2005 Symposium on Advanced Wound Care | |
| 4 |
Clinical Research
|
Effectiveness of a four-layer Compression Bandage* and the modified Unna’s boot for the treatment of lower leg ulcers in ambulatory patients with chronic venous disease: a crossover study involving 80 patients Oscar M. Alvarez, PhD, Lee Markowitz, DPM, Center for Palliative Wound Care Calvary Hospital, Bronx, NY; Juanita Booker, RN, BSN, Roisin S. Rogers, RN, MSN, Visiting Nurse Service of New York, New York, NY; Mayank Patel, MD, University wound Care and East Tremont Vascular Center, Bronx, NY After 6 weeks of compression with a modified Unna’s Boot (MUB) consisting of a paste boot and an elastic cohesive bandage, patient’s whose wound had not healed by 50% (N=47) were crossed over to receive treatment with a four-layer compression bandage (4LB). Those whose wound had healed by more than 50% (N=33) continued to receive MUB. Both groups were followed for 12 weeks or until healing. Weekly evaluations consisted of wound measurements, edema control, and adverse effects. Nonadherent primary dressings were used for both groups. Compression bandages and dressings were changed once weekly in the majority (75 patients). Five patients had larger wounds that demanded treatment twice weekly. Wound areas were calculated from serial tracings and digital planimetry. The median time to healing was significantly shorter for the group receiving 4LB (76 days vs. 119 days p=0.039). Thirty-five of the 46 patients (76%) in the 4LB group healed within 12 weeks, and 19 (61%) treated with MUB had closure (P=0.02). Compression with 4LB was greater (41.5 compared to 27.0 mmHg at the ankle). The 4LB compression bandage system also provided better edema control. These results show that 4LB should be recommended for venous ulcer patients who do not heal following a 6-week therapeutic course of standard compression. In patients with very thin legs (ankle circumference <23 cm) compression with either MUB or 4LB can exceed 44 mmHg. Careful examination of the patients’ arterial circulation (ABI and PVR) is recommended prior to starting any compression therapy. * Profore Smith and Nephew Inc. Largo, FL |
|