Effectiveness Of Four-Layer Compression Dressing Versus Single-Layer Compression Dressing in Post-Ablation Patients with Active Venous Ulcer: A Prospective Comparative Interventional Study

Abstract

Background
Chronic venous insufficiency is a common cause of lower-limb ulceration and is associated with venous hypertension, edema, skin inflammation and delayed wound healing. Endovenous ablation addresses superficial venous reflux but does not immediately resolve the local inflammatory and tissue changes associated with an established venous ulcer. Compression therapy therefore remains an important component of post-ablation management. Evidence from randomized controlled trials and systematic reviews has demonstrated that compression improves venous ulcer healing and that multi-component compression systems may be more effective than single-component systems [1-4]. Early treatment of superficial venous reflux with endovenous ablation has also been shown to accelerate ulcer healing when combined with compression therapy [11].
Aim
The aim of this study was to compare the effectiveness of four-layer compression dressing with conventional single-layer crepe-bandage compression in post-ablation patients with active venous ulcers.
Methods
This prospective comparative interventional study included 50 adult patients who had undergone successful endovenous ablation for chronic venous insufficiency and presented with an active venous ulcer in the treated limb. Patients were divided into two equal groups of 25 patients each. Group A received four-layer compression dressing and Group B received conventional single-layer crepe-bandage compression. Patients were assessed at baseline, Day 7, Day 14 and Day 28. The primary outcome was complete ulcer healing within 2 weeks. Secondary outcomes included healing after the first and second dressing, reported time to complete healing, cellulitis and requirement for wound debridement.
Results
In the four-layer group, 12 of 25 patients (48%) achieved healing after the first dressing and 13 patients (52%) achieved healing after the second dressing. Thus, all 25 patients (100%) in the four-layer group achieved complete healing within 2 weeks. In the single-layer group, no patient was reported to have achieved complete healing within 2 weeks, with a reported complete healing time of 4 weeks. The difference in complete healing within 2 weeks was statistically significant using Fisher’s exact test (p<0.001). Cellulitis occurred in two patients (8%) in the single-layer group and in none of the patients in the four-layer group. Both patients with cellulitis required wound debridement. The difference in cellulitis was not statistically significant (p=0.490).
Conclusion
Four-layer compression dressing was associated with faster healing of active venous ulcers following endovenous ablation compared with conventional single-layer crepe-bandage compression. Although the findings favour four-layer compression, larger randomized studies with standardized wound measurements, detailed baseline characteristics and longer follow-up are required to confirm the observed benefit.