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Randomised clinical trial of three-layer tubular bandaging

Supplier: Sutherland Medical
20 November, 2013

The purpose of this study was to assess the effectiveness, acceptability, and cost of the SS compression bandage compared with the 3L bandage for the treatment of VLUs.

We hypothesized there would be no difference in wound size reduction with 3L bandage system when compared with SS.3L straight bandage (Tubular-Form, Sutherland Medical, Oakleigh, Vic., Australia), Lastolan, Hartmann, two layers.

Compression in both groups was applied over a padding layer (Tubular Plus, Sutherland Medical) to protect underlying bony prominences and prevent skin breakdown. Healed ulcers was higher for the 3L group (17/23 (74%) vs.10/22 (46%)). Both groups reported high levels of compliance and tolerability for the bandages and there were no significant between-group differences.

Costs per healed ulcer per bandage

Application time for the 3L bandage was approximately 30 minutes. 3L tubular bandage was replaced weekly at an average cost of $2 per week resulting in a cost per visit for the 3L group of $25. SS group application was reported by nurses to take approximately 1 hour per visit.

The cost for the SS was $66 per patient irrespective of number of visits. The cost per week for the SS group was $46 with the bandage costs added to the cost of the baseline (week 0) giving a week 0 cost of $112. The median total cost over the treatment period for the 3L group was $200 (range $25, $300) and for the SS group was $618 (range $158, $618; Wilcoxon rank-sum test p = 0.0001).

The estimated difference in amplitude of SBP between the bandages during exercise was 15.5 mmHg (95% CI 12.2, 18.9). It is known that SS bandages lose pressure over time The 3L bandage delivered lower SBP than SS in the in vivo study yet still showed potential for improved healing in this clinical trial. To our knowledge, there are no clinical trials of the 3L system even though it is a commonly used compression system in Australia.

A previous non-comparative study treated 28 patients who were unable to tolerate standard compression with three layers of graduated Tubigrip (tubular bandage; Medshop Australia, Preston, Australia) as an alternative to therapeutic compression.

They reported 50% of the group healed in the 12-week treatment period with a mean reduction in ulcer area of 4.6 cm2.12  The strengths of our study include in vivo SBP measurement of both 3L and SS17 prior to the study as recommended by international experts,16,20,21

Here we report the first randomised controlled trial comparing 3L bandage for wound healing. We found 3L bandages can heal VLUs and the finding is worth further exploration particularly in view of minimal cost per ulcer healed for the 3L bandage and because it can be applied with relative ease compared with SS. Further work is required to explore whether 3L bandage should be adopted as main stay treatment for VLUs in the community.

The potential impact of early adoption of weekly 3L bandages by community and general practice nurses may have benefits, with significant cost savings in terms of reduced bandage costs, reduced time nurses spent bandaging, and improved healing. Greater investment is required to monitor outcomes at a population level on patients who present with VLUs and to ensure that practice is in line with established evidence-based practice guidelines.

Sutherland Medical provided Tubular-Form Bandages but had no role in data collection, statistical analysis, or writing of this manuscript or the decision to submit for publication. Bale S, Harding KG. Managing patients unable to tolerate therapeutic compression. Br J Nurs 2003; 12 (19 Suppl.): S4–13.