Deep Vein Thrombosis Prophylaxis
The role of mechanical devices graduated compression stockings and intermittent pneumatic compression is dependent on the risk of venous thromboembolism in the medical or surgical patient. They may be used in combination with drug therapy or alone, especially if drugs are contraindicated because of an unacceptable bleeding risk. These mechanical devices are contraindicated in patients with severe peripheral vascular disease, severe leg deformity and severe peripheral neuropathy.
Evidence supports the use of graduated compression stockings as thromboprophylaxis for abdominal, cardiac, thoracic, vascular, major general or gynaecological surgery, neurosurgery and total hip replacement. Similarly, there is evidence for the use of intermittent pneumatic compression for total hip replacement, hip fracture surgery, total knee replacement, vascular, cardiothoracic surgery, neurosurgery, and for major gynaecological surgery. Graduated compression stockings should be measured for the individual and worn for as long as possible until the patient is fully mobile.20
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Is Compression Therapy Good For Arterial Ulcers
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When applied correctly, compression therapy, which uses increased pressure over the wound, may improve the flow of blood in the arteries and aid in healing in patients with arterial leg ulcers.
Compression therapy is the standard method for treating venous leg ulcers . Wound care and compression therapy can be effective in the short term in the treatment of venous ulcers. Compression stockings and bandages are widely used in compression settings. When compression bandages are applied to bony prominences, they must be applied over padding in order to prevent friction and pressure damage. Compression is preferable to no compression in healing VLU. Compression pressures in high-performance bandages can range between 25 and 35 mm per square inch. The Hg is at the ankle.
In 2001, the journal 27: 61121 published. The following are the authors: Phillips TJ, Abu-Own A, Scurr JH, Coleridge Smith PD, OMeara S, Cullum NA, Nelson EA, Harper DR, Prescott RJ, Gibson B, Brown D, and Ruckley CV. Using static stiffness index as a measure of compression material elasticity is a simple method. There is a dermatologistss specialty indermatologic Surg. I wrote a book titled 31:30: 625 in 2005. The randomized controlled study of compression versus unnas boot for venous ulcers, a four-layer compression technique, was conducted. Wound care service J. Wound Care.
Treatment Of Varicose Ulcers
Varicose ulcers or venous ulcers are usually treated using compression therapy. Compression therapy in wound care usually includes using compression bandages to help increase venous return in decrease venous hypertension. Dressings can be used to manage the wound and provide symptom control.
- Alginate Dressings Alginate dressings are a great option while treating venous ulcers as they provide a great moist wound healing environment and allow the wound to heal faster. Since they are made from natural seaweed, they can be easily used as packing material within the wound, which can then be covered by a bandage.
- Compression Bandages Compression bandages are the cornerstone of any venous ulcer treatment. Once a dressing is applied to the wound, one can cover the wound with compression bandages that not only keep the dressing in place but act on the veins around the ulcer to expedite the healing process.
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Directions For Future Research
A consistent definition and scoring system for adherence would allow improved comparison between studies such as the standardized tools used to measure medication adherence. A more sensitive tool with an interval scale is needed. Personalized multidimensional approaches may be more likely to improve adherence. Future attempts to address this complex issue should aim to consider multidimensional packages, personalized to an individuals needs. Considerations include education, negotiation, and stocking selection tailored to patients tolerance for compression and their ability to apply and remove stockings. Further, a high-quality trial to investigate the cost-effectiveness of such an intervention is recommended to improve our understanding of the financial implications and to consider any perceived patient and societal benefit.
Care Of Your Compression Bandage
It’s important to wear your compression bandage exactly as instructed. If you have any problems, it’s best to contact your GP or practice nurse instead of trying to remove it yourself.
The compression bandage may feel too tight and uncomfortable in bed at night. If it does, getting up for a short walk will usually help.
In rare circumstances you may need to cut the bandage off if:
- you get severe pain at the front of your ankle
- you get severe pain on the top of your foot or toes
- your toes become blue and swollen
Once you remove the bandage, make sure you keep your leg elevated. You should contact your GP or nurse as soon as possible.
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What Is Intermittent Pneumatic Compression
Intermittent pneumatic compression is a device that consists of a centralized air-pumping machine that is connected to a sleeve with multiple air chambers. When fitted over a limb or body region, the sleeve is inflated, causing it to squeeze or compress the areas of the body contained within.
Depending on the unit, many IPC devices can be programmed to apply different amounts of pressure to each of the compartments in order to help drain fluid or improve circulation in a region. Most machines also have preset compression cycles to maximize their effect on the targeted area.
Because of these features, IPC devices are often preferred over compressive wraps or manual therapy techniques when treating certain conditions. In addition, the devices have become much cheaper and more easily obtained, making them popular with therapists and patients alike.
