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Meta-Analysis
. 2021 Jul 26;7(7):CD013397.
doi: 10.1002/14651858.CD013397.pub2.

Compression bandages or stockings versus no compression for treating venous leg ulcers

Chunhu Shi  1 , Jo C Dumville  1 , Nicky Cullum  1 , Emma Connaughton  2 , Gill Norman  1
Affiliations
Meta-Analysis

Compression bandages or stockings versus no compression for treating venous leg ulcers

Chunhu Shi et al. Cochrane Database Syst Rev. .

Abstract

Background: Leg ulcers are open skin wounds on the lower leg that can last weeks, months or even years. Most leg ulcers are the result of venous diseases. First-line treatment options often include the use of compression bandages or stockings.

Objectives: To assess the effects of using compression bandages or stockings, compared with no compression, on the healing of venous leg ulcers in any setting and population.

Search methods: In June 2020 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions by language, date of publication or study setting.

Selection criteria: We included randomised controlled trials that compared any types of compression bandages or stockings with no compression in participants with venous leg ulcers in any setting.

Data collection and analysis: At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, and risk-of-bias assessment using the Cochrane risk-of-bias tool. We assessed the certainty of the evidence according to GRADE methodology.

Main results: We included 14 studies (1391 participants) in the review. Most studies were small (median study sample size: 51 participants). Participants were recruited from acute-care settings, outpatient settings and community settings, and a large proportion (65.9%; 917/1391) of participants had a confirmed history or clinical evidence of chronic venous disease, a confirmed cause of chronic venous insufficiency, or an ankle pressure/brachial pressure ratio of greater than 0.8 or 0.9. The average age of participants ranged from 58.0 to 76.5 years (median: 70.1 years). The average duration of their leg ulcers ranged from 9.0 weeks to 31.6 months (median: 22.0 months), and a large proportion of participants (64.8%; 901/1391) had ulcers with an area between 5 and 20 cm2. 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). Of the 14 included studies, 10 (71.4%) presented findings which we consider to be at high overall risk of bias. Primary outcomes There is moderate-certainty evidence (downgraded once for risk of bias) (1) that there is probably a shorter time to complete healing of venous leg ulcers in people wearing compression bandages or stockings compared with those not wearing compression (pooled hazard ratio for time-to-complete healing 2.17, 95% confidence interval (CI) 1.52 to 3.10; I2 = 59%; 5 studies, 733 participants); and (2) that people treated using compression bandages or stockings are more likely to experience complete ulcer healing within 12 months compared with people with no compression (10 studies, 1215 participants): risk ratio for complete healing 1.77, 95% CI 1.41 to 2.21; I2 = 65% (8 studies with analysable data, 1120 participants); synthesis without meta-analysis suggests more completely-healed ulcers in compression bandages or stockings than in no compression (2 studies without analysable data, 95 participants). It is uncertain whether there is any difference in rates of adverse events between using compression bandages or stockings and no compression (very low-certainty evidence; 3 studies, 585 participants). Secondary outcomes Moderate-certainty evidence suggests that people using compression bandages or stockings probably have a lower mean pain score than those not using compression (four studies with 859 participants and another study with 69 ulcers): pooled mean difference -1.39, 95% CI -1.79 to -0.98; I2 = 65% (two studies with 426 participants and another study with 69 ulcers having analysable data); synthesis without meta-analysis suggests a reduction in leg ulcer pain in compression bandages or stockings, compared with no compression (two studies without analysable data, 433 participants). Compression bandages or stockings versus no compression may improve disease-specific quality of life, but not all aspects of general health status during the follow-up of 12 weeks to 12 months (four studies with 859 participants; low-certainty evidence). It is uncertain if the use of compression bandages or stockings is more cost-effective than not using them (three studies with 486 participants; very low-certainty evidence).

Authors' conclusions: If using compression bandages or stockings, people with venous leg ulcers probably experience complete wound healing more quickly, and more people have wounds completely healed. The use of compression bandages or stockings probably reduces pain and may improve disease-specific quality of life. There is uncertainty about adverse effects, and cost effectiveness. Future research should focus on comparing alternative bandages and stockings with the primary endpoint of time to complete wound healing alongside adverse events including pain score, and health-related quality of life, and should incorporate cost-effectiveness analysis where possible. Future studies should adhere to international standards of trial conduct and reporting.

PubMed Disclaimer

Conflict of interest statement

Chunhu Shi: I received support from the Tissue Viability Society to attend conferences unrelated to this work. The Doctoral Scholar Awards Scholarship and Doctoral Academy Conference Support Fund (University of Manchester) also supported a PhD and conference attendance respectively; both were unrelated to this work.

Jo Dumville: this research was co‐funded by the National Institute for Health Research Manchester Biomedical Research Centre, and partly funded by the National Institute for Health Research Applied Research Collaboration Greater Manchester.

