De Carvalho MR, Peixoto BU, Silveira IA, Oliveria BGRB, et al.
Ostomy/wound management. Date of publication 2018 May 1;volume 64(5):30-37.
1. Ostomy Wound Manage. 2018 May;64(5):30-37.
A Meta-analysis to Compare Four-layer to Short-stretch Compression Bandaging for
Venous Leg Ulcer Healing.
De Carvalho MR, Peixoto BU, Silveira IA, Oliveria BGRB.
Compression therapy is the standard of care for venous leg ulcers (VLUs), and
some evidence suggests 4-layer compression is more effective than short-stretch
bandages. A meta-analysis was conducted to compare the effectiveness of these 2
compression bandages for venous ulcer healing. In March 2016, a systematic review
of the literature was conducted to identify randomized controlled trials.
Databases used included Pubmed/MEDLINE, EMBASE, Cochrane Central, the Cumulative
Index of Nursing and Allied Health Literature, and the Latin American and
Caribbean of Health Sciences Information System. Search terms were varicose
ulcer, venous leg ulcer, venous ulceration, leg ulcer, compression bandages,
compressive therapy, multilayer system, four-layer system, elastic bandages,
short-stretch bandage, short-stretch system, and inelastic bandage. No
publication time or language restrictions were imposed, but findings subjected to
analysis were limited to results of research that reported healing and healing
time using 4-layer and short-stretch compression only. The quality of the studies
was assessed using the Jadad scale. Data extracted included study design,
country, target population demographics, VLU clinical aspects at baseline, sample
size, interventions applied, follow-up period, complete healing, and healing time
as outcomes. Relative risk was calculated considering a 95% confidence interval
for dichotomous variables (complete healing), and heterogeneity was statistically
assessed among the studies using the chi-squared test assuming random effect when
I2 ≥50%. The search yielded 557 papers; 21 met the study criteria for full-text
analysis, and 7 met the meta-analysis inclusion criteria. The studies included
1437 patients, average age 70 (range 23-97) years with 1446 venous leg ulcers.
Most (5) studies were classified as being at low risk of bias. At 12 and 16
weeks, 259 ulcers (51.08%) healed completely in the 4-layer and 234 (46.34%) in
the short-stretch bandage groups, respectively (P = .41). At 24 weeks, 268 ulcers
(69.07%) in the 4-layer and 257 (62.23%) in the short-stretch bandage groups,
respectively, had healed (P = .16). The 2 bandage systems evaluated were similar
in achieving complete healing at their respective study endpoints. The average
time for healing was 73.6 ± 14.64 days in the 4-layer and 83.8 ± 24.89 days in
the short-stretch bandage groups; no meta-analysis was done for this outcome due
the inability to retrieve all the individual patient data for each study. The
choice of compression system remains at the discretion of the clinicians based on
evidence of effectiveness, patient tolerability, and preference. Additional
randomized controlled trials to compare various wound and patient outcomes
between different compression systems are warranted.
PMID: 29847309
