Compression of the lower extremities is one of the oldest and most widely used treatments for venous ulcers. Methods of compression vary and include stockings, multilayer bandages, high-pressure compression boots, and an Unna boot.
A Cochrane collaborative review has evaluated the role of compression in the treatment of venous ulcers.4 This review included 22 trials using a number of different compression methods. Six trials compared compression with no compression, and demonstrated a clear benefit of compression over no compression. Of these, three trials evaluated compression using an Unna boot versus no compression. Two of the three studies demonstrated a benefit of compression.5,6 Three additional studies compared compression bandages with non-compressive bandages and demonstrated a benefit of compression bandages. Of note, the results of only four of these six trials were statistically significant, although the preponderance of evidence suggests that compression results in a greater chance of healing than no compression.
Three trials compared elastic high-compression bandages with inelastic low-compression bandages.7 Pooled results from these studies evaluated in the Cochrane review suggest that the relative risk of healing with elastic highcompression bandages over inelastic low-compression bandages was 1-54 (CI 1-19-2-00).
Four trials compared multilayer highcompression bandages with single-layer (low) compression.8 A pooled analysis of these studies demonstrated a relative risk of healing of 1-41 (CI 1-11-1-80) when using multilayer compression bandages rather than single-layer bandages.
Four trials compared multilayer high-compression bandages with inelastic high-compression bandages (Unna boot and short-stretch bandages). No statistically significant differences were shown between these types of high-compression therapy. Similarly, studies comparing other types of high-compression therapy, including the four-layer Charing Cross bandage system, did not show statistically significant differences between the different types of high-compression therapies.
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