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Randomized clinical trial and economic analysis of four‐layer compression bandaging for venous ulcers. BJS 2003; 90: 794-798.

Published: 12th June 2003

Authors: J. F. O'Brien, P. A. Grace, I. J. Perry, A. Hannigan, M. Clarke Moloney, P. E. Burke et al.


The aim of this study was to compare the cost‐effectiveness of four‐layer compression bandaging for venous leg ulcers with that of other available treatments.


In this pragmatic trial, 200 patients with a venous leg ulcer were randomized either to four‐layer bandaging (intervention group; n = 100) or to continue their usual system of care (control group; n = 100). The follow‐up for each patient was 12 weeks. Analysis was by intention to treat; the main outcome measures were time to healing and cost to the health board per leg healed.


Baseline characteristics were well matched in the two groups. The Kaplan–Meier estimate of the healing rate at 3 months was 54 per cent with four‐layer bandaging and 34 per cent in the control group. Throughout the 3 months, four‐layer bandaging healed leg ulcers significantly earlier (P = 0·006). There was a significant reduction in the median cost per leg healed with four‐layer bandaging (€210 versus €234; P = 0·040).


Four‐layer bandaging is currently the most effective method of treating venous leg ulcers in a community setting. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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