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

doi:10.1136/bmj.b1344

Published 17 April 2009, doi:10.1136/bmj.b1344
Cite this as: BMJ 2009;338:b1344

Research

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

Susan O’Meara, research fellow¹, Jayne Tierney, head of meta-analysis group², Nicky Cullum, deputy head of department (research)¹, J Martin Bland, professor of health statistics¹, Peter J Franks, professor of health sciences³^,4, Trevor Mole, statistics manager⁵, Mark Scriven, consultant vascular surgeon⁶

¹ Department of Health Sciences, University of York, York YO10 5DD, ² Meta-analysis Group, MRC Clinical Trials Unit, London NW1 2DA, ³ Centre for Research and Implementation of Clinical Practice, London SW15 5ES, ⁴ Faculty of Medicine, Division of Nursing and Healthcare, University of Glasgow, Glasgow G12 8LW, ⁵ Smith and Nephew Wound Management, Hull HU3 2BN, ⁶ Department of Vascular Surgery, Birmingham Heartlands Hospital, Birmingham B9 5SS

Correspondence to: S O’Meara smo4{at}york.ac.uk

Objective To compare the effectiveness of two types of compressiontreatment (four layer bandage and short stretch bandage) inpeople with venous leg ulceration.

Design Systematic review and meta-analysis of patient leveldata.

Data sources Electronic databases (the Cochrane Central Registerof Controlled Trials, the Cochrane Wounds Group SpecialisedRegister, Medline, Embase, CINAHL, and National Research Register)and reference lists of retrieved articles searched to identifyrelevant trials and primary investigators. Primary investigatorsof eligible trials were invited to contribute raw data for re-analysis.

Review methods Randomised controlled trials of four layer bandagecompared with short stretch bandage in people with venous legulceration were eligible for inclusion. The primary outcomefor the meta-analysis was time to healing. Cox proportionalhazards models were run to compare the methods in terms of timeto healing with adjustment for independent predictors of healing.Secondary outcomes included incidence and number of adverseevents per patient.

Results 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 wasassociated with significantly shorter time to healing: hazardratio (95% confidence interval) from multifactorial model basedon five trials was 1.31 (1.09 to 1.58), P=0.005. Larger ulcerarea at baseline, more chronic ulceration, and previous ulcerationwere all independent predictors of delayed healing. Data fromtwo trials showed no evidence of a difference in adverse eventprofiles between the two bandage types.

Conclusions Venous leg ulcers in patients treated with fourlayer bandages heal faster, on average, than those of peopletreated with the short stretch bandage. Benefits were consistentacross patients with differing prognostic profiles.

© O et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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