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Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers [Commentary]

Enoch, S., Williams, D., Price, Patricia and Harding, Keith 2003. Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers [Commentary]. British Journal of Surgery 90 (10) , p. 1307.

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Sir, We have read the above study with great interest and would like to highlight some points. The BMI of patients should have been recorded, as obesity is associated with chronic venous insufficiency, a known risk factor for venous ulceration (1). The infection rates and the incidence of recurrence of ulcers would have been useful. The cost of educating the community nurses to use four-layer bandaging (4LB) appears to have been overlooked in the final analysis. Finally, the authors' conclusion that 4LB is the most effective method to treat venous ulcers in community should be interpreted with caution. Though 4LB was effective compared to the control group's usual system of care (non-standardised), it was not compared with another form of compression (elastic, inelastic, cohesive etc), as only five patients among controls seem to have received compression. In addition, as compression treatment expedites healing of venous ulcers (2,3) it could be argued that any form of compression would have facilitated healing in the study group, not necessarily 4LB. It should be acknowledged that chronic venous ulcers produce copious exudate, necessitating frequent dressing changes and in such instances, single layer compression rather than 4LB is more practical (training patient and family) and has better patient compliance. Likewise, as the authors agree, the cost of 4LB dressing materials is high and some ulcers could be managed with single layer compression alone at a reduced cost. Therefore, a pragmatic approach should be adopted to choose the most appropriate and cheapest compression on an individual patient basis. References: 1. Padberg F Jr, Cerveira JJ, Lal BK et al. Does severe venous insufficiency have a different etiology in the morbidly obese? Is it venous? J Vasc Surg 2003 Jan; 37 (1): 79-85. 2. Marston WA, Carlin RE, Passman MA et al. Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency. J Vasc Surg 1999 Sep; 30 (3): 491-8. 3. Fletcher A, Cullum N, Sheldon TA. A systematic review of compression treatment for venous leg ulcers. BMJ 1997 Sep 6; 315 (7108): 576-80.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Healthcare Sciences
Additional Information: This is a comment on the article 'Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers' by J. F. O'Brien, P. A. Grace, I. J. Perry, A. Hannigan, M. Clarke Moloney and P. E. Burke, British Journal of Surgey 90: 7 (2003), pp. 794-8.
Publisher: Wiley-Blackwell
ISSN: 0007-1323
Last Modified: 04 Jun 2017 04:04

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