The 4-layer bandage was originally designed to provide sustained leg compression to patients with venous leg ulcers. Since then, the practice of 4-layer bandaging has become widespread in the United Kingdom. Ulcer healing rates vary for a number of reasons. This review, by a member of the original design team, seeks to discuss reasons of varying success and offers advice for its appropriate usage.
Blair SD, Wright DDI, Backhouse CM, Riddle E, McCollum CN.Sustained compression and healing of chronic venous ulcers. Br Med J1988;297:1159-1161.
2.
Moffatt CJ, Franks PJ, Oldroyd M, et al.Community clinics for leg ulcers and impact on healing. Br Med J1992a;305:1389-1392.
3.
Simon DA, Freak L, Annette K, et al.Community leg ulcer clinics: a comparative study in two health authorities. Br Med J1996;312:1648-1651.
4.
Morrell CJ, King B, Brereton L.Community based leg ulcer clinics: organisation and cost effectiveness. Nurs Times1998;94(9, Occasional paper):20-23.
5.
Torra I, Bou J, Lopez JR.Use of multi layer compression bandage system in the treatment of venous leg ulcers, a multi centre evaluation in a non-hospital setting. Proceedings of the 11th Conference of the European Wound Management Association, May, Dublin (Compression Symposium), 2001.
6.
Allegra C, Cariotti R, Bonadeo S, et al.Four layer compared with Unna’s boot in venous leg ulcer management. Proceedings of the 11th Conference of the European Wound Management Association, Dublin, 21, 2001.
7.
Stemmer R, Marescaux J, Furderer C.Compression treatment of the lower extremities particularly with compression stockings. Dermatologist1980;31:355-365.
8.
Moffatt CJ, Harper P.Access to clinical education: leg ulcers. Edinburgh: Churchill Livingstone; 1997.
9.
Bosanquet N, Franks P, Moffatt CJ, et al.Community leg ulcer clinics: cost effectiveness. Health Trends1993;25:146-148.
10.
Carr L, Philips Z, Posnett J.Comparative cost effectiveness of four layer bandaging in the treatment of venous leg ulceration. J Wound Care1999;8(5):243-248.
11.
Partsch H.Compression therapy of the legs. Dermatol Surg Oncol1991;17:799-805.
12.
Williams R, Wertheim D, Melhuish J, Harding K.Detection of shear forces under compression bandages. Proceedings of the 7th European Wound Management Conference, November 37, 1997.
13.
Wertheim D, Melhuish J, Llewellyn M, Williams R, Harding K.Assessment of forces and skin surface temperature under the four layer bandage system. Proceedings of the 7th European Wound Management Conference, November 38, 1997.
14.
Partsch H.Dermal lymphangiopathy in chronic venous incompetence. In: Bollinger A, Partsch H, Wolfe JHN, editors. The initial lymphatice. New York: Thieme Stratton; 1985. p. 27-32.
15.
McGeown JG, McHale NG, Thornbury KD.The role of external compression and of movement in lymph propulsion in the sheep hind leg. J Physiol1987;387:83-93.
16.
Mahler F, Chen D.Intravital microscopy for evaluation of chronic venous incompetence. Int J Microcirc Clin Exp (Suppl)1990;106:1.
17.
Coleridge-Smith PD.How does a leg ulcerate? In: Ruckley CV, Fowkes FGR, Bradbury AW, editors. Venous disease: epidemiology, management, and delivery of care. London: Springer; 1999. p. 51-70.
18.
Abu-Own A, Shami SK, Chittenden SJ, Farrah J, Scurr JH, Smith PD.Microangiopathy of the skin and the effect of leg compression in patients with chronic insufficiency. J Vasc Surg1994;19:1074-1083.
19.
Partsch H.Improvement of venous pump function in chronic venous insufficiency by compression depending on pressure and material. Vasa1984;13:58-64.
20.
Emter M.Modifications du finis sanguin dans les veines des membres inferieurs apres compression. Phlebology1991;44(2):481-484.
21.
Sarin S, Scurr JH, Coleridge-Smith PD.Mechanism of action of compression. In: Raymond-Martinbeau P, Prescott R, Zummo M, editors. Venous disease. Phlebology. Paris: John Libbey, Eurotext; 1992. p. 32-33.
22.
Menzinger G, Horakowa M, Mayer W, Partsch H.Reduction of venous reflux by compression: a comparison between short and long stretch material. Phlebology1995;19(Suppl 1):888-891.
23.
Christopoulos D, Nicolaides AN, Szendro G.Venous reflux: quantification and correlation with the clinical severity of chronic venous disease. Br J Surg1988;75:352-356.
24.
Nicolaides AN, Hussein MK, Szendro G, Christopoulos D.The relation of venous ulceration and ambulatory venous pressure measurement. J Vasc Surg1993;17:414-418.
