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Comparing 2-Layer (Dual Compression System*) with Traditional 4-Layer Compression Therapy

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David Houserman

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In the wound care community, compression therapy is standard of care for edema control and wound healing for several conditions, including venous insufficiency ulcers, mixed arteriovenous insufficiency ulcers, and other lower extremity wounds complicated by edema. Compression therapy is used to reduce inflammation, aid in fluid collection, help decrease pericapillary cuffing, and remove toxins such as lactic acid. Satisfactory compression includes consistent application, patient compliance, and exudate management with the goal to allow continuous, sustained, therapeutic pressure compression that is comfortable for the patient and that subsequently leads to better compliance.1

The most common bandage systems are single, long-stretch bandages; paste bandages; and multilayer compression systems. Single, long-stretch bandages require a daily reapplication; as such, they may be most beneficial in wounds that require daily dressing changes along with edema management.2 Paste bandages customarily are impregnated with zinc oxide or calamine. Paste boots often are uncomfortable and provide sustained compression only while the patient is ambulating. These bandages may lose sustained compression after 24 hours’ use.

Most wound centers use multilayer systems as the gold standard. These compression systems come in prepackaged kits and have been found to be more effective than traditional paste boots or single, long-stretch bandages. Multilayer wraps comprise either a 3-layer or 4-layer system. Three (3)-layer systems consist of a padded layer, compression layer, and an outer layer to keep the system intact; 4-layer systems feature an additional layer for exudate management.

These graduated compression systems are claimed to provide 30 mm Hg to 40 mm Hg of pressure, maintain constant compression for approximately one week, and are not dependent on ambulation.3

Dual Compression System*
This system is an easy-to-apply, 2-layer compression bandage that features the Dual Compression System*, designed to optimize the safe application of the recommended therapeutic pressure and increase patient compliance. This system provides the same high standard compression provided by 4-layer bandage systems. Numerous clinical studies, including a large randomized controlled trial (RCT), have proven the ability of the wrap system to provide the 3 Cs of a good compression wrap — Consistency, Continuity, and Comfort.4-8

The first layer of the system includes wadding of viscose and polyester and a knitted layer of polyamide and elastane. This white, short-stretch bandage provides compression, protection, and absorbency. Layer 2 is comprised of acrylic, polyamide, and elastane; this pink/beige cohesive long-stretch bandage layer provides the additional compression necessary to achieve the therapeutic pressure for leg ulcers and secures the bandage system in place. Both layers in the 2-layer compression bandage that features the Dual Compression System* contain ovals that turn into circles when the appropriate tension is applied to the material. The latex-free system comes in 2 sizes depending on the circumference measured 2 cm above the patient’s malleous. Figure 1 shows proper application.

Observational Study
A study was conducted to compare traditional 4-layer compression with the Dual Compression System*.

Participants included patients (who all had previously used a 4-layer compression system) and staff at a single community wound care center at which staff apply approximately 8000 compression wraps per year. Patients who received the Dual Compression System* completed a survey comparing their experience with the DCS* with a traditional 4-layer multilayer compression wrap that they had received before using the DCS*. The staff member removing the wrap answered the relevant questions. All responses were recorded as Yes, No, or Neutral. Patients were asked two questions: one regarding comfort and one about stickiness to clothing and bed linen (a common complaint with the traditional dressing). Staff (with an average experience applying compression wraps of 8 years) were provided one training session on the 2-layer system and also were asked 2two questions: one about whether the Dual Compression System* stayed in place and one regarding how well it managed exudate. Additionally, a Juzo Pressure Monitor (J&B Medical, Inc) was used to measure the compression provided by the DCS* or 4-layer compression therapy after initial application at bedside. Pressures were recorded 10 cm proximal to the lateral malleolus. The same compression wrap was utilized when a patient required bilateral wraps.

The 53 patient participants had a total of 62 leg ulcers. Of these, 31 legs were wrapped with Dual Compression System* and 31 with a traditional 4-layer compression wrap. Among the 4-layer compression users, 13 wraps (42%) were applied within the therapeutic range of pressure. In the DCS* group, 27 (87%) were within the therapeutic range. Among the 43 surveys completed, 30 patients responded the 2-layer system was more comfortable than the 4-layer system, five thought it was less comfortable, and eight were neutral. Thirty-four (34) thought the 2-layer system was not as sticky as the 4-layer system, one thought it was not less sticky, and eight were neutral. All staff believed the 2-layer system remained in place better in this observational study than the 4-layer system; 25 believed the 2-layer system offered greater absorption (fewer moisture-wicking products were needed to keep the periwound bed dry), one did not find this to be the case, and 17 were neutral.

Results of this comparison showed that, similar to what has previously been observed,5 even experienced practitioners fail to consistently deliver adequate therapeutic pressures (i.e., 30 mm Hg to 40 mm Hg) using a 4-layer compression system, while they have better success with the Dual Compression System*. The majority of the 4-layer wraps were at subtherapeutic pressure, which could potentially cause a delay in wound closure and healing. The wound care center staff had never before only utilized the Dual Compression System*, yet after one training session were better able to consistently obtain pressures within the desired therapeutic range utilizing the 2-layer system. Because the Dual Compression System* identifies (via the visual clue of ovals turning into circles) when the appropriate tension is applied, the user knows exactly how much pressure is applied with each layer. Thus, continuous, consistent, sustained compression is delivered without having to estimate the appropriate amount of stretch. Practitioners using traditional 4-layer systems need to estimate a 50% stretch, a process that can lead to great variability. Additionally, because 2 sizes are available, consistent compression can be applied no matter the size of the patient’s leg.

The DCS* guided system was easy to teach and after just one application and training, the staff was able to apply consistent, continuous, therapeutic compression along with better overall patient comfort. Utilizing the Dual Compression System* may improve time to wound closure, decrease costs to the clinic, and lead to overall improvement in patient adherence to compression therapy. The results we observed confirm many of the observations in previous clinical studies.4-8

1.Partsch H. Compression therapy of the legs. J Derma-tol Surg Oncology. 1991;17(10):799–805.
2. Moffatt C, Kommala D,Dourdin N, Choe Y. Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence. Int Wound J. 2009;6(5):386–393.
3. Milic DJ, Zivic SS, Bogdanovic DC, et al. The influence of different subbandage pressure values on venous leg ulcers healing when treated with compression thera-py. J Vascular Surg. 2010;51(3):655–661.
4. Jünger M, Ladwig A, Bohbot S, Haase H. Comparison of interface pressures of three compression bandaging systems used on healthy volunteers. J Wound Care. 2009;18(11):474–480.
5. Hanna R, Bohbot S, Connolly N. A comparison of in-terface pressures of three compression bandage sys-tems. Br J Nurs. 2008;17(20):16–24.
6. Benigni JP, Lazareth I, Parpex P, et al. Efficacy, safety and acceptability of a new two-layer bandage system for venous leg ulcers. J Wound Care. 2007;16(9):385–390.
7. Lazareth L, Moffatt C, Dissemond J, et al. Efficacy of two compression systems in the management of VLUs: results of a European RCT. J Wound Care. 2012; 21(1):553–565.
8. Young T, Connolly N, Dissemond J. UrgoKTwo Com-pression Bandage System made easy. Wounds Int. 2013;4(1). Available at: www.woundsinternational. com. Accessed March 27, 2020.

*UrgoK2 • This work was supported by Urgo Medical North America

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