Nicky Cullum: this research was co‐funded by the National Institute for Health Research Manchester Biomedical Research Centre, and partly funded by the National Institute for Health Research Applied Research Collaboration Greater Manchester.

My previous and current employers received research grant funding from the NHS Research and Development programme and the Health Technology Assessment Programme for systematic reviews on compression, and for two randomised controlled trials of compression. These RCTs were not eligible for inclusion in this review. The funders had no role in the conduct of this review.

Emma Connaughton: none known.

Gill Norman: this research was co‐funded by the National Institute for Health Research Manchester Biomedical Research Centre.

Clifford Richardson (peer reviewer for the protocol for this review) declares that one of the review authors was the Head of the department in which he works, although he himself is not involved with the wound care research team within this department and has not been involved with the preparation or writing of this review.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Compression bandages or stockings compared with no compression, Outcome 1: Time‐to‐complete wound healing
1.2
1.2. Analysis
Comparison 1: Compression bandages or stockings compared with no compression, Outcome 2: Proportion of wounds completely healed during follow‐up
1.3
1.3. Analysis
Comparison 1: Compression bandages or stockings compared with no compression, Outcome 3: Adverse events
1.4
1.4. Analysis
Comparison 1: Compression bandages or stockings compared with no compression, Outcome 4: Participant health‐related quality of life/health status
1.5
1.5. Analysis
Comparison 1: Compression bandages or stockings compared with no compression, Outcome 5: Mean pain score
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EudraCT2007‐004831‐47 {published data only}
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Finlayson 2014 {published data only}
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Folguera‐Álvarez 2016 {published data only}
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Folguera‐Álvarez 2020 {published data only}
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Franks 1995 {published data only}
    1. Franks PJ, Bosanquet N, Brown D, Straub J, Harper DR, Ruckley CV. Perceived health in a randomised trial of single and multilayer bandaging for chronic ulceration. Phlebology/Venous Forum of the Royal Society of Medicine 1995;(Suppl 1):17-9.
    1. Franks PJ, Bosanquet N, Brown D, Straub J, Harper DR, Ruckley CV. Perceived health in a randomised trial of treatment for chronic venous ulceration. European Journal of Vascular and Endovascular Surgery 1999;17(2):155-9. - PubMed
Franks 1999 {published data only}
    1. Franks PJ, Moffatt CJ, Ellison DA, Connolly M, Fielden S, Groarke L, et al. Quality of life in venous ulceration: a randomized trial of two bandage systems. Phlebology/Venous Forum of the Royal Society of Medicine 1999;14(3):95-9. [DOI: 10.1007/s005230050032] - DOI
Franks 2000 {unpublished data only}
    1. Franks PJ, Moffatt C. A prospective randomised, factorial, multi-centre open trial to compare the performance of a new foam dressing (Mepilex) with an existing foam dressing (Allevyn non adhesive) and to compare four layer bandaging and short stretch bandaging in the treatment of venous ulceration. Unpublished trial protocol. Trial sponsor: Molnlycke Health Care 2000.
Franks 2002 {published data only}
    1. Franks PJ, Stevens J, Hourican C, Doherty D, O'Connor T, McCullagh L. Quality of life in venous ulceration: use of the SF-36 in a randomised trial of two bandage systems. 11th Conference of the European Wound Management Association; 2001 May 17-19; Dublin (Ireland) 2001:26.
    1. Franks PJ, Stevens J, Hourican C, Doherty DC, O'Connor T, McCullagh L, et al. Quality of life in venous ulceration: use of the SF-36 in a randomized trial of two bandage systems (abstract only). Ostomy/Wound Management 2002;48(4):73.
Franks 2003 {published data only}
    1. Franks P, Moody M, Moffatt C. Randomised trial of four layer and cohesive short stretch compression in venous ulceration. Journal of Tissue Viability 2003;13(4):170.
Franks 2004a {published data only}
    1. Franks PJ, Moody M, Moffatt CJ, Martin R, Blewett R, Seymour E, et al. Randomized trial of cohesive short-stretch versus four-layer bandaging in the management of venous ulceration. Wound Repair and Regeneration 2004;12(2):157-62. [DOI: 10.1111/j.1067-1927.2004.012206.x] - DOI - PubMed
Franks 2004b {published data only}