25.
Partsch H, Menzinger G, Mostbeck. Inelastic compression is more effective to reduce deep venous refluxes than elastic bandages. Dermatol Surg1999;25:695-700.
26.
Struckman J.Compression stockings and their effect on the venous pump: a comparative study. Phlebology1986;1:37-45.
27.
Gjores JE, Thulesius O.Compression treatment in venous insufficiency evaluated with foot volumetry. Vasa1977;6:364-368.
28.
Franks PJ, Moffatt CJ, Connolly M, et al.Factors associated with healing leg ulceration with high compression. Age Aging1995;24:490-494.
29.
Barwell JR, Taylor M, Deacon J, Davies C, Whyman MR, Poskitt KR.Ankle motility is a risk factor for healing of chronic venous leg ulcers. Phlebology2001;16:38-40.
30.
Araki CT, Back TL, Padberg FT, Thompson PN, Jamil Z, Lee BC.The significance of calf muscle pump function in venous ulceration. J Vasc Surg1994;20:872-879.
31.
Doherty DC, Moffatt CJ, Franks PJ.Mobility as a risk factor for leg ulcer healing. Proceedings of the 11th conference of the European Wound Management Association, Dublin, 65, 2001.
32.
Franks PJ, Moffatt CJ, Connolly M, et al.Community Leg ulcer Clinics: effect on quality of life. Phlebology1994;9:83-86.
33.
Franks PJ.Quality of life for leg ulcer patients. In: Ruckley CV, Fowkes FGR, Bradbury AW, editors. Venous disease: epidemiology, management, and delivery of care. London: Springer; 1999. p. 254-261.
34.
Gniadecka M.Dermal oedema in lipodermatosclerosis: distribution, effects of posture and compressive therapy evaluated by high frequency ultrasonography. Acta Derm Venereol1995;75:120-124.
35.
Falanga V, Bucalo B.Use of a durometer to assess skin hardness. J Am Acad Dermatol1993;29:47-51.
36.
Nilsson IM, Robertson B.Effect of venous occlusion on coagulation and fibrinolytic components in normal subjects. Thromb Diath Haemorrh1968;20:397-408.
37.
Allenby F, Boardman L, Pflug JJ, Calnan JS.Effect of external pneumatic compression on fibrinolysis in man. Lancet1973;2:412-414.
38.
Mayrowitz HN, Larsen PB.Effects of compression bandaging on the leg pulsatile blood flow. Clin Physiol1997;17:105-117.
39.
Stockport JC, Groake L, Ellison DA, McCollum CN.Single layer and multi layer bandaging in the treatment of venous leg ulcers. J Wound Care1997;6(10):485-486.
40.
Nelson EA, Ruckley CV, Barbanel JC.Improvements in bandaging technique following training. J Wound Care1995;4(4):181-184.
41.
Taylor AD, Taylor RJ, Said SSS. The use of sub bandage pressure monitor as an aid to improving bandaging skills. Proceedings of the 4th European Conference on Advances in Wound Management, p. 203-206, 1995.
42.
Partsch H, Mezinger, Blazek V.Static and dynamic measurement of compression pressure. In: Blazek V, Schultz, Ehrenburg U, editors. Frontiers in computer aided visualisation of vascular function. Berlin: Verlag; 1997. p. 145-152.
43.
Hafner J, Botonakis I, Burg G.A comparison of multi-layer bandage systems during rest, exercise, and over 2 days of wear time. Arch Dermatol2000;136:857-863.
44.
Veraart JC, Daamen E, Neumann HA.Short stretch versus elastic bandages: effect of time and walking. Phlebology1997;26:19-24.
45.
Taylor AD, Taylor RJ.A comparison of sub-bandage pressures produced with two multi-layer bandaging systems. J Wound Care1999;8(9):40-45.
46.
Veraart JCJM, Neumann HAM. Interface pressure measurements underneath elastic and non-elastic bandages. Phlebolgy Suppl1996;S2-S5.
RCN Institute. Clinical practice guidelines: the management of patients with venous leg ulcers. London: Author; 1998.
49.
Edinburgh Royal College of Physicians: Scottish Intercollegiate Guidelines Network. The care of patients with chronic leg ulcers. Edinburgh: Author; 1998.
50.
Moffatt CJ, O’Hare L.Venous leg ulceration: treatment by high compression ostomy. Wound Manage1995;41(4):16-25.
51.
Ruckley CV, Fowkes FGR, Bradbury AW.Venous disease: epidemiology, management, and delivery of care. London: Springer; 1999.
52.
Pun YLW, Barraclough DRE, Muirdeu KD.Leg ulcers in rheumatoid arthritis. Med J Aust1990;153(10):585-587.
53.
