A dual pressure indicator, two-layer compression system for treatment of venous leg ulcers: a review

Abstract

Objective: Venous leg ulcers (VLUs) are considered the most frequent category of hard-to-heal limb ulcers. Although evidence-based care of VLUs suggests that compression therapy plays a pivotal role in the standard of care, patient adherence is considered low, with at least 33% non-compliance, either due to perceived problems from clinicians regarding their own competency in applying the bandages, or from the patient finding the wrapping bothersome. For many years, four-layer bandaging has been considered the ‘gold standard’, but application can be difficult and may also prove uncomfortable for patients. Accurate application may be facilitated by a stretch indicator which has been engineered to act as a surrogate for appropriate pressure application that can address the skill concern, while fewer layers can save clinicians' time and improve the quality of life of patients. Here, we review the literature supporting a two-layer system which combines elastic (long stretch) and inelastic (short stretch) components as well as both layers having graphic markers to define that the dressing has been applied at the proper tension. Method: An initial search was conducted on PubMed and then followed up by a manual search of Google Scholar to retrieve evidence of different levels, in order to evaluate the outcomes of use of the specific two-layer compression system with pressure indicators in the management of patients presenting with VLUs. Results: A total of four papers discussing the specific compression system in question were identified from 32 publications retrieved from PubMed, while a further six were retrieved from Google Scholar. These 10 publications were considered relevant to the two-layer system and were analysed for the outcomes of care, including wound healing, appropriate application, time-saving and better patient acceptance and adherence. Conclusion: Previous authors have demonstrated that two-layer systems are equivalent to four-layer systems. However, the ability to reproducibly apply appropriate compression has remained a question. The papers reviewed demonstrate that evidence suggests that the two-layer compression bandage system with indicators provides continuous, consistent and comfortable treatment that may be easier to apply with accurate pressure levels due to their indicator systems, and therefore, is a procedure that may increase patient adherence and acceptability to the wound therapy.

A prospective study on the wound healing and quality of life outcomes of patients with venous leg ulcers in Singapore—Interim analysis at 6 month follow up

“…Following our treatment protocol and wound healing at the 3‐ and 6‐month intervals, we also showed significantly higher EQ‐5D‐5L perfect health states at the respective follow‐up periods. The above findings are not surprising, as both VLU and the use of compression therapy are associated with significant pain 10,37 …”

“…The above findings are not surprising, as both VLU and the use of compression therapy are associated with significant pain. 10,37 Our study has its strengths. First, this is a large prospective study using our Chronic Wounds Registry on the longitudinal outcomes of patients with VLU in the Asian population, which is scarce in the current literature.…”

“…8 Compression therapy remains the mainstay of treatment, with two-layer compression bandages (2LCB) demonstrating similar time to healing as compared with four-layer compression bandages (4LCB), but with better cost-effectiveness, tolerability and patient compliance. [9][10][11] The median time to healing has been reported to be 99 days with 2LCB, 9 and a monthly wound area reduction (WAR) of 30%. 12 A retrospective study by Aloweni et al in Singapore on 308 patients with VLUs showed 3-month wound healing of 34.9% with 2LCB (n = 43) and 22.3% with 4LCB (n = 265), with an overall 3-month wound healing of 24.0%.…”

“…Facets of management include compression therapy and local wound care 8 . Compression therapy remains the mainstay of treatment, with two‐layer compression bandages (2LCB) demonstrating similar time to healing as compared with four‐layer compression bandages (4LCB), but with better cost‐effectiveness, tolerability and patient compliance 9‐11 . The median time to healing has been reported to be 99 days with 2LCB, 9 and a monthly wound area reduction (WAR) of 30% 12 …”

A prospective study on the efficacy of sequential treatment of technology Lipido‐Colloid Impregnated with Silver and Technology Lipido‐Colloid Nano‐Oligosaccharide Factor in the management of venous leg ulcers

“…While recent evidence showed that 2LB has similar healing outcomes compared to 4LB, 11,12 other advantages of 2LB over 4LB have been described. 2LB has been reported to be more tolerable as it is less bulky 11,12 . To add on, pain has been reported to be the most important factor impairing the QOL in patients with VLU 34,35 .…”