    1. Franks PJ, Moody M, Moffatt CJ, Patton J, Bradley L, Chaloner D, et al. Quality of life in a trial of short stretch versus four-layer bandaging in the management of chronic venous ulceration. Phlebology/Venous Forum of the Royal Society of Medicine 2004;19(2):87-91.
Gardon‐Mollard 2003 {published data only}
    1. Gardon-Mollard C, Junger M, Partsch H, Zuccarelli F, Taupin V. Efficacy of a short-stretch tubular compression orthosis compared to a non elastic bandage in the treatment of venous ulcers. 13th Conference of the European Wound Management Association; 2003 May 22-24; Pisa (Italy) 2003:108.
    1. Gardon-Mollard C, Junger M, Partsch H, Zuccarelli F, Taupin V. Efficacy of a tubular compression orthosis compared to a SSB in the treatment of venous ulcers (abstract from European Venous Forum). Phlebology/Venous Forum of the Royal Society of Medicine 2003;18(3):152.
Gillet 2019 {published data only}
    1. Gillet JL, Guex JJ, Allaert FA, Avouac B, Leger P, Blaise S, et al. Clinical superiority of an innovative two-component compression system versus four-component compression system in treatment of active venous leg ulcers: a randomized trial. Phlebology/Venous Forum of the Royal Society of Medicine 2019;34(9):611-20. [DOI: 10.1177/0268355519833523] - DOI - PubMed
Gould 1993 {published data only}
    1. Gould DJ, Campbell S, Harding E. A clinical evaluation of Setopress high compression bandage with Elastocrepe in the management of chronic venous ulceration. 2nd European Conference on Advances in Wound Management; 1992 October 20-23; Harrogate (UK) 1993:211.
    1. Gould DJ, Campbell S, Harding EF. Short stretch vs long stretch bandages in the management of chronic venous leg ulcers. Phlebology/Venous Forum of the Royal Society of Medicine 1993;8(1):43.
Gould 1998 {published data only}
    1. Gould DJ, Campbell S, Newton H, Duffelen P, Griffin M, Harding EF. Clinical. Setopress vs Elastocrepe in chronic venous ulceration. British Journal of Nursing 1998;7(2):66-73. - PubMed
Harley 2000 {published data only}
    1. Harley J, Harcourt D, Hutchinson B, Liew I. A comparative trial of two layer compression bandaging versus four layer compression bandaging in the treatment of chronic venous ulcers. First World Wound Healing Congress; 2000 September 10-13; Melbourne (Australia) 2000:92.
Harley 2004 {published data only}
    1. Harley J, Harcourt D, Hutchinson B, McLean M, Long M. A comparative trial of long stretch compression bandaging versus multi-layer compression bandaging in the treatment of chronic venous ulcers. Primary Intention: The Australian Journal of Wound Management 2004;12(1):6-13.
Harrison 2011 {published data only}
    1. Harrison MB. The Canadian bandaging trial: a multi-site RCT of bandaging technologies for venous leg ulcers. The 2011 International Nursing Research Conference; 2011 May 16-18; Harrogate (UK) 2011:50.
    1. NCT00202267. Community RCT of the effectiveness of two compression bandaging technologies. ClinicalTrials.gov/show/NCT00202267 (first received 20 September 2005).
    1. Pham B, Harrison MB, Chen MH, Carley ME. Cost-effectiveness of compression technologies for evidence-informed leg ulcer care: results from the Canadian Bandaging Trial. BMC Health Services Research 2012;12(1):346. [DOI: 10.1186/1472-6963-12-346] - DOI - PMC - PubMed
Hendricks 1985 {published data only}
    1. Hendricks WM, Swallow RT. Management of statis leg ulcers with Unna's boots versus elastic support stockings. Journal of the American Academy of Dermatology 1985;12(1):90-8. - PubMed
Iglesias 2004 {published data only}
    1. Iglesias C, Nelson EA, Cullum NA, Torgerson DJ. VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers. Health Technology Assessment (Winchester, England) 2004;8(29):iii, 1-105. - PubMed
    1. Iglesias CP, Nelson EA, Cullum N, Torgerson DJ. Economic analysis of VenUS I, a randomized trial of two bandages for treating venous leg ulcers. British Journal of Surgery 2004;91(10):1300-6. [DOI: 10.1002/bjs.4755] - DOI - PubMed
    1. Iglesias CP, Nelson EA, Torgerson DJ, Cullulm N. Economic analysis of VenUS I: a randomised controlled trial of two bandages for treating venous leg ulcers. 2nd World Union of Wound Healing Societies Meeting; 2004 July 8-13; Paris (France) 2004:38.
ISRCTN47210331 {published data only}
    1. ISRCTN47210331. Efficacy and safety of K-Two® versus Actico® compression system in the management of venous leg ulcers: a pilot study. www.isrctn.com/ISRCTN47210331 (first received 20 April 2009).
ISRCTN67751142 {published data only}
    1. ISRCTN67751142. Community treatment of venous ulcers with concomitant use of compression pump and V.A.C. suction therapy - a novel approach. isrctn.com/ISRCTN67751142 (first received 29 September 2006).