Swelling In The Legs And Ankles
Venous leg ulcers are often accompanied by swelling of your feet and ankles , which is caused by fluid. This can be controlled by compression bandages.
Keeping your leg elevated whenever possible, with your toes above your hips, will also help ease swelling.
You can put pillows under your feet and legs to help keep your legs raised while you sleep.
You should also keep as active as possible and aim to continue with your normal activities.
Regular exercise, such as a daily walk, will help reduce leg swelling.
But you should avoid sitting or standing still with your feet down. You should elevate your feet for 30 minutes, 3 to 4 times a day.
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Identifying Patients At Risk Of Ulceration
Not all people who have CVD will develop ulceration specific risk factors are associated with ulceration in this patient group.
Skin changes are the biggest predictor of lower-leg ulceration: patients with CVD who have varicose veins, lipodermato-sclerosis or venous eczema are at significantly increased risk .
Oedema is the most common cause of lower-leg oedema and present in 90% of cases . It occurs when the rate of capillary filtration exceeds lymphatic drainage because of increased capillary filtration , inadequate lymphatic flow or both . This leads to a build-up of interstitial fluid, causing the lower legs to swell. Chronic oedema is common and its prevalence rises with age from 3.93 per 1,000 in the general adult population to 28.75 per 1,000 in people aged > 85 years .
Lower-limb oedema and CVD both significantly reduce quality of life. Symptoms can include pain, heaviness in the legs, cramps and itching, as well as significant aesthetic effects . When severe, this can lead to reduced mobility, poor body image and social isolation .
Oedema and CVD also have a substantial physiological impact on the skin, causing multiple chemical inflammatory mediators to be released, resulting in the tissue becoming chronically inflamed. This can lead to haemosiderin staining , lipodermatosclerosis and, ultimately, cellular hypoxia and ulceration .
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Factors Which Determine Sub
The pressure developed beneath any bandage is governed by thetension in the fabric, the radius of curvature of the limb and thenumber of layers applied. Applying a bandage with a 50% overlapproduces two layers of fabric, which generates a pressure twicethat produced by a single layer.
Sub-bandage pressure may be calculated using a using a simpleformula derived from the Laplace equation as follows
where P = pressure T = bandage tension C = circumference of the limb W = bandage width N = number of layers applied
Sub-bandage pressure is therefore directly proportionalto bandage tension but inversely proportional to theradius of curvature of the limb to which it is applied.
This means, therefore, that a bandage applied with constanttension to a limb of normal proportions will automatically producegraduated compression with the highest pressure at the ankle. Thispressure will gradually reduce up the leg as the circumferenceincreases.
Care should be taken also to ensure that bandages do no slip orbecome displaced as this will lead to multiple layers forming,which in turn may lead to localised areas of high pressure.
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Compression Versus No Compression/usual Care/simple Dressings
Various guidelines have recommended that some compression is better than no compression . A Cochrane review in 2009 compared compression with either primary dressing, noncompressive bandages and usual care that always did not include compression and concluded that venous ulcers healed faster with compression and some form of compression is better than no compression in healing VLU.
Description Of The Condition
Leg ulcers are open skin wounds on the lower leg that can last weeks, months or even years. They occur as a consequence of arterial or venous insufficiency, or both. Less frequently, chronic leg ulceration may occur due to some other disease, such as rheumatoid disease or rarer conditions . Most leg ulcers are the result of venous disease , where blood flow in the veins can be impaired by vein damage, obstruction and calf muscle pump failure . These problems mean that blood no longer returns efficiently from the legs to the heart and the pressure within the veins rises . The precise chain of events that links high venous pressures with skin breakdown and subsequent chronic wounds is not fully understood.
Leg ulcers of mixed aetiology usually involve a combination of venous and arterial disease. Open skin ulceration that is due solely to limb ischaemia is less common.
The making of a differential diagnosis of the underlying aetiology of a specific leg ulcer is made by taking a clinical history, physical examination, laboratory tests and other assessments . Typically, the latter includes an assessment of the arterial blood supply to the leg using the anklebrachial pressure index , measured using a handheld Doppler ultrasound scanner.
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After The Ulcer Has Healed
Once you have had a venous leg ulcer, another ulcer could develop within months or years.
The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed.
Your nurse will help you find a stocking that fits correctly and that you can manage yourself.
Various accessories are available to help you put them on and take them off.
Page last reviewed: 16 November 2022 Next review due: 16 November 2025
Should You Debride An Arterial Ulcer
Debridement of arterial ulcers is not recommended because this can lead to further ischaemia and the formation of a larger ulcer. Wound dressings will be based on the wounds nature in order to provide the best possible care. Nonselective blockers, such as Vasoconstrictive drugs, are not recommended.
