Background: Chronic venous ulcers (CVUs) are a common and debilitating condition resulting from chronic venous insufficiency. Compression therapy remains the cornerstone of management. Among the various modalities, two-layered (2LB) and four-layered (4LB) compression dressings are widely used. This study compares the effectiveness of 2LB and 4LB systems in managing CVUs in a tertiary care setting in Tamil Nadu. Aim: To compare the healing outcomes, patient comfort, and recurrence rates between two-layered and four-layered compression dressings in the treatment of chronic venous ulcers. Materials and Methods: This prospective comparative study was conducted on 60 patients with CVUs, divided equally into two groups (2LB and 4LB). Patients were followed up weekly for 12 weeks. Ulcer size, time to healing, pain (VAS score), and patient satisfaction were recorded. Recurrence was assessed at 3 months post-healing. Data were analyzed using appropriate statistical tools. Results: The 4LB group showed significantly faster healing (mean 9.1 weeks vs. 11.2 weeks, p < 0.05). Mean reduction in ulcer size was greater in the 4LB group (68.5% vs. 54.3%). Patient comfort and satisfaction scores were higher with the 4LB system. Fewer follow-up visits and lower recurrence rates (13.3% vs. 26.7%) were noted in the 4LB group, though the latter was not statistically significant. Conclusion: Four-layered compression dressing is more effective than two-layered dressing in promoting healing, improving comfort, and reducing recurrence in chronic venous ulcer patients. It should be considered the preferred modality in resource-adequate settings.

Chronic venous ulcers, Compression therapy, Two-layered dressing, Four-layered dressing, Ulcer healing.