Compression therapy improves healing rates for venous leg ulcers. High-compression multilayered therapy appears to be more effective than medium or low compression, but there is uncertainty over which high-compression therapy is best. Compression bandages and stockings reduce recurrence rates, but the overall evidence is limited.

• Compression versus no compression: one systematic review (search date 2000, six randomized controlled trials [RCTs], n = 260) and one additional RCT (n = 200) showed that multilayered elastomeric high-compression bandages, short-stretch bandages, double-layered bandages, compression stockings, and Unna's boots healed more ulcers compared with no compression (dressing alone, non-compression bandages, usual care). The RCTs were considered heterogeneous, using different forms of compression in different settings and populations [Cullum et al, 2001].
• Different high-compression regimens: one systematic review (search date 2000, three RCTs, n = 285) [Cullum et al, 2001] and two RCTs showed no overall difference in healing rates between the original 'Charing Cross' 4-layered high-compression regimen compared with other high-compression regimens (commercial kits and 2-layered system). One RCT (n = 133) found that 3-layered paste significantly increased healing rates compared with 4-layered bandages [Moffatt et al, 2003; Iglesias et al, 2004; Nelson et al, 2006].
• Multilayered high-compression versus short-stretch bandages or Unna's boot: one systematic review (search date 2000, four small RCTs, n = 164) [Cullum et al, 2001] and three subsequent RCTs showed no significant difference in healing rates between all three therapies. Two additional RCTs suggested that 4-layered compression increased healing rates compared with short-stretch bandaging [Nelson et al, 2006]. However, overall there was no clear evidence of a difference in healing rates. It is difficult to pool data and draw conclusions, given that most of the studies reported various endpoints for healing and did not provide survival data [RCN, 2006].
• Multilayered high-compression versus single-layered bandages: one systematic review (search date 2000, four RCTs, n = 280) [Cullum et al, 2001] found a significant increase in the proportion of people whose reference ulcers had healed with multilayered compression compared with single-layered compression (56% with multilayered versus 42% single-layered, RR 1.41, 95% CI 1.12 to 1.77) [Nelson et al, 2006].