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

et al. Randomized clinical trial of three-layer paste and four-layer bandages for venous leg ulcers. Q Are 3 layer paste bandages as effective as 4 layer bandages for healing of venous leg ulcers? METHODS Design: randomised controlled trial. Setting: a hospital leg ulcer outpatient clinic in London, UK. Patients: 133 patients (56% men) with venous leg ulcers. Exclusion criteria: arterial disease, diabetes mellitus, rheumatoid arthritis or systemic lupus erythematosus, positive sickle cell test, HIV infection, ulcer area ,0.25 cm 2 or .100 cm 2 , known sensitivity to paste, or ulcer not of venous aetiology. Interventions: 3 layer paste bandages (a SteripasteH hypoallergenic paste bandage, a SetopressH compression bandage, and a TubigripH bandage to hold everything in place) (n = 64) or 4 layer bandages (VelbandH orthopaedic wool, a crepe bandage, an ElsetH compression bandage, and a CobanH bandage to secure preceding layers) (n = 69). Fully trained ulcer clinic nurses applied the bandages. Patients were initially seen weekly in clinic, which was extended to fortnightly if the ulcer was healing well. Randomisation was stratified by ulcer size (small >0.25 but (2.5 cm 2 , medium .2.5 but (25 cm 2 , and large .25 but (100 cm 2). Outcomes: time to total ulcer healing, complete ulcer healing (restoration of entirely unbroken skin integrity with no purulent discharge after removal of scabs), and time to apply bandages. The 3 layer paste group had a shorter median time to healing than the 4 layer group (12 v 16 wks, p = 0.04 for log rank test), although the difference in healing rates occurred only after .20 weeks. At 1 year, more patients in the 3 layer paste group had healed ulcers (one sided p = 0.031). Over the course of the study, 3 layer paste bandages took less time to apply than 4 layer bandages (mean 4.6 v 5.5 min, p = 0.008). CONCLUSION 3 layer paste bandages were more effective than 4 layer bandages for healing venous leg ulcers, and healed ulcers more quickly than 4 layer bandages after 20 weeks of treatment. A lthough we know that compression heals venous ulcers, there is insufficient evidence to recommend a specific high compression system. 1 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 …