veins. Am Fam Phys. 2008;78(11):1289–1294.
    1. Simon DA, Dix FP, McCollum C. Management of venous leg ulcers. BMJ. 2004;328:1358–1362.
    1. van Gent WB, Wilschut ED, Wittens C. Management of venous ulcer disease. BMJ. 2010;34:c6045.
    1. Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Phys. 2010;15:989–996.
    1. Kucharzewski M, Kozka M Urbanek T. Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment. Evid Based Complement Alternat Med. 2013:ID254017.
    1. Waniczek D, Kozowicz A, Muc - Wierzgon M. et al. Adjunct Methods of the Standard Diabetic Foot Ulceration Therapy. Evid Based Complement Alternat Med. 2013:ID243568.
    1. O'Donnell TF, Balk EF. The need for an Intersociety Consensus Guideline for venous ulcer. J Vasc Surg. 2011;54:83–90.
    1. Duby T, Cherry G, Hoffman D. et al. A randomized trial in the treatment of venous leg ulcers comparing short stretch bandages, four layer bandage system, and a long stretch - paste bandage system. Wounds. 1993;5:276– 269.
    1. Colgan MP, Teevan M, McBride M, Cost comparisons in the management of venous ulceration. 5th European Conference on Advances in Wound Management. 1993. 103.
    1. Danielsson G, Arfvidsson B, Eklof B, Kistner RL. Reflux from thigh to calf, the major pathology in chronic venous ulcer disease: surgery indicated in the majority of patients. Vasc Endovasc Surg. 2004;38:209– 219.
    1. Vowden K. The use of intermittent pneumatic compression in venous ulceration. Br J Nurs. 2001;10:491–509.
    1. Partsch H, Damstra RJ, Tazelaar DJ. et al. Multicentre, randomized controlled trial of four - layer bandaging versus short - stretch bandaging in the treatment of venous leg ulcers. VASA. 2001;30:108– 113.
    1. Meyer FJ, Burnand KG, Lagattola NR, Eastham D. Randomized clinical trial comparing the efficacy of two bandaging regimens in the treatment of venous leg ulcers. Br J Surg. 2002;89:810.
    1. O'Brien JF, Grace PA, Perry IJ at al. Randomized clinical trial and economic analysis of four - layer compression bandaging for venous ulcers. Br J Surg. 2003;90:1307.
    1. Franks PJ, Moody M, Moffat CJ at al. Randomized trial of cohesive short - stretch versus four - layer bandaging in the management of venous ulceration. Wound Rep Regen. 2004;12:157– 160.
    1. Junger M, Wollina U, Kohnen R, Rabe E. Efficacy and tolability of an ulcer compression stocking for therapy of chronic venous ulcer compared with a beelow - knee compression bandage: results from a prospective, randomized, multicentre trial. Curr Med Res Opin. 2004;20:1613– 1623.
    1. Vanscheidt W, Kohnen R, Achhammer I. Tubulcus - Kompressionstherapie des venosen ulcus cruris. Phlebologie. 2004;33:12– 16.
    1. Brizzio EO, Blatter W, Rossi G. et al. Healing venous ulcers with different modalities of leg compression: unexpected findings of a pilot study, Phlebologie. 2006;35:349–355.
    1. O'Meara S, Tierney J, Cullum N. et al. Four layer bandage compared with short stretch bandage for venous leg ulcers: review and meta-analysis of randomized controlled trials with data from individual patients. BMJ. 2009;338:1344–1353.
    1. Gilman TH. Parameter for measurement of wound closure. Wounds. 1990;3:95–101.
    1. Nelson EA, Mani R, Thomas K. et al. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database Syst Rev. 2011;16:CD001899.
    1. O'Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;14:CD000265.
    1. Cullum N, Nelson EA, Flemming K, Sheldon T. Systematic reviews of wound care management: beds; compression; laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess. 2001;5:1–221.
    1. Stebbins WG, Hanke CW, Petersen J. Enhanced healing of surgical wounds of the lowerleg using weekly zinc oxide compression dressings. J Dermatol Surg. 2011;37:158–165.
    1. Schaum KD. Unna boots versus multilayered, sustained, graduated high compression bandage systems. Ostomy Wound Manage. 2005;51:30.

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