Leg Ulcers: Bandage comparison, systematic review and IPD meta-analysis

Four-layer compression bandage compared with short stretch bandage for venous leg ulcers: A systematic review and meta-analysis of randomised controlled trials of individual patient data

Which type of bandage is it best to use for venous leg ulcers?

What was this study about?

Venous leg ulcers are a type of chronic (long-lasting) skin ulcer. They occur when the flow of blood in your legs is blocked or too slow. They are more common in older people and in women. One method of treatment is for a nurse or doctor to apply a firm compression bandage or stocking to the lower leg, following a careful assessment of the leg ulcer. This is thought to help the blood move back up the leg.

Research has shown that applying a compression bandage can help to heal venous leg ulcers. Different types of bandages are available. We know that high compression bandages work better than low compression bandages. We don't know if four-layer or short-stretch high compression bandages works best.

This study is a systematic review and meta analysis of individual patient data. It brings together information from all patients who took part in similar trials. These trials compared what happens to people who had a four-layer bandage with those who had a short-stretch bandage. This study aimed to find out:

  • Whether a four-layer or short-stretch bandage helps healing the best, and how long this takes.
  • Whether a four-layer or short-stretch bandage stops ulcers coming back best.

What difference did this study make?

This study showed that venous leg ulcers in patients treated with the four layer bandages heal faster than those of patients treated with the short-stretch bandage. Patients with larger ulcers, older ulcers and recurring wounds have poorer healing regardless of what bandage was used.

O'Meara S, Tierney J, Cullum N, Bland JM, Franks PJ, Mole T, et al. Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients. BMJ. 2009;338::b1344.


Type of study


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Who funded the study?

This study was funded by the Department of Health.

When did it take place?

This study was completed and published in 2009. The trials included were done between 1993 and 2004.

Where did it take place?

The study was done at the University of York. But it brings together the results of trials from all over Europe. The MRC Clinical Trials Unit provided help and advice.

Who was included?

People with venous leg ulcers who took part in randomised controlled trials comparing a four-layer bandage with a short-stretch bandage.