Margolis DJ, Berlin JA, Strom BL.Which venous ulcers will heal with limb compression bandages?Am J Med2000;109:15-19.
54.
Skene AI, Smith JM, Dore CJ, Charlett A, Lewis JD.Venous leg ulcers: a prognostic index to predict time to healing. Br Med J1992;305:1119-1121.
55.
Moffatt CJ, McCullagh L, O’Connor T, et al.Randomised trial comparing four layer with two layer high compression bandaging in the management of chronic leg ulceration. Proceedings of the 11th Conference of the European Wound Management Association, Dublin, 13, 2001.
56.
Hollinworth H.Nursing assessment and management of pain at wound dressing changes. J Wound Care1995;4(2):77-83.
57.
Franks PJ, Moffatt CJ.Who suffers most from leg ulceration?J Wound Care1998;7(8):383-385.
58.
Muir Gray JA.Social aspects of peripheral vascular disease in the elderly. In: McCarthy S, editor. Peripheral vascular disease in the elderly. London: Churchill Livingstone1983. p. 191-199.
59.
Morison MJ, Moffatt CJ.The assessment and management of leg ulcers. 2nd ed.London: Mosby Year Book; 1994.
60.
Callam MJ, Ruckley CV, Dale JJ, Harper DR.Hazards of compression treatment of the leg: an estimate from Scottish surgeons. Br Med J1987;295:1382.
61.
Fletcher A, Cullum N, Sheldon TA.A systematic review of compression treatment for venous leg ulcers. Br Med J1997;315:576-580.
62.
Taylor A, Taylor RJ, Marcuson RW.Prospective comparison of healing rates and therapy costs for conventional and four layer high compression bandaging treatments of venous leg ulcers. Phlebology1998;13:20-24.
63.
Marston WA, Carlin RE, Passman MA, Farber MA, Keagy BA.Healing rates and cost efficacy of outpatient treatment for leg ulcers associated with venous insufficiency. J Vasc Surg1999;September:491-498.
64.
O’Brien JF, Grace PA, Perry IJ, Burke PE.Randomised controlled trial: cost effectiveness of four-layer compression bandaging in venous leg ulcer care. Proceedings of the 11th Conference of the European Wound Management Association, Dublin, 63, 2001.
65.
McKirdy L, Greenwood J, Dunn K.A prospective randomised controlled study to compare the non-surgical management of pre-tibial lacerations. Proceedings of the 11th Conference of the European Wound Management Association, Dublin, 29, 2001.
66.
Marlow S.System four: the four layer bandage system from SSL international. Br J Nurs1999;8(16):1104-1107.
67.
Ballard K, McGregor F, Baxter H.An evaluation of the Parema four layer bandage system. Br J Nurs2000;19(16):1089-1094.
68.
Simpson C, Johnson BJ.An in vitro investigation of multi-layer bandages. J Wound Care1998;17(4):182-186.
69.
Thomas S.High compression bandages. J Wound Care1996;5(1):40-43.
70.
McCollum CN, Ellison DA, Groarke L, et al.Randomised trial comparing Profore and the original four layer bandage. Proceedings of the Conference of the European Wound Management Association, Milan, London, Macmillan, 8, 1997.
71.
Moffatt CJ, Ellison DA, Franks PJ, et al.Randomised trial comparing two four layer bandage systems in the management of chronic leg ulceration. Phlebology1999;14:139-142.
72.
Vowden KR, Mason A, Wilkinson D, Vowden P.Comparison of the healing rates and complications of three four layer bandage systems. J Wound Care2000;9(60):269-272.
73.
Moffatt CJ, Wright DDI, Franks PJ, Oldroyd M, Greenhalgh RM, McCollum CN.Healing chronic venous ulcers: a community perspective. Phlebologie. In: Davy A, Stemmer R, editors. Paris: John Libbey, Eurotext; 1989. p. 1139-1141.
74.
Lambourne LA, Moffatt CJ, Jones AC, Dorman MC, Franks PJ.Clinical audit and effective change in leg ulcer services. J Wound Care1996;5(8):348-351.
75.
Cameron J, Hofman D, Poore S, Duby T, Cherry G, Ryan T.A retrospective trial in the treatment of venous leg ulcers. Clin Res Pract1996;3(3):95-100.
76.
Vowden KR, Barker A, Vowden P.Leg ulcer management in a nurse led, hospital-based clinic. J Wound Care1997;6(5):233-236.
Gupta AK, De Koven J, Lester R, Shear NH, Sauder DN.Open label study to evaluate the healing rate and safety of the Profore Extra four layer bandage system in patients with venous leg ulceration. J Cutan Med Surg2000;4(1):8-11.
79.
Loftus S, Wheatley C.Developing skills in leg ulcer nursing: the lessons learned. J Wound Care2000;9(10):483-487.
