Comparing 2-Layer With Traditional 4-Layer Compression Therapy

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. In our experience, 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 1 week, and are not dependent on ambulation.³

UrgoK2.  UrgoK2 (URGO Medical) 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 UrgoK2 system (KTECH) 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 (KPRESS) 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 UrgoK2 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.

A study was conducted to compare traditional 4-layer compression with the UrgoK2 Dual Compression System.

Methods. 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 UrgoK2 wrap completed a survey comparing their experience with the UrgoK2 compression wrap with a traditional 4-layer multilayer compression wrap that they had received before using the UrgoK2 system. The staff member removing the wrap answered the relevant questions. All responses were recorded as Yes, No, or Neutral. Patients were asked 2 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 2 questions: one about whether the UrgoK2 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 UrgoK2 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 UrgoK2 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 UrgoK2 group, 27 (87%) were within the therapeutic range (see Figure 2).

Among the 43 surveys completed, 30 patients responded the 2-layer system was more comfortable than the 4-layer system, 5 thought it was less comfortable, and 8 were neutral. Thirty-four (34) thought the 2-layer system was not as sticky as the 4-layer system, 1 thought it was not less sticky, and 8 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), 1 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 (ie, 30 mm Hg to 40 mm Hg) using a 4-layer compression system, while they have better success with the UrgoK2 system. The majority of the 4-layer wraps were at subtherapeutic pressure, which is not optimal for the healing process and could potentially cause a delay in wound closure and healing. The wound care center staff had never before only utilized the UrgoK2 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 UrgoK2 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 circumference of the patient’s leg.

The UrgoK2 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 UrgoK2 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 The results we observed confirm many of the results observed in previous clinical studies.^4-8