Jawien 2008 {published data only}
    1. Jawien A, Szewczyk MT, Moscicka P, Cierzniakowska K, Cwajada J. Evaluation of clinical effectiveness of two- and four-layer compression in venous leg ulcer treatment: randomized study. European Venous Forum abstracts. Phlebology/Venous Forum of the Royal Society of Medicine 2008;23:234-5.
Jawien 2010 {published data only}
    1. Jawien A, Szewczyk MT, Banaszkiewicz Z, Moscicka T, Hancke E. Pain associated with venous ulcers and its relation to dynamics of wound healing. EWMA Journal 2010;10(2):42, Abstract 43.
Juenger 2005 {published data only}
    1. Juenger M, Wollina U, Kohnen R, Rabe E. Efficacy of a compression stocking (Venotrain (r) Ulcertec) for therapy of venous leg ulcers. Proceedings of the 15th World Congress International Union of Phlebology; 2005 October 2-7; Rio De Janeiro (Brazil) 2005:177-84.
Jünger 2004a {published data only}
    1. Jünger M, Partsch H, Ramelet A, Zuccarelli F. Efficacy of a ready-made tubular compression device versus short-stretch compression bandages in the treatment of venous leg ulcers. Wounds 2004;16(10):313-20.
    1. Jünger M, Partsch H, Ramelet AA, Zuccarelli F. Efficacy of a new compression device versus bandages in the treatment of venous leg ulcers. 2nd World Union of Wound Healing Societies Meeting; 2004 July 8-13; Paris (France) 2004:Abstract No.B011.
Jünger 2004b {published data only}
    1. Jünger M, Wollinar U. Compression therapy of venous leg ulcers with the compression stocking Venotrain® ulcertec: initial data from a prospective randomised study. Vasomed - Bonn 2002;14(4):158-9.
    1. Jünger M, Wollina U, Kohnen R, Rabe E. Efficacy and tolerability of an ulcer compression stocking for therapy of chronic venous ulcer compared with a below-knee compression bandage: results from a prospective, randomized, multicentre trial. Current Medical Research and Opinions 2004;20(10):1613-23. [DOI: 10.1185/030079904X4086] - DOI - PubMed
    1. Jünger M, Wollina U, Kohnen R, Rabe E. Efficacy of a compression stocking (Venotrain ® Ulcertec) for therapy of venous leg ulcers. Proceedings of the 15th World Congress International Union of Phlebology; 2005 October; Rio de Janiero (Brazil) 2005.
    1. Jünger M, Wollina U, Kohnen R, Rabe E. Efficacy of a compression stocking for therapy of chronic venous ulcer compared with bandages. 2nd World Union of Wound Healing Societies Meeting; 2004 July 8-13; Paris (France) 2004:6, Abstract No.A004.
Jünger 2007 {published data only}
    1. Jünger M, Kohnen R, Stahl HW. Efficacy and cost effectiveness of a compression stocking system for treatment of venous leg ulcers. 17th Conference of the European Wound Management Association; 2007 May 2-4; Glasgow (UK) 2007.
    1. Jünger M, Kohnen R, Stahl HW. Efficacy and cost effectiveness of a compression stocking system for treatment of venous leg ulcers [Oral presentation no: 24]. 17th Conference of the European Wound Management Association; 2007 May 2-4; Glasgow (UK) 2007:27.
Knight 1996 {published data only}
    1. Knight CA, McCulloch JM. A comparative study between two compression systems in the treatment of venous insufficiency in leg ulcers. 9th Annual Symposium on Advanced Wound Care and 6th Annual Medical Research Forum on Wound Repair; 1996 April 20-24; Atlanta (GA) 1996:117.
Koksal 2003 {published data only}
    1. Koksal C, Bozkurt AK. Combination of hydrocolloid dressing and medical compression stocking versus Unna's boot for the treatment of venous leg ulcers. Swiss Medical Weekly 2003;133(25-6):364-8. - PubMed
Kralj 1997 {published data only}
    1. Kralj B, Kosicek M. Randomised comparative trial of single-layer and multi-layer bandages in the treatment of venous leg ulcer. Proceedings of the 6th European Conference on Advances in Wound Management; 1996 October 1-4; Amsterdam (The Netherlands) 1997:158-62.
Kucharzewski 2013 {published data only}
    1. Kucharzewski M, Kozka M, Urbanek T. Topical treatment of nonhealing venous leg ulcer with propolis ointment. Evidence-Based Complementary & Alternative Medicine: eCAM 2013;2013:254017. - PMC - PubMed
Lazareth 2012 {published data only}
    1. Lazareth I, Moffatt C, Dissemond J, Lesne Padieu AS, Truchetet F, Beissert S, et al. Efficacy of two compression systems in the management of VLUs: results of a European RCT. Journal of Wound Care 2012;21(11):553-4, 556, 558. - PubMed
Mancini 2009 {published data only}
    1. Mancini S, Bucalossi M, Mariani F. Elastic stocking* versus bandage. A multicentric randomised trial. EWMA Journal 2009;9(2):Abstract P193.
Mariani 2008 {published data only}
