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Compression Stockings For Leg Ulcers

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How Does Compression Therapy Help Heal Ulcers

Applying Compression Hosiery Kits

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.

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by the JBI , the search strategy for the review will follow a three-step search to identify both published and unpublished studies.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the first five pages of google scholar, and the reference list of relevant studies will also be screened for any unpublished studies.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.

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Basic Principles Of Compression Therapy

Depending on the position of the body, compression therapy improves venous return . The consistent pressure applied to the veins results in a decrease in vessel diameter, in reduced transmural pressure, and thus in a flow rate that is almost twice as high. In a lying position, pressure values as low as 15 mmHg are sufficient to constrict superficial and deep veins, which subsequently leads to an acceleration in blood flow. To achieve this while standing up, significantly higher pressure values are required . Compression with a stiff, rigid material provides stable support for the leg muscles, thereby increasing the effects of the muscle pump, which in turn results in improved venous return . The latter leads to edema reduction as well as pain relief. The question as to whether leg ulcer patients might potentially benefit from additional compression of the thighs cannot be unequivocally answered based on current literature. Although strong nonelastic thigh bandages may reduce venous return , there are as yet no reports on accelerated ulcer healing. Moreover, additional thigh compression is likely to result in poorer adherence, which has similarly been described for the use of thromboembolic devices and compression stockings for the prevention of PTS . Thus, although thigh compression may indeed be applied in individual cases, it is currently not recommended as standard treatment for venous leg ulcers.

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How Is Venous Leg Ulcer Diagnosed

For all ulcer patients, it is recommended to take a close look at the medical history:

  • personal or familiar history of varicose veins, treated or not
  • personal or family history of deep vein thrombosis and/or superficial vein thrombosis and/or pulmonary embolism
  • personal history of significant trauma or lower limb surgery
  • a previous venous ulcer
  • presence of diabetes

Your health care professional will examine your leg, both when youre standing up and lying down.

They’ll also feel your pulse at the ankles to make sure the arteries in your leg are working properly. To rule out peripheral arterial disease as a possible cause of your symptoms, your health care professional will carry out a test known as a Doppler study.

Further examinations might be done in order to assess the blood flow in your veins.

Compression Hosiery For Preventing Venous Leg Ulcers Returning

JOBST UlcerCARE Compression Stockings for Leg Ulcers (40mmHg)

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.

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Compression Therapy In The Treatment Of Venous Leg Ulcer

03 September, 2002

VOL: 98, ISSUE: 36, PAGE NO: 39

Michael Stacey, University of Western Australia, Fremantle

Vincent Falanga, Boston University, USA William Marston, University of North Carolina, USA Christine Moffat, Thames Valley University, London Tania Phillips, Boston University School of Medicine, USA R. Gary Sibbald, University of Toronto, Canada Wolfgang Vanscheidt, Universitèts-Hautklinik, Freiburg, Germany Christina Lindholm, Karolinska Hospital, Stockholm, Sweden

The appropriate management of venous leg ulcers is a continuing challenge for health care professionals, despite the publication of numerous useful management guidelines and systematic reviews . Approximately 1-2% of the general population suffer from a poorly healing ulcer of the lower extremity in their lifetime .

More effective management strategies are required which are based on the results of randomised controlled trials , improved organisational structures and multidisciplinary cooperation. It is also vital that any evidence-based recommendations are widely disseminated and easily implemented to maximise benefits to patients.

About Health Quality Ontario

Health Quality Ontario is the provincial lead on the quality of health care. We help nurses, doctors and other health care professionals working hard on the frontlines be more effective in what they do by providing objective advice and data, and by supporting them and government in improving health care for the people of Ontario.

We focus on making health care more effective, efficient and affordable through a legislative mandate of:

  • Reporting to the public, organizations, government and health care providers on how the health system is performing,

  • Finding the best evidence of what works, and

  • Translating this evidence into clinical standards recommendations to health care professionals and funders and tools that health care providers can easily put into practice to make improvements.

Health Quality Ontario is governed by a 12-member Board of Directors with a broad range of expertise doctors, nurses, patients and from other segments of health care and appointed by the Minister of Health and Long-Term Care.

Health Quality Ontario also develops quality standards for health conditions that demonstrate unnecessary gaps and variations in care across the province, such as in major depression or schizophrenia. Quality standards are based on the best evidence and provide recommendations to government, organizations and clinicians. They also include a guide for patients to help them ask informed questions about their care.

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Cleaning And Dressing The Ulcer

The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.

A simple non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week.

Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

Compression Stockings For Treating Venous Leg Ulcers

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

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.

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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.

Can I Use Compression Stockings If I Have An Ulcer On My Leg

Can I use compression stockings if I have an ulcer on my leg? I’ve had surgery two years ago because of the ulcer. After a few months the ulcer healed but now it has coem back again. Would I need to have surgery again?

