Randomized controlled trial of four‐layer bandaging and simple venous surgery for venous ulceration

Background: No randomized controlled trials exist to show whether simple venous surgery benefits healing or maintenance of healing of venous ulcers. Methods: Some 121 consecutive patients with new episodes of venous ulceration were identified; 45 patients were unfit or unwilling for randomization. The remaining 76 (39 women) were assigned randomly to received a four‐layer bandage ( n = 39) or simple venous surgery ( n = 37). All patients were followed for a minimum of 6 months. Outcome was assessed at a minimum of 6 months as healing and health‐related quality of life (HRQL). Results: The two groups had similar co‐morbidity and pattern of venous incompetence. There were no major complications in either group. The healing rate was 64 per cent (25 of 39) in the conservatively treated group and 68 per cent (25 of 37) in the operated group ( P = 0·75, Pearson χ 2 test). There was no significant difference between time to ulcer healing in the two treatment groups (log rank statistic = 0·69, P = 0·41). Patterns of venous incompetence did not affect the healing rate. There were no major differences in HRQL between the two groups. Conclusion: This pilot study suggests that simple venous surgery gives no adjuvant benefit to four‐layer bandaging in venous ulceration from the point of view of healing rate and quality of life. © 2001 British Journal of Surgery Society Ltd