    1. Mariani F, Mattaliano V, Mosti G, Gasbarro V, Bucalossi M, Blattler W, et al. The treatment of venous leg ulcers with a specifically designed compression stocking kit: comparison with bandaging. Phlebologie 2008;37(4):191-7.
McCollum 1997 {published data only}
    1. McCollum CN, Ellison DA, Groake L, Fielden S, Connolly M, Franks PJ. Randomised trial comparing Profore and the original four layer bandage in the treatment of venous leg ulceration. European Wound Management Association Conference; 1997 April 27-29; Milan (Italy) 1997:30.
Meyer 2002 {published data only}
    1. Meyer FJ, Burnand KG, Lagattolla NR, Eastham D. Randomized clinical trial comparing the efficacy of two bandaging regimens in the treatment of venous leg ulcers. British Journal of Surgery 2002;89(1):40-4. [DOI: 10.1046/j.0007-1323.2001.01936.x] - DOI - PubMed
    1. Ruckley CV, Callam MJ, Harper DR, Dale JJ, Gibson B, Prescott RJ, et al. Randomized clinical trial comparing the efficacy of two bandaging regimens in the treatment of venous leg ulcers (Br J Surg 2002; 89: 40-4). Letter 1. British Journal of Surgery 2002;89(6):810; author reply 810. - PubMed
    1. Ruckley CV, Callam MJ, Harper DR, Dale JJ, Gibson B, Prescott RJ, et al. Randomized clinical trial comparing the efficacy of two bandaging regimens in the treatment of venous leg ulcers (Br J Surg 2002; 89: 40-4) [5] (multiple letters). British Journal of Surgery 2002;89(6):810. - PubMed
Meyer 2003 {published data only}
    1. Meyer F, Burnand KG, McGuiness C, Lagattolla N, Eastham D. More venous ulcers are healed by three-layer paste than by four-layer bandages: a randomised, controlled prospective study. Annual Meeting of the Venous Forum of the Royal Society of Medicine; 2000 October 13; Chester (UK) 2000;92-3.
    1. Meyer FJ, Burnand KG, Lagattolla NR, Eastham D. More venous leg ulcers are healed by three-layer paste than by four-layer bandages: a randomized, controlled, prospective study. British Journal of Surgery 2000;87(Suppl 1):88.
    1. Meyer FJ, Burnand KG, Lagattolla NRF, Eastham D. More venous leg ulcers are healed by three-layer paste than by four-layer bandages: a randomised, controlled, prospective study. Proceedings of the First World Wound Healing Congress; 2000 September 10-13; Melbourne (Australia) 2000:74-5.
    1. Meyer FJ, McGuinness CL, Lagattolla NRF, Eastham D, Burnand KG. Randomized clinical trial of three-layer paste and four-layer bandages for venous leg ulcers. British Journal of Surgery 2003;90(8):934-40. - PubMed
Milic 2007 {published data only}
    1. Milic DJ, Zivic SS, Bogdanovic DC, Perisic ZD, Milosevic ZD, Jankovic RJ, et al. A randomized trial of the Tubulcus multilayer bandaging system in the treatment of extensive venous ulcers. Journal of Vascular Surgery 2007;46(4):750-5. [DOI: 10.1016/j.jvs.2007.04.062] - DOI - PubMed
Milic 2010 {published data only}
    1. Milic DJ, Zivic SS, Bogdanovic DC, Jovanovic MM, Jankovic RJ, Milosevic ZD, et al. The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy. Journal of Vascular Surgery 2010;51(3):655-61. - PubMed
Moffatt 1999 {published data only}
    1. Moffatt CJ, Franks PJ, Connolly M, Fielden S, Ellison D, Groake L, et al. Randomised trial comparing two four layer bandage systems in the treatment of venous leg ulceration. Smith and Nephew 1997.
    1. Moffatt CJ, Simon DA, Franks PJ, Connolly M, Fielden S, Groarke L, et al. Randomised trial comparing two four-layer bandage systems in the management of chronic leg ulceration. Phlebology/Venous Forum of the Royal Society of Medicine 1999;14(4):139-42.
Moffatt 2001 {published data only}
    1. Moffatt CJ, McCullagh L, O'Connor T, Doherty DC, Hourican C, Lewis C, et al. Randomised trial comparing four layer with two layer high compression bandaging in the management of chronic leg ulceration. 12th Conference of the European Wound Management Association; 2002 May 23-25; Granada (Spain) 2002.
    1. Moffatt CJ, McCullagh L, O'Connor T, Doherty DC, Hourican C, Lewis C. Randomised trial comparing four layer with two layer high compression bandaging in the management of chronic leg ulceration. 11th Conference of the European Wound Management Association; 2001 May 17-19; Dublin (Ireland) 2001:24.
    1. Moffatt CJ, McCullagh L, O'Connor T, Doherty DC, Hourican C, Stevens J, et al. Randomized trial of four-layer and two-layer bandage systems in the management of chronic venous ulceration. Wound Repair and Regeneration 2003;11(3):166-71. - PubMed
Moffatt 2003a {published data only}
    1. Moffatt CJ, Moody M, Franks PJ. Randomised trial comparing four layer with cohesive short stretch compression bandaging in the management of chronic venous ulceration. 13th Conference of the European Wound Management Association; 2003 May 22-24; Pisa (Italy) 2003:109, presentation 81.