Compression stockings are appropriate for some small venous ulcers. Other forms of compression often are used for larger ulcers. If you have a recurrent ulcer, you need to be sure to see a physician experienced in evaluation of venous insufficiency for a work up for venous reflux.Stephen F. Daugherty, MD, FACS, RVT, RPhS

Compression stockings are appropriate for some small venous ulcers. Other forms of compression often are used for larger ulcers. If you have a recurrent ulcer, you need to be sure to see a physician experienced in evaluation of venous insufficiency for a work up for venous reflux.Stephen F. Daugherty, MD, FACS, RVT, RPhS

Need to be seen by vein specialist or wound care specialist.

Need to be seen by vein specialist or wound care specialist.

Compression stockings will certainly be very important if you have ulcer provided that the ulcer is due to vein disease. But just as important will be to have a re-evaluation of your leg venous circulation. You might need further treatment of your abnormal veins.Dr Farhy

See your provider. In general however, if your ulcer is from a venous etiology stockings can be helpful, as well as any measure that reduces leg swelling. Michael D. Ingegno

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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.

Working Pressure And Resting Pressure

JOBST UlcerCARE Compression Stockings for Leg Ulcers w/Zipper (40mmHg)

The distinction between resting and working pressure is necessary to understand the effects of compression therapy. Resting pressure is the result of compression of the extremity at rest. It corresponds to the force exerted by the bandage when the muscles are relaxed. Working pressure is the pressure generated through the interaction of muscle contraction and compression when the body is in motion it arises from the resistance the bandage exerts to counteract muscle movement. The less the bandage yields in this process, the higher the working pressure. Both kinds of pressure depend on the material used, the number of layers applied as well as the force with which the compression has been applied. Given that the working pressure is generated by active muscle contraction, it is always higher than the resting pressure. When applying compression, pressure values may be checked with simple-to-use measuring instruments , .

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Healing Serious Venous Ulcers

There is some evidence that compression socks can even help to heal venous ulcers that have already developed faster than bandages alone. Talk to your medical professional to see how compression socks can fit into your treatment plan for improved healing and less downtime from living your best life.

What Is The Treatment For Leg Ulcer

If you are diagnosed with venous leg ulcer, you are probably already working closely with a wound clinic or your physician and a certified fitter in the management of the wound.

Control and heal the wound: medical compression plays an important rule

The primary treatment of a venous leg ulcer includes controlling any infection and healing the wound. This may take several months, depending of the size of the wound. Managing pain and minimizing the edema as well as protecting the healthy skin are important.

Compression helps to improve vein circulation in your legs and to treat swelling. It plays an important role in the healing of your wound and in post-wound care.

Traditionally, short-stretch compression bandages are used in the initial phase of treatment of large ulcers until healing is nearly complete or the patient can be fitted in a knee-length graduated compression stocking at 30-40 mmHg or higher.

Compression stocking systems

Also, compression stocking systems are available. They consist of a normal compression stocking and a patented low-compression understocking. These systems offermany benefits above and beyond those of bandages:

With appropriate treatment, most venous leg ulcers heal within 3 to 4 months.

Once your wound is healed, you should continue wearing your compression stockings for life to prevent development of another ulcer.

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What Is A Leg Ulcer

Venous leg ulcers usually develop on the inside, sometimes on the outside of the leg, just above the ankle.

The symptoms of a venous leg ulcer include

  • pain
  • itching
  • swelling

in the affected leg. There may also be discolored or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge.

Venous disease is the main reason for over two thirds of all leg ulcers. Other common types of leg ulcer include:

  • arterial leg ulcers caused by poor blood circulation in the arteries
  • diabetic leg ulcers caused by the high blood sugar associated with diabetes
  • vasculitic leg ulcers associated with chronic inflammatory disorders such as rheumatoid arthritis and lupus
  • traumatic leg ulcers caused by injury to the leg
  • malignant leg ulcers caused by a tumor of the skin of the leg

Most ulcers caused by artery disease or diabetes occur on the foot rather than the leg.

Study Selection Data Extraction And Analysis

Leg Ulcers – Essential One Minute Briefing

We included systematic reviews and randomized controlled trials according to the following criteria: study population of elderly with venous insufficiency and swollen legs without recent deep vein thrombosis evaluating the preventive effects of European standard compression stockings class 2 or 3 compared to a different class of compression stockings, other interventions to promote venous backflow or no intervention assessed on thrombosis, leg ulcer and mobility or other health related outcomes such as pain, discomfort, quality of life or post-thrombotic syndrome . Compliance was not defined as an outcome in the original protocol, but following feedback, we included compliance as a secondary outcome post hoc.

Two reviewers independently assessed the titles and abstracts of records identified by the search. Records appearing to meet the inclusion criteria and those with insufficient details were obtained in full text. Two reviewers independently assessed the full text publications according to a pre-defined inclusion form. Any discrepancies were resolved by consensus.

The first author described the included trials with regard to population, intervention, comparison, outcome and main results in tables. Another reviewer checked the extracted information. Two reviewers independently assessed the methodological quality of included studies using the Risk of Bias assessment tool .

Table 1 Confidence in effect estimates with interpretation

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