Intended for healthcare professionals

Practice ABC of wound healing

Non-surgical and drug treatments

BMJ 2006; 332 doi: (Published 13 April 2006) Cite this as: BMJ 2006;332:900
  1. Stuart Enoch,
  2. Joseph E Grey,
  3. Keith G Harding
  1. Stuart Enoch is research fellow of the Royal College of Surgeons of England and is based at the Wound Healing Research Unit, Cardiff University.

    Despite great strides in technological innovations and the emergence of a wide range of treatments for wounds, non-healing wounds continue to perplex and challenge doctors. Various non-surgical approaches have been developed and numerous drugs have been introduced to aid the management of such wounds.

    Fig 1

    Left: Components of four layer bandage system. Right: Four layer bandage system to treat venous ulcer (note class II compression stocking on right leg for prevention of ulceration)

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    Single layer compression bandages

    Non-surgical treatments

    Bandages and hosiery

    Compression bandages are used to treat lower limb ulcers secondary to venous insufficiency (venous leg ulcers) and lymphoedema. Single layer compression bandages (elastic) are classified into four groups according to the predetermined levels of compression they provide at the ankle. Inelastic compression bandages (short stretch), when applied at full extension, improve the calf muscle pump action and exert higher pressures when the patient is upright (and walking) and lower pressures at rest. They are useful in patients who are adequately mobile. An elasticated tubular bandage (one to three layers) may be useful to treat and prevent venous leg ulcers.

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    Non-surgical and drug treatments to consider in the treatment of chronic ulcers

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    Caution in use of compression bandages

    Multilayer compression bandaging, such as the four layer method, is well established in the management of venous leg ulcers. It consists of four layers—padding, a crepe bandage, and classes 3a and 3b (UK classification) compression bandages—applied from the base of the toes to knee. Ideally, it should be left in place for four to seven days. Although effective, the bulkiness of these layers may lead to non-compliance in some patients. Its use is limited in heavily exuding ulcers as repeated dressing changes may be needed.

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    Top left: Single layer elastic compression bandage. Top right: Inelastic (short stretch) compression bandage. Left: Three layer elasticated tubular bandage

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