Clinical Outcomes of Venous Leg Ulcers Treated with Four-Layer Compression Bandage: A Prospective Study from a Tertiary Care Centre

Abstract

Background: Venous leg ulcer is the most severe manifestation of chronic venous disease and is associated with delayed healing, high recurrence and significant impairment of quality of life. Multicomponent compression systems are the cornerstone of management, and the four-layer compression bandage is widely used, but Indian prospective data remain limited.

Aim: To study the clinical outcome of patients with venous ulcer treated with a four-layer compression bandage in a tertiary care setting.

Methods: This observational prospective study was conducted in the Department of General Surgery of a tertiary care medical college and hospital from May 2020 to December 2021 (18 months). Thirty consecutive adult patients (>18 years) with clinically and duplex-confirmed venous disease presenting with venous leg ulcers and fulfilling predefined inclusion and exclusion criteria were enrolled. All patients underwent standard clinical assessment, bedside venous tests (Brodie–Trendelenburg, multiple tourniquet, modified Perthes), and arterial/venous Doppler evaluation. A standard four-layer compression bandage protocol was applied, and patients were followed up clinically. Ulcer characteristics (size, edge, bed, discharge), limb edema and early response at day 4 were recorded, along with subsequent progress until healing or last follow-up.

Results: A total of 30 patients with venous leg ulcers received four-layer compression bandaging. On assessment at day 4, 28 (93.3%) ulcers had developed healthy granulation tissue over the ulcer bed, 30 (100%) retained a sloping edge, 22 (73.3%) showed reduced or absent discharge, 23 (76.7%) demonstrated reduction in ulcer size, and 22 (73.3%) had significant reduction in limb swelling. No serious bandage-related complications were recorded during the early follow-up period. [To be updated with mean age, sex distribution, mean ulcer duration and overall time to complete healing based on thesis tables].

Conclusion: Four-layer compression bandage therapy provides favourable early clinical outcomes in patients with venous leg ulcers, with rapid improvement in ulcer bed granulation, reduction in exudate, size and limb edema. These findings support the routine use of multicomponent four-layer compression systems as a simple, effective and well-tolerated modality in the management of venous leg ulcers in resource-constrained tertiary care settings. Larger studies with longer follow-up are needed to confirm healing rates and recurrence outcomes.