Different context, different results: venous ulcer healing and the use of two high-compression technologies.

Aims and objectives: To update the evidence for the relative effectiveness of the four-layer and short-stretch compression technologies used for the treatment of venous ulcers. Background: Compression bandages are the most effective method for venous ulcer healing. Both four-layer and short-stretch compression are effective but the relative benefit of one over the other is not fully understood. Design: Meta-analysis of data from randomised trials of short-stretch and four-layer compression bandages. Methods: We conducted a hazards ratio meta-analysis that combined the results from the existing review evidence with the latest randomised trial. Results: Prior to inclusion of the Canadian Bandaging Trial, the meta-analysis of the available evidence from four trials indicated that short-stretch bandaging was associated with a lower chance of healing than four-layer bandaging. Adding this trial to the meta-analysis however, the relative benefit for the four-layer bandaging did not persist. Conclusions: Addition of the largest trial of compression technologies attenuated the apparent relative benefit for four-layer bandaging over short-stretch seen in the previous systematic reviews. This may be because the latest trial was large and found no difference in healing rates, attributed to the fact that both technologies were in common use in the trial centres, rather than being a trial of a new bandaging technology over an existing technology. Relevance to clinical practice: This analysis indicates that the choice of a compression system can be safely made with equal regard to clinician choice, patient preference and economic considerations as these technologies appear comparable in terms of healing rates.