Treating a Venous Leg Ulcer: Compression Hosiery vs Compression Bandages
A venous stasis ulcer is an open sore on your lower leg caused by poor circulation or venous insufficiency. Venous ulcers are usually treated with compression, either bandaging or compression stockings, and on average take about 3 months to heal. They often recur, and once healed, compression stockings should be worn daily to prevent a recurrence.
As reported in The Lancet, a clinical study was recently completed comparing the effectiveness and cost effectiveness of four layer bandaging and a two part ulcer care stocking. Going into the study, it was assumed that bandaging was the most effective form of treatment, but there are drawbacks to this method. Bandages are difficult for a patient to apply, they can slip, and due to their bulky nature, reduce ankle and leg mobility. This in turn can have a negative impact on a patients quality of life.
Ulcer care compression stockings consist of two stockings. A lower compression liner, and a higher compression outer stocking. Together they deliver a compression of 40mmHg at the ankle. This system is easier to apply, fits in most shoes, and over the course of treatment is less expensive.
The study conducted in England and Northern Ireland, randomly assigned 457 participants into two groups: 230 to two-layer hosiery, and 227 to the four-layer bandaging. The results for healing were almost identical, 99 days for the hosiery group and 98 days for the bandage group. The cost for treating the hosiery group was lower by about $480 over the course of a year. The increased cost for the bandaging group was mainly due to more frequent nursing consultations.
What was unexpected, were the number of participants in the hosiery group that switched to another form of treatment. It was almost 10% higher than the participants in the bandaging group. Going into the study it was assumed that stockings would be more comfortable and easier to apply, and therefore the preferred treatment. This wasn’t the case with some of the older participants.
Although not officially part of the study, the researchers did find a lower recurrence of ulcers in the hosiery group. It was postulated that these participants would be more likely to wear stockings for maintenance after their ulcer healed, and the evidence supports this theory.