Consistent application of compression: An under‐considered variable in the prevention of venous leg ulcers

Abstract

Venous leg ulcers, the most common leg ulcer, occur in patients with chronic venous insufficiency due to venous hypertension. Evidence supports the conservative treatment with lower extremity compression, ideally between 30-40 mm Hg. Pressures in this range provide enough force to partially collapse lower extremity veins without restricting arterial flow in patients without peripheral arterial disease. There are many options for applying such compression, and those who apply these devices have varying levels of training and backgrounds. In this quality improvement project, a single observer utilised a reusable pressure monitor to compare pressures applied using different devices by individuals in wound clinics with diverse training from specialties of dermatology, podiatry, and general surgery. Average compression was higher in the dermatology wound clinic (n = 153) compared to the general surgery clinic (n = 53) (35.7 ± 13.3 and 27.2 ± 8.0 mm Hg, respectively, p < 0.0001), and wraps applied by clinic staff (n = 194) were nearly twice as likely as a self-applied wrap (n = 71) to have pressures greater than 40 mm Hg (relative risk: 2.2, 95% confidence interval: 1.136-4.423, p = 0.02). Pressures were also dependent upon the specific compression device used, with CircAid ® s (35.5 mm Hg, SD: 12.0 mm Hg, n = 159) providing higher average pressures than Sigvaris Compreflex (29.5 mm Hg, SD: 7.7 mm Hg, n = 53, p = 0.009) and Sigvaris Coolflex (25.2 mm Hg, SD: 8.0 mm Hg, n = 32, p < 0.0001). These results indicate that the device-provided pressure may be dependent on both the compression device and the background and training of the applicator. We propose that standardisation in the training of compression application and increased use of a point-of-care pressure monitor may improve the consistency of applied compression, thus improving adherence to treatment and outcomes in patients with chronic venous insufficiency.

Haemodynamic effect of a leg compression bandage on the distal posterior tibial artery using 4D flow magnetic resonance imaging: A quantitative study

“…Compression therapy is one of the most common therapeutic approaches for certain vascular pathologies of the lower limb and their consequent skin ulcers. 1 , 2 Regarding ulcers associated with circulatory impairment of the lower limb, almost 1% of the world's population is affected, with a higher prevalence in the elderly population. 3 About 81% of the ulcers have a venous origin, and 16.3% are directly related to peripheral arterial disease.…”

“…3 Peripheral vascular pathology entails high costs and a decrease in patients' quality of life. 4,5 Compressive bandaging is the most widely used and effective therapy for high-pressure venous ulcers, 2,5,6 although there is no consensus about the most adequate application method. 7,8 The application of compression bandage has been considered a contraindication in the presence of arteriopathy due to the possible association of an ischemic effect induced by the bandage.…”