Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients

<p><b>Objective:</b> To compare the effectiveness of two types of compression treatment (four layer bandage and short stretch bandage) in people with venous leg ulceration.</p> <p><b>Design:</b> Systematic review and meta-analysis of patient level data.</p> <p><b>Data:</b> sources Electronic databases (the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register, Medline, Embase, CINAHL, and National Research Register) and reference lists of retrieved articles searched to identify relevant trials and primary investigators. Primary investigators of eligible trials were invited to contribute raw data for re-analysis.</p> <p><b>Review:</b> methods Randomised controlled trials of four layer bandage compared with short stretch bandage in people with venous leg ulceration were eligible for inclusion. The primary outcome for the meta-analysis was time to healing. Cox proportional hazards models were run to compare the methods in terms of time to healing with adjustment for independent predictors of healing. Secondary outcomes included incidence and number of adverse events per patient.</p> <p><b>Results:</b> Seven eligible trials were identified (887 patients), and patient level data were retrieved for five (797 patients, 90% of known randomised patients). The four layer bandage was associated with significantly shorter time to healing: hazard ratio (95% confidence interval) from multifactorial model based on five trials was 1.31 (1.09 to 1.58), P=0.005. Larger ulcer area at baseline, more chronic ulceration, and previous ulceration were all independent predictors of delayed healing. Data from two trials showed no evidence of a difference in adverse event profiles between the two bandage types.</p> <p><b>Conclusions:</b> Venous leg ulcers in patients treated with four layer bandages heal faster, on average, than those of people treated with the short stretch bandage. Benefits were consistent across patients with differing prognostic profiles.</p&gt

Comparison of short-stretch bandage and long-stretch bandage for post-traumatic hand edema

Introduction and importance: Hand edema is a common post-surgical or traumatic complication in orthopedic patients, necessitating effective treatment interventions. This study aimed to investigate the effects of two different types of bandages, along with finger flexion exercises, on managing hand edema. Case presentation: Our orthopedic patients with post-surgical or traumatic hand edema and three non-edematous hands were enrolled in the study. A mixed model effect with fixed factors of time (pre-post) and bandage type (M, C, N), and random factors of hand, edema, fingers, and phalanges was applied. The bandage types were circular with short elastic bandage (M) and circular with elastic bandage (C). Finger flexion exercises involved alternating contractions of extrinsic and intrinsic flexors. Randomization ensured unbiased allocation to bandage types. Clinical discussion: The M bandage demonstrated a significant reduction in hand edema by effectively moving free fluids, reinforcing tissue hydrostatic pressure, and facilitating venous and lymphatic flow. On the other hand, the C bandage did not produce significant pre-post differences in hand circumference. Conclusions: The combination of a circular bandage with finger flexion exercises shows promise in reducing hand edema in orthopedic patients. Particularly, the stiff bandage M exhibited superior efficacy compared to the elastic one C in reducing hand circumference. These findings provide valuable insights for clinical practice, offering an effective strategy for managing hand edema and promoting better patient outcome

Experimental investigation of pressure applied on the lower leg by elastic compression bandage

International audienceCompression therapy with stockings or bandage is the most common treatment for venous or lymphatic disorders. The objective of this study was to investigate the influence of bandage mechanical properties, application technique and subject morphology on the interface pressure, which is the key of this treatment. Bandage stretch and interface pressure measurements (between the bandage and theleg) were performed on 30 healthy subjects (15 men and 15 women) at two different heights on the lower leg and in two positions (supine and standing). Two bandages were applied with two application techniques by a single operator. The statistical analysis of the results revealed: no significant difference in pressure between men and women, except for the pressure variation between supine and standing position; a very strong correlation between pressure and bandage mechanical properties (p<0.00001) and between pressure and bandage overlapping (p<0.00001); a significant pressure increase from supine to standing positions (p<0.0001). Also, it showed that pressure tended to decrease when leg circumference increased. Overall, pressure applied by elastic compression bandages varies with subject morphology, bandage mechanical properties and application technique. A better knowledge of the impact of these parameters on the applied pressure may lead to a more effective treatment

Robert Jones bandage pressure range assessment using a pressure mapping system and application to band calibration

International audienceThe Robert Jones bandage (RJ) is a widely used bandage among veterinary surgeons to maintain physiological position of the limbs. It is a 3-layer composite bandage, which realization involves the use of several types of bands in a specific arrangement to give the bandage all its properties. Its proper making is difficult and requires experience, as the bandage needs to be not too tight or not too loose. This issue is a recurrent matter with every type of compression bandage (Rimaud et al. 2014). For the realization of a RJ, various types of bands can be used, depending on the surgeon but each layer has its own function that cannot be changed.The purpose of this study is to measure the pressure under a RJ bandage with a pressure mapping system and to evaluate the properties of some commonly used bands. The final application of these results is to propose a band calibration system to apply the correct pressure as a function of the band’s deformation

Immediate Hemodynamic Effect of the Additional Use of the SCD EXPRESS™ Compression System in Patients with Venous Ulcers Treated with the Four-layer Compression Bandaging System

ObjectivesTo test the hypothesis that the SCD EXPRESS™ intermittent pneumatic compression applied in combination with a four-layer bandage in patients with venous ulcers increases popliteal vein volume flow and velocity.DesignTwenty limbs of 18 patients with venous leg ulcers were studied, median age 76 years. The Total Volume Flow (TVF) and the Peak Systolic Velocity (PSV) were recorded in the popliteal vein using duplex ultrasonography. Measurements were made (i) without bandage, (ii) with four layer bandage and (iii) following the application of the SCD Compression System on top of a four-layer bandage for at least 15 minutes.ResultsThe median VCSS was 17 (range, 12–22) while the median VSDS for reflux was 4.5 (range, 1–7.5). The median TVF was 71mL/min (inter-quartile range 57–101) without bandage, 112 (IQR 89–148) with four-layer bandage and 291 (IQR 241–392) with the addition of the SCD System (P<.001, Wilcoxon signed ranks test). The median PSV was 8.4cm/sec (IQR 6.8–14) without bandage, 13 (9.0–19) with four-layer bandage and 27 (21–31) with the addition of the SCD System (P<.001, Wilcoxon signed ranks test). Both TVF and PSV increased slightly with the addition of the four-layer bandage. However, with the addition of the SCD System these parameters increased three fold.ConclusionsThe SCD EXPRESS Compression System accelerates venous flow in the legs of patients with venous ulcers already treated with a four-layer bandage. The combination of four-layer compression with the SCD System on healing venous ulcers needs to be tested by a clinical effectiveness study

Home Care of the Sick

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First Aid in Common Injuries and Accidents

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