September 27, 2022

Compression therapy is regarded as the mainstay of treatment of venous leg ulcers (VLU). Good wound care & an adequate level of compression therapy will heal the majority of small venous ulcers within a short duration of time. The goals of compression therapy are reduction of pain, ulcer healing, edema, & prevention of recurrence. Compression is used for VLU, narrows veins & restores valve competence, and it helps in the reduction of ambulatory venous pressure, thus reducing the venous reflux (VR). It also helps in lowering the cases of inflammatory cytokines, accelerates capillary flow, lowering of capillary fluid leakage, thereby eradicating limb edema. It also softens lipodermatosclerosis, improves lymphatic flow & function, and also enhances fibrinolysis. In 2020, the overall share of the Global Compression Therapy Market resulted in USD 2.84 billion. It is expected to touch a value of USD 4.71 billion by 2030, with a promising CAGR of 5.2 % throughout the forecasted period.

Some of the key factors that should be noted are as follows:

Compression Bandages

All the bandages that are used in compression must be applied on the top of padding (i.e. the sub compression wadding bandage) for the prevention of friction and pressure damage over the bony prominences by spreading the level of pressure across a greater area. Bandages should generally be applied at the areas of the toe to knee at 50% stretch along with a 50% overlap, but in this case, specific manufacturer’s instructions should be followed for each bandage. 

Interface pressure peaks on the leg during the time of walking, thereby exceeding 50-60 mm Hg & increases the venous pumping function. This can be achieved by stiff compression textiles such as multicomponent bandages, especially during the application of any sort of cohesive material or by zinc paste bandages. These compression types exert a higher level of stiffness which is characterized by a tolerable resting pressure & high-pressure peaks during the time of walking (“working pressure”). On the other hand, it is to be made sure that it is applied by well trained & experienced staffs. Short stretch adjustable Velcro wraps & double compression stockings can be some promising alternatives allowing self-management.

PNEUMATIC COMPRESSION (INTERMITTENT)

Intermittent pneumatic compression constitutes both the process of inflating & deflating an airtight bag that is worn around the leg. IPC adequately controls edema in case the compression bandage & stocking fails. IPC upon compression therapy may accelerate the process of ulcer healing. It is particularly useful for patients with restricted mobility & when the concomitant arterial disease is detected accurately, then it helps to reduce edema & enhance the process of arterial blood flow. IPC may show sheer signs of improvement in hematologic, hemodynamic & endothelial effects, which explains its role in the healing process of VLU.

CONCLUSION

Compression therapy is thus regarded as a highly effective treatment for VLU. Utmost care should be taken during the administration of this therapeutic modality in the case of mixed-arteriovenous ulcers. The minimum range of the tolerable compression pressure tailored to the patient’s requirement should be properly ensured so as to maximize the level of compliance.

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