title: Comparative systematic review and meta-analysis of compression modalities for the promotion of venous ulcer healing and reducing ulcer recurrence.
abstract: OBJECTIVE
  This was a systematic review of the literature to determine which compression method is superior in promoting ulcer healing and reducing recurrence in patients with lower extremity venous ulcer disease.
  
  
  METHODS
  We conducted a comprehensive search of multiple databases for randomized and nonrandomized comparative studies from 1990 to December 2013.
  
  
  RESULTS
  We identified 36 studies and two Cochrane systematic reviews. Many studies had moderate risk of bias. We found no overall difference between compression stockings vs compression bandages with respect to ulcer healing, time to ulcer healing, or ulcer recurrence outcomes. When we compared stockings vs short stretch bandages, stockings were superior with respect to ulcer healing. However, stockings compared with four-layer systems showed no difference in ulcer healing outcomes. When four-layer systems were compared with compression with less than four layers, there was also no significant difference in ulcer healing outcomes. Similarly, short stretch bandages were not superior to long stretch bandages with respect to ulcer healing, time to ulcer healing, or ulcer recurrence. One Cochrane review presented many additional comparisons and reported increased wound healing with compression compared with no compression, with multicomponent systems over single component systems, and compression systems with an elastic component over no elastic component. Another Cochrane review demonstrated a reduction in recurrence with compression in patients with healed ulcers.
  
  
  CONCLUSIONS
  At least moderate-quality evidence supports compression over no compression, multicomponent systems over single component systems, and systems with an elastic component over those without. We did not find significant differences with respect to ulcer healing outcomes for other comparisons. Low-quality evidence supports the effect of compression on ulcer recurrence.
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Karen F
authors.initials: KF
authors.lastname: Mauck
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Noor
authors.initials: N
authors.lastname: Asi
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Tarig A
authors.initials: TA
authors.lastname: Elraiyah
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Undavalli
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nabhan
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Osama
authors.initials: O
authors.lastname: Altayar
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
authors.forename: Mohamad Bassam
authors.initials: MB
authors.lastname: Sonbol
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D058128:Compression Bandages / Q000009:adverse effects; D004548:Elasticity; D004867:Equipment Design; D006801:Humans; D016017:Odds Ratio; D012307:Risk Factors; D055502:Secondary Prevention; D053828:Stockings, Compression / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000175:diagnosis / Q000628:therapy*; D014945:Wound Healing