To Debride Or Not To Debride: That Is The Question
When it comes to wound debridement, it is not always effective with autolytic debridement. Autolysis may not be enough for some patients if there is significant devitalisation, such as in burns. It is possible for mechanical debridement to be required in these cases using a scalpel or scissors. Mechanical debridement is used when the wound is severe, there is an infection, and the patients overall health is good. Mechanical debridement may be the most effective method for treating moderately to severely injured wounds. When there is no infection and the wound is not as severe, autolytic debridement may be more effective. In any case, it is critical to carefully examine the wound and make the right decision based on the severity of the wound.
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Why It Is Important To Do This Review
Venous leg ulcers have a large impact on peoples lives and incur high costs to health services and compression therapy is currently the first line treatment. Since the publication of the original Cochrane Review of compression bandages and stockings for venous leg ulcers , the number of relevant randomised controlled trials has more than doubled the range of compression modalities has increased and the classification of compression modalities has been refined. In order to offer uptodate evidence for decision makers, we have decided to update the previous version of this review, , and to split it into separate reviews of different compression modalities. We will then bring the results together into an overview, which will incorporate a network metaanalysis , in order to rank the different treatments on their individual probabilities of being the most effective compression modalities for healing venous leg ulcers. This particular review provides evidence about the comparison of compression bandages or stockings versus no compression.
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Treatment What Treatment Will I Be Offered For My Leg Ulcer
If your wound isnt healing because of venous hypertension and there are no problems with the blood supply to your legs, then you should be offered compression therapy.
Compression therapy improves blood supply by applying pressure to the leg. This can be done by bandaging the lower leg or by wearing supportive socks, stockings or tights. Compression therapy is very effective at reducing swelling, improving blood flow in the veins and healing or preventing sores or ulcers.
There are lots of different types of compression therapy so ask your nurse to find something that is right for you.
Compression can be a little uncomfortable when you first start treatment but should not cause you any pain. Any discomfort should reduce as the swelling goes down. If you do experience discomfort, talk to your nurse or doctor about it and they will advise you on ways of alleviating this.
In addition to the compression, your nurse should also advise you on wound care and dressings to keep your wound healthy.
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What Is The Best Treatment For Venous Stasis Ulcers
Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures.
Why are venous ulcers so painful?
The associated symptoms of a venous leg ulcer are caused by blood not flowing properly through your veins. This is known as venous insufficiency, and can cause: leg pain, which can be continuous or may come and go. varicose eczema
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What Are The Best Ways To Prevent Diabetic Ulcers
The best way to prevent diabetic ulcers is to keep your blood sugar levels under control through prescribed medications and the lifestyle changes detailed above.
Other ways to prevent diabetic ulcers include:
- Wearing proper footwear and avoiding going barefoot
- Checking your feet daily for cuts, scrapes, blisters, or other issues
Although there is no foolproof method to prevent diabetic ulcers, following these tips can help reduce your risk. If you do develop diabetic ulcers, it is important to seek medical care.
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Compression Hosiery For Preventing Venous Leg Ulcers Returning
Venous leg ulcers can be caused by a blockage or breakdown in the veins of the legs. Compression, using bandages or hosiery , can help heal most of these ulcers and is also widely used after healing to prevent ulcers returning. One small trial confirms that compression reduces ulcer recurrence compared with no compression. There is some evidence that people wearing high rather than moderate-compression hosiery are less likely to get a new ulcer. It is not clear whether moderate strength hosiery is better tolerated than high compression. There is, therefore, some evidence that compression hosiery might prevent ulcers, but the evidence is not strong.
There is evidence from one trial that compression hosiery reduces rates of reulceration of venous ulcers compared with no compression. Results from one trial suggest that recurrence is lower in high-compression hosiery than in medium-compression hosiery at three years whilst another trial found no difference at 5 years. Rates of patient intolerance of compression hosiery were high. There is insufficient evidence to aid selection of different types, brands, or lengths of compression hosiery.
The majority of venous ulcers heal with compression bandages, however ulcers frequently recur. Clinical guidelines therefore recommend that people continue to wear compression, usually in the form of hosiery after their ulcer heals, to prevent recurrence.
Signs Of An Infection
A venous leg ulcer can be susceptible to bacterial infection. Symptoms of an infected leg ulcer can include:
A number of factors can increase your risk of developing a venous leg ulcer, including:
- obesity or being overweight this increases the pressure in the leg veins
- if you have difficulty walking this can weaken the calf muscles, which can affect circulation in the leg veins
- previous deep vein thrombosis blood clots that develop in the leg can damage valves in the veins
- varicose veins swollen and enlarged veins caused by malfunctioning valves
- previous injury to the leg, such as a broken or fractured bone, which may cause DVT or impair walking
- previous surgery to the leg, such as a hip replacement or knee replacement, which can prevent you from moving about
- increasing age people find it harder to move around as they get older, particularly if they suffer from arthritis
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