Compression therapy in patients with venous leg ulcers

Abstract

Summary Wund‐D.A.CH. is the umbrella organization of the various wound care societies in German‐speaking countries. The present consensus paper on practical aspects pertinent to compression therapy in patients with venous leg ulcers was developed by experts from Germany, Austria, and Switzerland. In Europe, venous leg ulcers rank among the most common causes of chronic wounds. Apart from conservative and interventional wound and vein treatment, compression therapy represents the basis of all other therapeutic strategies. To that end, there are currently a wide variety of materials and systems available. While especially short‐stretch bandages or multicomponent systems should be used in the initial decongestion phase, ulcer stocking systems are recommended for the subsequent maintenance phase. Another – to date, far less common – alternative are adaptive Velcro bandage systems. Medical compression stockings have proven particularly beneficial in the prevention of ulcer recurrence. The large number of treatment options currently available enables therapists to develop therapeutic concepts geared towards their patients’ individual needs and abilities, thus resulting in good acceptance and adherence. Compression therapy plays a crucial role in the treatment of patients with venous leg ulcers. In recent years, a number of different treatment options have become available, their use and application differing among German‐speaking countries. The present expert consensus is therefore meant to outline concrete recommendations for routine implementation of compression therapy in patients with venous leg ulcers.

Pathogenesis of wound healing disorders in the elderly

“…For example, patients with peripheral artery disease will greatly benefi t from revascularization and ruling out metabolic disorders such as diabetes [ 74 ] , whereas those with venous insuffi ciency tend to benefi t from compression therapy [ 81 ] as well as surgical or endovenous treatment [ 82 ] . Glycemic control, regular tests of protective sensation, pressure mitigation, appropriate perfusion, and infection control constitute top priorities in the prevention and treatment of diabetic foot ulcers [ 83 ] .…”

“…Je nach Ursache können völlig unterschiedliche therapeutische Regimes erforderlich sein. Patienten mit peripherer arterieller Verschlusskrankheit beispielsweise profi tieren erheblich von einer Revaskularisierung und dem Ausschluss von Diabetes [ 74 ] , während Patienten mit Veneninsuffi zienz eher aus einer Kompressionstherapie [ 81 ] sowie einer Operation oder einer endovenösen Behandlung Nutzen ziehen [ 82 ] . Kontrolle des Blutzuckerspiegels, regelmäßige Tests auf Empfi ndungsverlust, Druckminderung, ausreichende Durchblutung und die Kontrolle von Infektionen haben höchste Priorität bei der Prävention und Behandlung diabetischer Fußulzera [ 83 ] .…”

Systemische Therapien des Ulcus cruris

“…Weitere Diagnostik ist nur zum Ausschluss von Differentialdiagnosen erforderlich. Die Therapie sollte, wann immer möglich, kausal orientiert erfolgen und mindestens eine suffiziente Kompressionstherapie beinhalten . Vorhandene strukturelle Veränderungen sollten, wenn möglich, ablativ oder operativ eradiziert werden .…”

“…Bei den die Wundheilung behindernden Kofaktoren, kommt der Behandlung von Ödemen die größte praktische Bedeutung zu. So sollte nicht nur bei Patienten mit CVI und Lymphödemen, sondern bei allen Arten von Ödemen konsequent eine Kompressionstherapie durchgeführt werden . Der Stellenwert der systemischen Therapien bei Patienten mit Ulcus cruris, wird in Abhängigkeit der Genese sehr unterschiedlich und oft kontrovers beurteilt.…”

Chronic Venous Insufficiency

“…Compression therapy should apply moderate pressure (20 to 30 mmHg) for patients with varicose veins who are not qualified endovenous ablation. However compression therapy is especially important in the treatment of healing leg ulcers (Dissemond, et al, 2016). Despite the clinical effectiveness of compression stockings, there are many limitations to their application, including poor compliance.…”