Wednesday, June 15, 2022

Compression For Venous Leg Ulcers

Must read

Adapted To Individual Needs

3M Simple Introduction to VLU and Compression Therapy

Within the treatment of venous leg ulcer compression therapy is essential for treating the underlying disease. Venous leg ulcer is often accompanied by oedema which needs to be reduced as it inhibits wound healing. The circaid product range offers two options matched to the planned therapy.

If there are large circumferences respectively oedema circaid juxtacures is the option to choose as it allows for oedema reduction thanks to its possibility to adapt to decreasing leg circumferences.

If there is no or only slight oedema circaid juxtalite, a ready-made adjustable compression device, is the alternative to ulcer compression stockings for patients who have challenges with compression stockings.

  • circaid® compressive undersock

    Easy-to-apply liner with targeted compression for foot and ankle

    New

  • Additional compression for the toes

    New

What To Expect During Pneumatic Compression Therapy

IPC devices are typically utilized while you are in a seated or lying down position. Your therapist may also have you elevate the affected area to assist with fluid reduction.

After the compression sleeve has been applied to the affected limb, your PT will help you connect it to the air compressor and select the appropriate parameters for your diagnosis.

When the treatment begins, you will feel the compression sleeve become snug as it squeezes the targeted area. While this pressure may feel strange or even a bit uncomfortable, it should not be painful. Be sure to notify your PT if you are experiencing discomfort so they can modify the intensity accordingly.

As the treatment continues, the amount and location of the compression typically fluctuate. You may also feel changes in the intensity of the compression depending on how the fluid in the region changes.

Once the program is complete, the sleeve will fully deflate and can be removed from your body.

Intermittent Pneumatic Compression For Treating Venous Leg Ulcers

Venous leg ulcers can be caused by a blockage or breakdown in the veins of the leg. Compression, using bandages or hosiery , can help heal ulcers. However, they do not always work, and some people are not willing or able to wear them. Intermittent pneumatic compression uses an air pump to inflate and deflate an airtight bag wrapped around the leg. This technique is also used to stop blood clots developing during surgery. However, the review of trials found conflicting evidence about whether or not IPC is better than compression bandages and hosiery. Intermittent pneumatic compression is better for healing leg ulcers than no compression. . Some studies suggest IPC might be a beneficial addition to bandages for some ulcers, but these studies might be biased. Delivering the IPC therapy in a rapid manner by inflating and deflating the IPC device more quickly resulted in more ulcers being healed than with a slower deflation regime.

IPC may increase healing compared with no compression. It is unclear whether it can be used instead of compression bandages. There is some limited evidence that IPC may improve healing when added to compression bandages. Rapid IPC was better than slow IPC in one trial. Further trials are required to determine the reliability of current evidence, which patients may benefit from IPC in addition to compression bandages, and the optimum treatment regimen.

Two trials found no difference between IPC and compression bandages alone.

Read Also: Mouth Ulcer On Tongue Remedies

Compression Bandages Or Stockings Versus No Compression For Treating Venous Leg Ulcers

Key messages

Compared with not using compression, compression therapy that uses bandages or stockings to treat venous leg ulcers:

– probably heals venous leg ulcers more quickly

– probably increases the number of people whose ulcer has completely healed after 12 months

– probably reduces pain and

– may improve some aspects of peoples quality of life.

However, there is still uncertainty about whether or not compression therapy causes unwanted side effects, and if the health benefits of using compression outweigh its cost.

What are leg ulcers?

Leg ulcers are open skin wounds on the lower leg that can last weeks, months or even years. Most leg ulcers are caused by venous diseases that affect the circulation of blood in leg veins. Venous leg ulcers can cause distress and pain to patients, and can be very costly to the health service.

What did we want to find out?

Standard treatment options for venous leg ulcers often include compression therapy. This involves applying external pressure around the lower leg to help the return of blood from the legs to the heart. Compression therapy uses bandages, stockings or other devices.

We wanted to find out if compression therapy delivered by bandages and stockings compared with no compression:

– heals venous leg ulcers

– improves peoples quality of life

– has health benefits that outweigh the costs and

– reduces pain.

What did we do?

What did we find?

Venous leg-ulcer healing and unwanted effects

Other effects

Primary outcomes

Venous Leg Ulcers: The Extent Of The Problem And Management With Compression

What is the treatment for venous leg ulcers

Leg ulceration is typically a chronic recurring condition with duration of episodes of ulceration ranging from a matter of weeks to more than 10 years .

A systematic review of the epidemiological literature from developed countries reported prevalence rates for any aetiology of open lower limb ulceration ranging from 1.2 to 11.0 per 1000 population . Recent surveys undertaken in the UK collected data from populations in Wandsworth, London , Hull and East Yorkshire , and Bradford and Airedale primary care trust . The prevalence of venous leg ulceration was estimated as 0.23 per 1000 population in London , 0.44 per 1000 in Hull and East Yorkshire , and 0.39 per 1000 in Bradford . The lower estimates in the recent UK surveys relative to the earlier worldwide literature searches done during 2000 might be explained by improvements in treatment as well as the broad versus narrow selection criteria for leg ulcers . The epidemiological data have consistently suggested that prevalence increases with age and is higher among women .

