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Hosiery may better than pressure bandages for some leg ulcers

NEW YORK (Reuters Health) – Two-layer compression hosiery is at least as effective as four-layer compression bandages for many patients with venous leg ulcers, UK researchers say.

Both approaches work by application of graduated pressure to the leg, which improves venous return and reduces reflux, as the researchers note in a December 6th paper online in The Lancet.

But compression bandages “are bulky, unattractive and may interfere with normal footwear,” Dr. Jo C. Dumville of the University of Manchester told Reuters Health by email. “They can also be costly as they take time to apply and often require frequent nurse visits to change them.”

The four-layer compression bandage is the standard method, despite those drawbacks and others, including poor application affecting compression, slippage, and bulk that can hinder leg and ankle movement.

A newer approach is two-layer hosiery with an understocking and overstocking worn together. They aren’t as bulky, so patients may have better mobility, and those with sufficient dexterity can remove and reapply by themselves.

To compare these approaches, Dumville and colleagues randomized 457 patients to two-layer hosiery or the four-layer bandage. Although participants and health-care providers were not masked to treatment allocation, the primary endpoint was measured by masked assessment of photographs.

Median time to ulcer healing was 99 days in the hosiery group and 98 days in the bandage group. The proportion of healing was also very similar (70.9% versus 70.4%). However, ulcer recurrence was significantly more common with bandages than with hosiery (23% vs 14%).

Overall, 33% of the participants changed to a nontrial treatment before their ulcers healed. Unexpectedly the proportion was greater in the hosiery group (38% vs 28%), leading the authors to caution that “hosiery might not be suitable for all patients.”

Hosiery appeared more cost effective, with average costs about 300 pounds sterling less per patient per year in the hosiery group (equal to about US$490 per patient per year). This difference, say the investigators was mainly due to more frequent nurse consultations in the bandage group.

Overall the researchers conclude, “Two-layer compression hosiery is a viable alternative to the four-layer bandage.”

Commenting on the results by email, Dr. Robert S. Kirsner of the University of Miami School of Medicine, co-author of an accompanying editorial, said, “The finding that stockings are equally effective as compression bandaging suggests for some patients a more convenient way to apply compression may exist.”

But Dr. Kirsner also warns that patients need to be carefully selected and closely followed, and if they do not improve, doctors will need “to rapidly change therapy.”

Dr. Dumville did not respond to requests for comments.


Lancet 2013.