A Cochrane review «Compression bandages or stockings versus no compression for treating venous leg ulcers»1 «O'Meara S, Cullum N, Nelson EA et al. Compression ...»2 included 14 studies with a total of 1391 subjects to assess the effects of using compression bandages or stockings, compared with no compression, on the healing of venous leg ulcers. Studies had a median follow-up of 12 weeks. Compression bandages or stockings applied included short-stretch bandage, four-layer compression bandage, and Unna's boot (a type of inelastic gauze bandage impregnated with zinc oxide), and comparator groups used included 'usual care', pharmacological treatment, a variety of dressings, and a variety of treatments where some participants received compression (but it was not the norm).
There was a shorter time to complete healing of venous leg ulcers in people wearing compression bandages or stockings compared with those not wearing compression (HR 2.17, 95% CI 1.52 to 3.10; statistical heterogeneity, I2=59%; 5 studies, n=733). Compression bandages or stockings increased complete ulcer healing within 12 months compared with no compression (RR 1.77, 95% CI 1.41 to 2.21; I2=65%; 8 studies, n=1123), decreased pain score (MD −1.39, 95% CI −1.79 to −0.98; 3 studies, n=495), and improved disease-specific quality of life, but not all aspects of general health status during the follow-up of 12 weeks to 12 months (4 studies, n=859). Cost-effectiveness remained uncertain (3 studies, n=486).
A Cochrane review «Compression for venous leg ulcers»2 «O'Meara S, Cullum N, Nelson EA et al. Compression ...»2 included 48 studies reporting 59 comparisons with a total of 4321 subjects. There was evidence from 8 studies (unpooled) that healing outcomes (including time to healing) were better when patients received compression compared with no compression.
Single-component compression bandage systems was less effective than multi-component compression for complete healing at 6 months (1 large study). A two-component system containing an elastic bandage healed more ulcers at 1 year than one without an elastic component (1 small study). Three-component systems containing an elastic component healed more ulcers than those without elastic at 3 to 4 months (RR 1.83, 95% CI 1.26 to 2.67; 2 studies), but another study showed no difference between groups at 6 months. An individual patient data meta-analysis of 5 studies suggested significantly faster healing with the four-layer bandage (4LB) than the short stretch bandage (SSB): median days to healing estimated at 90 and 99 respectively (HR 1.31, 95% CI 1.09 to 1.58). High-compression stockings were associated with better healing outcomes than the short stretch bandage at 2 to 4 months (RR 1.6, 95% CI 1.26 to 2.10; 4 studies).