Recommended Reading: What Does Asacol Do For Ulcerative Colitis

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.

High Compression Versus Low Compression

High compression bandages provide and maintain high levels of compression pressures in the range 25-35 mm Hg at the ankle. High compression is useful for bigger legs or more active patients. They can be used over padding on their own or as part of a layered system, and should be applied in a spiral according to manufacturer’s instructions. Evidence exists that high compression is better than low compression in managing VLU .

You May Like: What Are Infusions For Ulcerative Colitis

How Does Compression Therapy Help Heal Ulcers

Compression therapy works by applying controlled pressure to the surface veins, keeping their diameter small and forcing blood back into the deep vein system which in turn pushes the blood uphill towards the heart. Improved blood flow aids in the healing of active ulcers and in preventing ulcer recurrences.

Search Methods For Identification Of Studies

Venous Disease Overview: CVD, CVI, and Treating Venous Leg Ulcers with Compression Therapy

Electronic searches

Details of the search strategy for the original version of this review are available in .

The following electronic databases were searched, without date or language restrictions, to identify RCTs that investigated the use of bandages or stockings for the treatment of venous leg ulcers:

  • Cochrane Wounds Group Specialised Register

  • The Cochrane Central Register of Controlled Trials

  • Ovid MEDLINE

  • Ovid MEDLINE

  • Ovid EMBASE

  • EBSCO CINAHL .

The following search strategy was used in the The Cochrane Central Register of Controlled Trials :

#1 MeSH descriptor Occlusive Dressings explode all trees #2 MeSH descriptor Stockings, Compression explode all trees #3 :ti,ab,kw #4 #5 MeSH descriptor Leg Ulcer explode all trees #6 or or or or :ti,ab,kw #7 #8

The search strategies for Ovid MEDLINE, Ovid EMBASE and Ovid CINAHL can be found in , and respectively. The Ovid MEDLINE search was combined with the Cochrane Highly Sensitive Search Strategy for identifying randomised trials in MEDLINE: sensitivity and precisionmaximizing version Ovid format . The EMBASE and CINAHL searches were combined with the trial filters developed by the Scottish Intercollegiate Guidelines Network .

Searching other resources

Read Also: How To Prevent Pressure Ulcers In Wheelchairs

Compression Stockings For Treating Venous Leg Ulcers

J. P. Benigni

1Cardiology Unit, HIA Bégin, 69 Avenue de Paris, 94160 Saint Mandé, France

2URDIA, Université des Saints Pères, 15 Rue des Saints Pères, 75006 Paris, France

Abstract

1. Background

Compression increases ulcer healing rates compared with no compression .

Thus to improve the healing process it is recommended to treat venous or mixed venous with high pressure. A pressure between 30 and 40mmHg should be obtained at the ankle .

Multicomponent systems are more effective than single-component systems. Multicomponent systems containing an elastic bandage appear more effective than those composed mainly of inelastic constituents. Two-layer stockings appear more effective than the short-stretch bandage . In fact, there are no clear differences in the effectiveness of different types of high compression.

Putting on the bandages requires a great experience and the respect of the bandage stretching rules. A pressure level from 30 to 40mmHg may not be easy to achieve. The main criticism that can be made against the use of a multilayer bandage or short stretch is linked to bandage slippage. Slippage is a cause of adverse effects: pain, aggravation of ulcer ulceration, and necrosis .

The use of compression stockings seems to be the best option because of the pressure control it allows for and it is not operator dependant. However 3040mmHg compression stockings are often hard to put on, especially for the elderly. In this case a donning and doffing aid could be useful.

Potential Biases In The Review Process

Although the search strategy was comprehensive, it is possible that eligible unpublished trials could remain unidentified. One unpublished trial of compression came to light during a wound management conference . Communication with the trial authors confirmed that: the trial was small , compared the 4LB with SSB, and had terminated prematurely . Since no baseline or outcome data were available, it is not possible to judge the potential effect of including this trial in the review. Other eligible unpublished evaluations may exist that have not been identified by the review process. Therefore, the effect of publication bias on this review should not be discounted.

Don’t Miss: What To Drink With Stomach Ulcer

Stage : Identifying Relevant Studies

As suggested by the JBI , the search strategy for the review will follow a three-step search to identify both published and unpublished studies. First, an initial search of MEDLINE via OVID will be conducted, followed by an analysis of the keywords contained in the title and abstracts, as well as the subject headings used to describe the study. We will then use all identified keywords and subject headings to undertake search across all included databases. Last, the bibliographies of all identified studies, especially systematic reviews and literature reviews, will be screened for additional studies not identified through electronic database search.

Database search terms will be developed by the research team in conjunction with an experienced research librarian using a combination of keywords and controlled vocabulary . Electronic database searching will be conducted in Medline, CINAHL and The Cochrane Central from inception to present day, with English language being the only limitation applicable. We will also search ICTRP WHO, ClinicalTrials.gov. and Australian New Zealand Clinical Trials Registry for ongoing clinical trials. Grey literature will be retrieved through hand searching the first five pages of google scholar, and the reference list of relevant studies will also be screened for any unpublished studies. A copy of the preliminary search terms and search strategy for Medline is available in Appendix 1.

