Case report 24 Journal of Lymphoedema, 2013, Vol 8, No 2 Malou van Zanten, Beth Kean Use of a two-layer compression system in severe bilateral leg lymphoedema with ulceration: A case report R esearch into the beneits of compression on venous congestion and associated ulceration has been widely documented (Milic et al, 2010; Stucker et al, 2013). However, research into the correct level of compression for lymphoedema is diicult to obtain, most likely due to a lack of inclusion of rigorous undergarment pressure measurements in reports. he preferred method of lymphoedema treatment is usually compression of the limb, due to its ability to enhance venous return, reduce capillary iltration, and increase lymphatic reabsorption and the breakdown of ibrotic tissue (Mofat et al, 2011; Muldoon and Charles, 2013). It is vital that, during the intensive treatment phase for lymphoedema, the compression garment does not hinder an individual’s range of movement to ensure maximum lymph low from the afected area. It has been documented that muscle contraction while wearing compression produces a higher peak in blood and lymph low velocity (Partsch and Mofat, 2012). Australian community (Barker and Weller, 2010). Chronic leg ulcers are believed to afect more than 3% of the population aged ≥65 years, with a 56% chance of reoccurrence within 3 months of healing (Barker, 2010). Case study A 61-year-old Caucasian male (Patient X) presented at the Lymphoedema Research Unit at Flinders University in April 2013 with severe bilateral lymphoedema, that had persisted since 2009. He had received several intensive reduction treatments since that time; however, due to high treatment costs, he ceased them in early 2011. he patient reported that in March 2008 he had multiple ibromas removed from the groin. he ibromas penetrated deeper than initially anticipated. Within 2 days of surgery, the postoperative deep tissue wounds had become infected, and the participant was admi ted for multiple daily dressing changes. hree days later, the wounds showed signs of continued breakdown and an increase in necrotic tissue. Patient X was immediately admi ted to Abstract Background: In this case report the authors present an individual with a medical history of severe bilateral leg lymphoedema, multiple bilateral ulceration, type 2 diabetes, and morbid obesity. Aim: To determine the eicacy of a commercially available compression system (Coban™ 2 Compression System; 3M) on an individual with severe bilateral leg lymphoedema, and multiple bilateral ulceration. Methods: Employing the Coban 2 Compression System toe-boot bandaging technique, objective and subjective data on leg volume, tissue compositional changes and wound healing were collected at baseline and three times per week over a 4-week follow-up period. Under-bandage pressures were controlled using a pressure monitor during bandage application. Results: he patient’s total limb volume decreased during treatment; circumference volume measurements showed a 3 L reduction in the let leg, and a 1.3 L reduction in the right leg. Limb volume decreased by 2.1 L in the let leg, and 2.1 L in the right. Bioimpedance spectroscopy data measured a reduction of 3.2 L in the let leg and 3.0 L in the right leg. Tissue luids reduced by 55% in the supericial tissue of both calves during the intervention period. he reduction of the total wound size was 21.7 cm 2 in the let leg and 19.95 cm 2 in the right leg. Conclusion: Treatment with Coban 2 Compression System improved wound healing and decreased leg volume in the present case. Key words Chronic ulcer, compression, lymphoedema, wound healing Malou van Zanten, Research Oicer and PhD candidate, Lymphoedema Research Unit, Department of Surgery, School of Medicine, Flinders University, South Australia, Australia. Beth Kean, Lymphoedema Research Unit Coordinator, Lymphoedema Research Unit, Department of Surgery, School of Medicine, Flinders University, South Australia, Australia Declaration of interest: None. he Coban™ 2 Compression System (3M) is a two-layer, latex-free, self-adherent compression bandage. Its rigidity and inelastic properties ensure a high working pressure and low resting pressure. he Coban 2 Compression System has been shown to be useful in lymphoedema reduction and venous ulcer healing in multicentre, randomised, controlled trial setings (3M, 2011; Mofat et al, 2011; Morgan et al, 2011). hese studies account for the user-friendliness of the application for the clinician, as well as monitoring slippage, patient comfort, and mobility. he burden of chronic wounds Chronic nonhealing wounds frequently occur in the later stages of lymphoedema. hey are especially problematic in the lower legs due to their dependency. Chronic wounds can be costly and are a major public health problem in addition to signiicantly reducing the quality of life of the afected person (Agale, 2013). A high incidence of venous ulcers and recurrence has been reported within the