Revisiting Compression Therapy for Venous Leg Ulcers: Institutional Experience With a Locally Developed Multilayer Bandage and Implications for Resource-Limited Settings

Background: Venous leg ulcers (VLUs) represent the most advanced stage of chronic venous disease and pose significant morbidity and socioeconomic burden, particularly in low-and middle-income countries.Compression therapy is the cornerstone of management; however, access to optimal multilayer systems is limited.This study evaluated the efficacy of a locally developed multilayer compression bandage compared with a conventional single-layer long stretch elastic compression bandage (SLB) in the management of VLUs in an Indian population.Methods: A prospective observational study was conducted between 2019 and 2025 at a tertiary academic center, Kasturba Medical College, Manipal, in southern India.Patients with VLUs were treated with either a four-layer compression bandage (4LB) or an SLB.The primary outcome was complete ulcer healing within six weeks; secondary outcomes included reduction in limb edema and identification of factors influencing healing.Results: A total of 192 patients were included (96 per group).Complete healing occurred in 78 patients (81.3%) in the 4LB group versus 52 patients (54.2%) in the SLB group (p = 0.013).The mean weekly ulcer healing rate was higher with 4LB (4.2 ± 1.1 cm² vs. 1.1 ± 0.6 cm²; p < 0.001), and the mean time to complete healing was shorter (2.13 ± 1.13 vs. 2.88 ± 1.03 weeks; p = 0.004).Conclusions: This locally developed multilayer compression system achieved superior healing and faster recovery.Its affordability, durability, and low maintenance make it a practical and effective option for VLUs in resource-limited settings.