title: What is the existing evidence supporting the efficacy of compression bandage systems containing both elastic and inelastic components (mixed-component systems)? A systematic review.
abstract: OBJECTIVE
  To analyse current evidence on the efficacy of bandage systems containing both elastic and inelastic components (mixed-component systems).
  
  
  BACKGROUND
  International consensus on the efficacy of types of compression systems is difficult to achieve; however, mixed-component systems are being promoted as combining the best properties of both elastic and inelastic bandage systems and increasingly being used to treat venous leg ulcers in practice.
  
  
  METHODS
  A systematic literature review.
  
  
  METHODS
  Search terms such as venous leg ulcer, varicose ulcer, leg ulcer, compression, bandage, elastic, inelastic, short stretch, healing rate, interface pressure, mixed component, two-layer, four-layer and multi-layer were used in database and hand searches in several combinations. Limits were set for years 2005-March 2015 and English-language publications.
  
  
  RESULTS
  A total of 475 studies were identified at initial search, and following elimination from abstract and title, this was reduced to 7. A further study was identified on Google Scholar, bringing the final number of studies fitting inclusion criteria to 8. The following subgroups relating to outcomes of efficacy were identified: ulcer healing, maintenance of interface pressure, slippage, ease of application and patient quality of life.
  
  
  CONCLUSIONS
  Mixed-component systems were found to have comparable ulcer healing rates to alternative compression systems and be easy to apply; have similar abilities to maintain pressure as four-layer bandages and better abilities than short-stretch bandages; have less slippage than alternative systems; and to be significantly associated with several favourable quality of life outcomes. Clinician skill in bandage application was an uncontrolled variable in all eight papers included in the review, which may limit reliability of findings.
  
  
  CONCLUSIONS
  This review synthesises existing evidence on the efficacy of mixed-component systems and encourages clinicians to regard them as an effective alternative to purely elastic or inelastic compression systems. Additionally, it highlights the importance of clinician skill in bandage application as a crucial determinant of effective compression.
authors.affiliation: University of the West of Scotland, Paisley, UK.
authors.forename: Lynn
authors.initials: L
authors.lastname: Welsh
mesh_terms: D002983:Clinical Competence; D058128:Compression Bandages; D004867:Equipment Design; D006801:Humans; D007871:Leg Ulcer / Q000628:therapy*; D011788:Quality of Life; D053828:Stockings, Compression; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000628:therapy*; D014945:Wound Healing / Q000502:physiology
keywords: literature review; quality of life; systematic review; venous leg ulcer; wound care