Moffatt 2003b {published data only}
    1. Moffatt CJ. A multi-centre randomised study comparing a new innovative vari-stretch compression bandaging system with a traditional multi-layer compression bandage system for the management of venous leg ulcers [Abstract]. 13th Conference of the European Wound Management Association; 2003 May 22-24; Pisa (Italy) 2003:111.
Moffatt 2003c {published data only}
    1. Moffatt C. Results of the examination of proguide in compression therapy (EXPECT) study. Official Satellite Symposium at the European Wound Management Association; 2003 May 23; Pisa (Italy) 2003:8-9.
Moffatt 2008 {published data only}
    1. Moffatt C, Edwards L, Harding K, Collier M, Treadwell T, Miller M. A randomized, cross-over, clinical trial of a two-layer and four-layer compression bandage system in the treatment of venous leg ulcers. 3rd Congress of the World Union of Wound Healing Societies Meeting; 2008 June 4-8; Toronto (Canada) 2008:Abstract no. OR045.
    1. Moffatt CJ, Edwards L, Collier M, Treadwell T, Miller M, Shafer L, et al. A randomised controlled 8-week crossover clinical evaluation of the 3M Coban 2 Layer Compression System versus Profore to evaluate the product performance in patients with venous leg ulcers. International Wound Journal 2008;5(2):267-79. - PMC - PubMed
    1. NCT00301496. Randomized controlled 8-week crossover evaluation of compression bandage systems for venous leg ulcers. ClinicalTrials.gov/show/NCT00301496 (first received 13 March 2006).
Moffatt 2012 {published data only}
    1. Moffatt C, Lazareth I, Dissemond J, Sauvadet A, Bohbot S. Evaluation of the efficacy and safety of an innovative two-layer (MLB) versus a four-layer (MLB) compression bandage system in the treatment of venous leg ulcers: results of a multicentre European randomized controlled trial (odyssey RCT). EWMA Journal 2012;12(2):107.
Moody 1999 {published data only}
    1. Moody M. Comparison of Rosidal K and SurePress in the treatment of venous leg ulcers. British Journal of Nursing 1999;8(6):345-50. - PubMed
Mosti 2011 {published data only}
    1. Mosti G, Crespi A, Mattaliano V. Comparison between a new, two-component compression system with zinc paste bandages for leg ulcer healing: a prospective, multicenter, randomized, controlled trial monitoring sub-bandage pressures. Wounds 2011;23(5):126-34. - PubMed
Mosti 2020 {published data only}
    1. Mosti G, Mancini S, Bruni S, Serantoni S, Gazzabin L, Bucalossi M, et al. Adjustable compression wrap devices are cheaper and more effective than inelastic bandages for venous leg ulcer healing. A multicentric Italian randomized clinical experience. Phlebology 2020;35(2):124-33. - PubMed
NCT00534937 {unpublished data only}
    1. NCT00534937. Flexitouch compression system for venous stasis ulcer. ClinicalTrials.gov/show/NCT00534937 (first received 26 September 2007).
NCT00558662 {unpublished data only}
    1. NCT00558662. Randomized clinical trial (RCT) to compare the efficacy of Coban 2 versus SSB in the treatment of venous leg ulcers. ClinicalTrials.gov/show/NCT00558662 (first received 15 November 2007).
NCT00821431 {unpublished data only}
    1. NCT00821431. Compression device versus 4-layer compression system. clinicaltrials.gov/ct2/show/NCT00821431 (first received 13 January 2009).
NCT02015221 {unpublished data only}
    1. NCT02015221. Evaluation of a dual action pneumatic compression device: patient ease of use and comfort. ClinicalTrials.gov/show/NCT02015221 (first received 19 December 2013).
NCT02284373 {unpublished data only}
    1. NCT02284373. Randomized clinical trial of pneumatic compression device for the treatment of venous ulcers and lymphedema. ClinicalTrials.gov/show/NCT02284373 (first received 6 November 2011).
NCT02364921 {unpublished data only}
    1. NCT02364921. Effectiveness of double-layer compression therapy in the healing of chronic venous ulcers in primary health care. ClinicalTrials.gov/show/NCT02364921 (first received 18 February 2015).
NCT02561013 {unpublished data only}
    1. NCT02561013. A clinical study to assess a compression device in patients with venous leg ulcers. ClinicalTrials.gov/show/NCT02561013 (first received 25 September 2015).
NCT02680834 {unpublished data only}
    1. NCT02680834. VLU non-inferiority study comparing a dual action pneumatic compression device to multi-layer bandaging. ClinicalTrials.gov/show/NCT02680834 (first received 12 February 2016).
NCT02728986 {unpublished data only}
