Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article Title: Review of Adjustable Velcro Wrap Devices for Venous Ulceration
Authors: Stather PW, Petty C, Howar AQ
Journal: Int Wound J. 2019 Mar 21 [Epub ahead of print].
Reviewed by: Olivia Hammond, class of 2020, Temple University School of Podiatric Medicine

Introduction

Chronic venous ulceration affects 0.6% of the UK population and is typically caused by venous insufficiency in older adults. The skin breaks down in response to a surplus of edema in the lower extremities, thus causing wounds that take an extensive amount of time to heal and often reappear later. The current gold standard of treatment is multilayered compression. Compression therapy is a critical part of treatment because it helps decrease edema and venous hypertension, as well as increase lymphatic circulation. When comparing compression with wound dressing unaided, compression provides more pain relief and quicker wound resolution. Unfortunately, many patients are not compliant with their multilayer compression because of factors such as pain, bandage slippage, difficulty with application, inability to maintain cleanliness, and trouble finding shoes that fit the thick layers of dressing.

Methods

In recent years, there have been several studies on Velcro-based wraps, an alternative compression therapy for venous leg ulcers. The authors of this UK study reviewed a series of literature that focused on how the Velcro-based wraps affect the patient's quality of life with ulcer healing rates, expense, and amount of time for dressing change. These authors found that Velcro wraps are relatively easy to apply and remove, which may promote independence and self-care for these patients.

The authors used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) to select studies, and quality was assessed using the Joanna Briggs Institute criteria. After removing articles that did not meet criteria, 16 studies were included. One randomized trial compared the Velcro device with bandaging on patients with bilateral venous ulcers. There was significantly faster healing in patients with the Velcro-based wrap. However, there was a pattern of initial deterioration with increased exudate for the first three weeks before a dramatic improvement.

Results

Studies found a significant reduction in limb circumference and improvement of tissue density with the Velcro wraps. When looking at actual sub-bandage pressures, the Velcro provided 47mmHg at the ankle and 35mmHg at the knee, whereas four-layer bandaging provided 26mmHg at the ankle and 23mmHg at the knee.

There was a cutback in nursing time required by over 50%. To apply the Velcro wrap the visit took about 19-22 minutes, whereas the multilayer-bandaging visit took an average of 40 minutes. On top of this, the patients who had Velcro wraps required only one visit per week, thereby reducing calls by two thirds per week. Furthermore, this likely contributed to a cut in cost seen with the Velcro-based wrap. In a six-month period of treatment, average savings from reduced staff time went from 30,000 euros to 11,000 euros, and 19,000 euros were saved on bandages.

Conclusion

All articles included in this literature review reported improved patient compliance, decreased pain, better quality of life, and empowerment in those patients who used Velcro wraps. The wraps also allowed better hygiene because the patients were able to remove them to shower and could reapply them on their own. There is potential with the Velcro-based wraps, especially for those who have been unable to heal with multilayer bandaging, because those bandages can slacken and lose pressure between dressings, thus lowering efficacy. Velcro-based wraps could benefit the treatment of chronic venous ulceration; however, the results of this study are limited, and further testing and good quality evidence are needed to truly assess the rate of healing.

About the Author
Olivia Hammond graduated from Towson University in Maryland in 2015 with a Bachelor of Science in Biology. In the fall of 2016, she matriculated at TUSPM with a merit scholarship. She is currently the President of the Practice Management Club, the In-House Coordinator of the Student National Podiatric Medical Association (SNPMA), and an active member of the Sports Medicine Club. Olivia holds a special interest in wound care, trauma, and reconstructive surgery.

Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.