Four-layer bandaging and healing rates of venous leg ulcers.

This paper reports the healing rates of venous leg ulcers in a community setting (Exeter and District Community Health Services NHS Trust) using the Charing Cross four-layer compression system. We report on 514 venous leg ulcers and show healing rates of 40% at 12 weeks, 50% at 17 weeks, 57% at 24 weeks and 80% predicted at 2 years. Patients were treated in one of 16 community leg ulcer clinics or in their homes. Nurses were allowed to use this system only after full training by the leg ulcer management service. Nurses had to prove their competence in leg ulcer assessment, Doppler measurement and the technique of four-layer compression. Even in patients whose leg ulcers did not heal, it was felt that the four-layer compression system was comfortable, convenient and cost effective with only weekly changes of bandages being necessary.