Early outcomes of four-layer compression therapy in chronic venous ulcers: A 2-year prospective study in resource-limited setting

Introduction Venous leg ulcers represent the most advanced stage of chronic venous insufficiency and are associated with significant morbidity and reduced quality of life. Compression therapy is the cornerstone of management, with four-layer compression dressing widely regarded as the standard of care. However, evidence regarding its effectiveness in resource-limited settings remains limited. This study aimed to evaluate the early clinical outcomes of four-layer compression therapy in patients with venous leg ulcers. Methods This prospective observational study included 39 patients treated with four-layer compression therapy over a 2-year period. Baseline demographics, ulcer characteristics, and comorbidities were recorded. Ulcer size, exudate, pain score, and Venous Clinical Severity Score (VCSS) were assessed at baseline and follow-up. The primary outcome was reduction in ulcer area at 4 weeks, while secondary outcomes included time to healing, symptom improvement, and complications. Results The mean age was 44 ± 10.55 years, with a male predominance (1.29:1). A prior history of deep vein thrombosis was documented in 92.3% of patients which was consistent with ultrasound finding of chronic DVT. The mean baseline ulcer area was 16.88 ± 14.65 cm 2 , with a duration of 5.6 ± 2.6 months. At 4 weeks, ulcer area reduced by 91 ± 5.66%, leaving a residual area of approximately 1.5 cm 2 . Mean healing time was 4 ± 2 weeks. VCSS improved significantly from 25 ± 4.55 to 16 ± 3.88 (p < 0.001). Exudate and pain scores improved by 90% and 95%, respectively. Minor complications included maceration, dermatitis, and infection. Conclusion Four-layer compression therapy demonstrated excellent early healing and clinical improvement, supporting its effectiveness in resource-limited settings.