Strengths And Limitations Of This Review

Venous Leg Ulcers

A strength of this review is its breadth and overview of the topic, also the new synthesis of information to aid understanding of adherence with compression within this patient group.

This review also had some limitations. Firstly, some factors with potential to impact adherence were excluded on the basis that they are non-modifiable at the time of intervention, such as climate, cognitive ability, and religious beliefs. This was an intentional decision, to focus the review results and conclusions on modifiable factors more able to be targeted with subsequent clinical research. Finally, the search was limited to the English language as language translation was beyond the scope of this work. A further three studies ,, that met inclusion criteria appear in Appendix 2 but are not cited in other tables or key themes within this review.

Recommended Reading: Compression Therapy For Venous Leg Ulcers

A Comparative Clinical Study On Five Types Of Compression Therapy In Patients With Venous Leg Ulcers

Pawel Dolibog1, Andrzej Franek1, Jakub Taradaj1,2 , Patrycja Dolibog1, Edward Blaszczak1, Anna Polak2, Ligia Brzezinska-Wcislo3, Antoni Hrycek4, Tomasz Urbanek5, Jacek Ziaja6, Magdalena Kolanko3

1. Department of Medical Biophysics, Medical University of Silesia in Katowice, Poland2. Department of Physiotherapy Basics, Academy of Physical Education in Katowice, Poland3. Department of Dermatology, Medical University of Silesia in Katowice, Poland4. Depatment of Internal, Autoimmune and Metabolic Medicine, Medical University of Silesia in Katowice, Poland5. Department of General and Vascular Surgery, Medical University of Silesia in Katowice, Poland6. Department of General, Vascular and Transplant Surgery, Medical University of Silesia in Katowice, Poland

Citation:Int J Med Sci

Looking After Yourself During Treatment

The following advice may help your ulcer heal more quickly.

  • Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
  • Whenever you’re sitting or lying down, keep your affected leg elevated.
  • Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
  • If you’re overweight, try to reduce your weight with a healthy diet and regular exercise.
  • Stop smoking and moderate your alcohol consumption. This can help the ulcer heal faster.
  • Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.

You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation, for support and advice.

Also Check: Is Green Tea Good For Ulcers

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.

What Is Intermittent Pneumatic Compression

Venous Leg Ulcer solutions for highly contoured legs | 3M Critical & Chronic Care Solutions

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.

Read Also: Colon Cancer Symptoms Vs Ulcerative Colitis

Data Collection And Analysis

Data extraction and management

References identified from searches were entered into a bibliographic software package . Two review authors, working independently, screened the references. If either review author considered a reference to be potentially relevant, the full report was retrieved for further scrutiny. Two review authors made independent decisions about inclusion and exclusion of studies by referring each retrieved report to the selection criteria described above. Disagreements were resolved by discussion.

Details of eligible studies were extracted and summarised using a data extraction sheet. The following data were extracted:

  • country of study

  • unit of investigation

  • patient selection criteria

  • baseline variables by group, e.g. age, sex, baseline area of ulcers, duration of ulceration

  • description of the interventions and numbers of patients randomised to each intervention

  • descriptions of any cointerventions or standard care

  • followup period

  • primary and secondary outcomes measured

  • primary and secondary outcome data

  • withdrawals from treatment, with reasons.

Attempts were made to obtain data missing from reports by contacting the authors. Studies that had been published in duplicate were included only once and all relevant data extracted. Data extraction was performed by one review author and verified independently by a second review author. Disagreements were resolved by discussion.

Assessment of risk of bias in included studies

Data synthesis

Compression Therapy For Venous Leg Ulcers: Risk Factors For Adverse Events And Complications Contraindications A Review Of Present Guidelines

Radboud UMC, Nijmegen & Andriessen Consultants, Malden, The Netherlands

International Compression Club , Berndorf, Austria

Department of Angiology, Clinica MD Barbantini, Lucca, Italy

International Compression Club , Berndorf, Austria

Medical University Vienna, Vienna, Austria

International Compression Club , Berndorf, Austria

Medical & Regulatory Affairs, Lohmann & Rauscher GmbH & Co KG, Rengsdorf, Germany

Patient Outcome Group , European Wound Management Association , Frederiksberg, Denmark

International Compression Club , Berndorf, Austria

Radboud UMC, Nijmegen & Andriessen Consultants, Malden, The Netherlands

International Compression Club , Berndorf, Austria

Department of Angiology, Clinica MD Barbantini, Lucca, Italy

International Compression Club , Berndorf, Austria

Medical University Vienna, Vienna, Austria

International Compression Club , Berndorf, Austria

Medical & Regulatory Affairs, Lohmann & Rauscher GmbH & Co KG, Rengsdorf, Germany

Patient Outcome Group , European Wound Management Association , Frederiksberg, Denmark

International Compression Club , Berndorf, Austria

Read Also: How To Calm Down An Ulcer

More articles

Popular Articles