    1. NCT02728986. Cost evaluation of venous leg ulcers management. ClinicalTrials.gov/show/NCT02728986 (first received 6 April 2016).
NCT02729688 {unpublished data only}
    1. NCT02729688. Effectiveness of a pressure indicator guided and a conventional bandaging in treatment of venous leg ulcer. ClinicalTrials.gov/show/NCT02729688 (first received 6 April 2016).
NCT02782689 {unpublished data only}
    1. NCT02782689. Clinical study to assess efficacy and safety of a new compression system in the management of venous leg ulcers. ClinicalTrials.gov/show/NCT02782689 (first received 25 May 2015).
NCT02790593 {unpublished data only}
    1. NCT02790593. Juxta-Cures™ versus bandaging for venous ulcers. clinicaltrials.gov/ct2/show/NCT02790593 (first received 6 June 2016).
NCT02798445 {unpublished data only}
    1. NCT02798445. TAPIRS technique plus adjustable compression system in treatment of venous leg ulcers. ClinicalTrials.gov/show/NCT02798445 (first received 14 June 2016).
NCT03396731 {unpublished data only}
    1. NCT03396731. Efficacy study for Geko device in VLU patients. ClinicalTrials.gov/show/NCT03396731 (first received 11 January 2018).
NCT03404297 {unpublished data only}
    1. NCT03404297. Compression therapy for leg ulcers and Kaposi sarcoma in western Kenya. clinicaltrials.gov/show/nct03404297 (first received 19 January 2018).
NCT03544788 {unpublished data only}
    1. NCT03544788. Evaluation of Cirvo™ mobile compression device for treatment of venous leg ulcers. ClinicalTrials.gov/show/NCT03544788 (first received 4 June 2019).
NCT03736941 {published data only}
    1. NCT03736941. Impact of venotrain UlcerteC venous compression device in the treatment of venous ulcers in daily practice. ClinicalTrials.gov/show/NCT03736941 (first received 9 November 2018).
Nelson 1995 {published data only}
    1. Gibson B, Nelson EA, Harper DR, Ruckley CV, Prescott RJ, Dale JJ. A prospective, randomized trial of single-layer and multi-layer bandages in the treatment of venous ulceration. Proceedings of the 5th European Conference on Advances in Wound Management; 1995 November 21-24; Harrogate (UK) 1996:56.
    1. Nelson EA, Harper DR, Ruckley CV, Perscott RJ, Gibson B, Dale JJ. Single-layer versus four-layer bandaging in the treatment of venous ulcers: a randomized controlled trial [abstract]. British Journal of Surgery 1996;83:563.
    1. Nelson EA, Harper DR, Ruckley CV, Prescott RJ, Gibson B, Dale JJ. A randomised trial of single layer and multi-layer bandages in the treatment of chronic venous ulceration. Phlebology '95: Proceedings of the XII Congress Union Internationale de Phlebologie, London 3-8 September 1995 1995;(Suppl 1):915-6.
    1. Prescott RJ, Nelson EA, Dale JJ, Harper DR, Ruckley CV. Design of randomized controlled trials in the treatment of leg ulcers: more answers with fewer patients. Phlebology 1998;13(3):107-12.
Nelson 2004 {published data only}
    1. ISRCTN06644918. A randomised controlled trial of two bandages for treating venous leg ulcers. isrctn.com/ISRCTN06644918 (first received 25 April 2003).
    1. Nelson EA, Iglesias CP, Cullum N, Torgerson DJ, VenUS I collaborators. A randomized controlled trial of four-layer and short-stretch compression bandages for venous leg ulcers (VenUS I). 38th Annual Scientific Meeting of the Vascular Surgical Society of Great Britain and Ireland; 2003 November 26-28; Glasgow (UK) 2003:27.
    1. Nelson EA, Iglesias CP, Cullum N, Torgerson DJ, VenUS I collaborators. Randomized clinical trial of four-layer and short-stretch compression bandages for venous leg ulcers (VenUS I). British Journal of Surgery 2004;91(10):1292-9. [DOI: 10.1002/bjs.4754] - DOI - PubMed
Nelson 2007 {published data only}
    1. Dale JJ, Ruckley CV, Harper DR, Gibson B, Nelson EA, Prescott RJ. A factorial trial of drugs, dressings and bandages in the treatment of leg ulcers. Proceedings of the 5th European Conference on Advances in Wound Management; 1995 November 21-24; Harrogate (UK) 1996:193-4.
    1. Nelson EA, Prescott RJ, Harper DR, Gibson B, Brown D, Ruckley CV. A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers. Journal of Vascular Surgery 2007;45(1):134-41. [DOI: 10.1016/j.jvs.2006.09.043] - DOI - PubMed
Northeast 1990 {published data only}
    1. Northeast AD, Layer GT, Wilson NM, Browse NL, Burnand KG. Increased compression expedites venous ulcer healing. Royal Society of Medicine Venous Forum, 1990 October Meeting 1990.
Olofsson 1996 {published data only}
    1. Olofsson B, Ljunghall K, Nordin-Bjorklund K, Sorensen S, Leppert J. Two therapeutic models in venous leg ulcers are compared: better results with optimized compression. Lakartidningen 1996;93(51-52):4752-4. - PubMed
Partsch 1994 {published data only}
