The management of venous leg ulcers: Effects of four-layer bandage system

Aim: Chronic Venous Ulcer (CVU) accounts for nearly 70% of all chronic leg ulcers (CLU), seriously impacting the quality of life and creating a heavy economic burden. Here, we present CVU therapy with a four-layer bandage system in 113 patients retrospectively treated by the General Surgery Chronic Wound Unit and Cardiovascular Surgery Department. Material and Methods: From January 2022 to January 2023, 113 patients with CVU were evaluated retrospectively. All patients were documented by color Doppler ultrasonography (CDUS), ulcer size, and demographics. If there were multiple ulcers, the largest one was assessed. Immobile patients and patients with an Ankle Brachial Index (ABI) of <0.7 were excluded. Debridement, exercise, venoactive drugs, and a four-layer bandage system were performed for all patients. The primary outcome was to assess the ulcer healing, and the secondary outcome was to obtain the recurrence rate and the treatment compatibility of patients. Results: The mean age of the patients was 60.73±11.3 (28-91) years and 77.9% were male. Body Mass Index (BMI) was 30.4±7.7 kg/m2 (min:18-max:51 kg/m2). The mean follow-up period was 18.82±13.4 weeks. Pseudomonas aeruginosa (38%) and Staphylococcus aureus (31.8%) were the most identified microorganisms. Four patients experienced recurrence of the CVU (3.5%). The older patients had larger ulcers than the younger patients. Female patients had larger-sized ulcers (p=0.001). Completely healed ulcers were 26.5% of the total. The four-layer compression bandage was applied 12 times for per patient. The mean healing period was 23.2±13.8 weeks. The mean healing rate was 4.17±3.78% for a week. The multivariant analysis revealed that age and pain had negatively affected the ulcer healing. Conclusion: The management of CVU is challenging and needs a multidisciplinary approach. Compression is the main goal of the treatment. Surgical or endovenous therapies may be beneficial for decreasing ulcer recurrence. For patients with slow ulcer healing, adjuvant treatment modalities such as patient education, smoking cessation, diet and lifestyle modification, and exercise should be recommended.