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There is growing evidence on an interconnection between the venous and lymphatic systems in venous leg ulceration, and the possible effects of prolonged oedema and lymphatic impairment in delayed wound healing. Compression therapy is a widely accepted treatment for venous and lymphatic disorders, as it decreases recurrence rates and prolongs the interval between recurrences. Compression bandages improve venous return, increase the volume and rate of venous flow, reduce oedema and stimulate anti-inflammatory processes. The pressure at the interface (IP) of the bandage and the skin is related to the elastic recoil of the product used and its resistance to expansion. The pressure difference between the IP in the supine and standing positions is called the static stiffness index (SSI). Elastic materials provide little resistance to muscle expansion during physical activity, resulting in small pressure differences between resting and activity, with an SSI <10mmHg. Stiff, inelastic materials with a stretch of <100% resist the increase of muscle volume during physical activity, producing higher peak pressures, an SSI of >10mmHg and a greater haemodynamic benefit than elastic systems. UrgoK2 is a novel dual-layer high-compression system consisting of an inelastic (short stretch) and elastic (long stretch) bandage, resulting in sustained tolerable resting pressure and elevated working pressures over extended wear times. It is indicated for the treatment of active venous leg ulcers and the reduction of chronic venous oedema. Each bandage layer has a visual aid to enable application at the correct pressure level. Published European studies have assessed this compression system, exploring its consistency of application, tolerability and efficacy. This article presents the first reports of health professionals' clinical experience of using the compression system in the US, where it has been recently launched. Initial feedback is promising.

Objective: To determine the in vivo effect of a sustained-release silver sulphadiazine powder foam dressing on the bacterial burden of venous leg ulcers (VLUs), with a view to correlating the wound closure rate with the degree of bioburden and to assess other markers of its progression towards healing., Method: Patients attending a tertiary care wound practice were screened for a VLU bacterial count of >105 colony forming units (cfu/g) per gram of tissue. Patients were treated with the above topical dressing plus multilayer compression bandaging for 12 weeks. Quantitative cultures were taken at weeks 0, 2, 4 and 8. Wounds were assessed at each weekly visit using photography and planimetry., Results: Twenty-four of the 33 screened patients met the inclusion criteria. The average baseline wound size was 12.3 cm². At week 8, the bioburden had reduced to < 105 cfu/g in 54.2% of patients, with 41.7% achieving this reduction by week 2. At week 8, the median reduction was 0.7 log¹⁰ (p < 0.001). The median percentage reductions in bioburden were 50.5%, 56.8% and 80.4% at weeks 2, 4 and 8 respectively. Over the study period, 79.2% of the patients had > 75% wound area reduction and 45.8% achieved ulcer closure in a median of 80.5 days., Conclusion: Although the wound size and bacterial counts reduced significantly, there was no statistical correlation between the two. Nevertheless, the in vivo data show that this active antimicrobial dressing was associated with a very high healing rate in these hard-to-heal wounds.