    1. Partsch H, Horakova MA. Compression stockings for the treatment of venous leg ulcers [Kompressionsstrumpfe zur behandlung venoser unterschenkelgeschwure]. Wiener Medizinische Wochenschrift 1994;144(10-1):242-9. - PubMed
Partsch 2001 {published data only}
    1. Partsch H, Damstra RJ, Tazelaar DJ, Schuller-Petrovic S, Velders AJ, De Rooij MJ, et al. Multicentre, randomised controlled trial of four-layer bandaging versus short-stretch bandaging in the treatment of venous leg ulcers. Vasa - Journal of Vascular Diseases 2001;30(2):108-13. - PubMed
Polignano 2003 {published data only}
    1. Polignano R, Bonadeo P, Guarnera G. Compression for venous leg ulcers via bandages or stockings: results of a pilot study comparing the performance of a two-layered compression stocking system with that of short stretch bandage. 13th Conference of the European Wound Management Association; 2003 May 22-24; Pisa (Italy) 2003:112.
Polignano 2004a {published data only}
    1. Polignano R, Guarnera G, Bonadeo P. Evaluation of SurePress Comfort: a new compression system for the management of venous leg ulcers. Journal of Wound Care 2004;13(9):387-91. - PubMed
Polignano 2004b {published data only}
    1. Polignano R, Bonadeo P, Gasbarro S, Allegra C. A randomised controlled study of four-layer compression versus Unna's Boot for venous ulcers. Journal of Wound Care 2004;13(1):21-4. - PubMed
Price 2008 {published data only}
    1. Price P, Harding K, Moffatt C. Randomized, cross-over, clinical trial to compare the impact of two-layer versus a four-layer compression bandage system in the treatment of venous leg ulcer. EWMA Journal 2008;8(2 (Supp)):75, Abstract no. 112.
Robinson 1998 {published data only}
    1. Robinson C, Santilli SM. Warm-Up Active Wound Therapy: a novel approach to the management of chronic venous stasis ulcers. Journal of Vascular Nursing 1998;16(2):38-42 5. - PubMed
Rocca 2012 {published data only}
    1. Rocca A, Compagna R, De Vito D, Della Corte GA, Bianco T, Amato B. Compression therapy in chronic venous disease. European Surgical Research 2012;49 (3-4):140.
Russo 1999 {published data only}
    1. Russo A. Multi-layer versus two-layer bandage system in the treatment of venous leg ulcers: a comparative study. 9th European Conference on Advances in Wound Management; 1999 November 9-11; Harrogate (UK) 1999:16.
Sabolinski 1996 {published data only}
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Scriven 1998 {published data only}
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Scriven 2000 {published data only}
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Smith Nephew 1991 {published data only}
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Szewcyzk 2010 {published data only}
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Tawfick 2013 {published data only}
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Torra i Bou 2003 {published data only}
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Tucker 2008 {published data only}
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Ukat 2003 {published data only}
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Vowden 2000 {published data only}
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Weller 2012a {published data only}
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    1. Weller CD, Evans S, Reid CM, Wolfe R, McNeil J. Protocol for a pilot randomised controlled clinical trial to compare the effectiveness of a graduated three layer straight tubular bandaging system when compared to a standard short stretch compression bandaging system in the management of people with venous ulceration: 3VSS2008. Trials 2010;11(26):26. [DOI: 10.1186/1745-6215-11-26] - DOI - PMC - PubMed
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Wilkinson 1997 {published data only}
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Wille 2002 {published data only}
    1. Wille J, Burdge J. Compression therapy versus cultured epidermal autografting for treatment of chronic venous ulcers. 12th Conference of the European Wound Management Association; 2002 May 23-25; Granada (Spain) 2002:246.
Zuccarelli 1997 {published data only}
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References to studies awaiting assessment

Cherry 1990 {published data only}
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Jünger 2008 {published data only}
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Kuznetsov 2009 {published data only}
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References to other published versions of this review

Shi 2019
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