Compression in leg ulcer treatment: inelastic compression

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 146-152 ◽  
Author(s):  
Giovanni Mosti
Keyword(s):  
Ulcer Healing ◽  
Healing Rate ◽  
Great Majority ◽  
Compression Therapy ◽  
Venous Hypertension ◽  
Reduced Pressure ◽  
Elastic Compression ◽  
Venous Ulcers ◽  
Arterial Inflow ◽  
Pumping Function

Compression therapy is extremely effective in promoting ulcer healing. Which material to use, if elastic or inelastic, is still a matter of debate. This paper will provide an overview on the recent findings in compression therapy mainly for venous or mixed ulcers which are the great majority of leg ulcers. In this paper it will be demonstrated that inelastic compression has been proved to be significantly more effective than elastic compression in reducing venous reflux, increasing venous pumping function and decreasing ambulatory venous hypertension. In addition it is comfortable, well accepted by patients and achieved an extremely high healing rate in venous ulcers. With reduced pressure inelastic compression is able to improve venous pumping function in patients with mixed ulcers without affecting but improving the arterial inflow. It will be also clearly shown that studies claiming a better effect of elastic compression compared to inelastic in favouring healing rate have significant methodological flaws making their conclusions at least doubtful. In conclusion inelastic- is significantly more effective than elastic compression in reducing ambulatory venous hypertension which is the main pathophysiological determinant of venous ulcers and demonstrated to be very effective in getting ulcer healing. New multicentric, randomized and controlled studies, without methodological flaws, will be necessary to prove that elastic- is at least as effective as inelastic compression or, maybe, more effective.

Efficacy of Ultrasound Guided Foam Sclerotherapy of Incompetent Ankle Perforators on Healing of Chronic Venous Ulcers with Deep Venous Reflux. (A Comparative Study)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahmoud Ahmed Mohamed El-shafei ◽  
Mostafa Soliman Mahmoud Abdelbary ◽  
Mina Gamil Zekri Basta ◽  
Omar Azzam Abdelrahman Ali Abdelrahman
Keyword(s):  
Healing Rate ◽  
Simple Procedure ◽  
Compression Therapy ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Venous Ulcers ◽  
Early Results

Abstract Background Compression therapy is the standard of care for venous ulcers and chronic venous insufficiency, but the treatment of underlying venous disease to relieve venous hypertension appears to improve wound healing and to decrease recurrence. Benefits of saphenous ablation have been well demonstrated; however, evidence for the treatment of incompetent perforating veins is less clear. Objective To assess the benefit of ultrasound-guided sclerotherapy (USGS) of incompetent perforator on healing of chronic venous ulcers. Patients and Methods This is a prospective cohort study which is a double arm clinical study to assess the healing rate for patients after USGFS vs standard compression therapy of patients with incompetent perforators veins within 6 month. Results Our preliminary data add further weight to the suggestion that eradication of SVR by means of UGFS improves CVU outcomes when compared to compression alone. In this regard, UGFS appears to be more effective more than compression therapy does, therefore, appear the more attractive option in this elderly patient population. Furthermore, the follow-up data presented here does suggest long-term healing following UGFS probably requires careful follow-up and, if required. Encouraged by these promising early results the authors have embarked upon a larger study to look at the role of UGFS in the treatment of CVU in greater depth. Conclusion Ultrasound guided foam sclerotherapy of perforator incompetent veins is a welltolerated and effective outpatient procedure. This study presents a patient cohort with limited exclusion criteria, allowing a representative cross section of VLU in general. Because of its higher healing rate and lower RR compared to other therapeutic options, and the improvement in quality of life that it brings, this minimally invasive, easily repeatable procedure may become the treatment of choice for VLU. Foam sclerotherapy is a simple procedure, compared to surgical intervention, no hospitalization, no anesthesia, can be done in outpatient clinic and the patient can return home after 45 min and no work off period. The relative freedom from serious complications and its evident success, makes this modality as a possible candidate for being the first line treatment for venous ulcers.

Compression in mixed ulcers: venous side

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 13-17 ◽  
Author(s):  
Giovanni Mosti
Keyword(s):  
Compression Therapy ◽  
Lower Leg ◽  
Venous Reflux ◽  
Elastic Materials ◽  
Normal Range ◽  
Compression Pressure ◽  
Reduced Pressure ◽  
Venous Ulcers ◽  
Arterial Involvement ◽  
Arterial Inflow

Introduction: arterial involvement may coexist in about 15–30 of venous ulcers. In this case compression therapy maybe applied, only by expert caregivers, with a reduced pressure which must not overcome the arterial pressure at ankle and foot level. It remains to assess if such a reduced pressure may be effective also on the impaired venous hemodynamics. Aim of this paper is to present an overview of the data we have, showing the effects on venous hemodynamics of a reduced compression pressure. Material and methods: in different groups of patients affected by deep and superficial venous incompetence, venous reflux and ejection fraction (EF) from the lower leg were measured in baseline conditions, without any compression, and after application of different elastic and inelastic compression devices exerting different pressure ranges from 20 to 60 mm Hg. The compression pressure was always recorded simultaneously with venous reflux of EF assessment. Results: strong pressures show the greatest effect in reducing/abolishing venous reflux and increasing EF but also a reduced pressure in the range of 20 to 40 mm Hg is effective in improving venous hemodynamics provided inelastic materials are used. Conclusions: inelastic but not elastic materials exert a standing pressure which is significantly higher than in supine position even starting from a reduced supine pressure of 40 mm Hg which does not impair the arterial inflow. This strong pressure is able to reduce and even abolish the venous reflux and improve the EF up to restoring its normal range. A reduced or modified compression pressure is able to significantly improve the venous hemodynamics without affecting the arterial inflow in patients with mixed ulcers, provided inelastic materials are used.

Which dressings reduce inflammation and improve venous leg ulcer healing

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 157-164 ◽  
Author(s):  
Joseph D Raffetto
Keyword(s):  
Adult Population ◽  
Clinical Effectiveness ◽  
Compression Therapy ◽  
Venous Hypertension ◽  
Western World ◽  
Venous Leg Ulcer ◽  
Tissue Integrity ◽  
Venous Ulcers ◽  
Eventual Healing ◽  
The Impact

Chronic venous leg ulcers (VLU) affect around 1% of the adult population in the Western world. The impact of VLU is both social and economic, with significant expenditures on active venous ulcers to provide medical treatment and eventual healing. At the core of VLU is venous hypertension which affects the venous macrocirculation. The changes incurred in venous hemodynamics leads to microcirculatory changes affecting the postcapillary venule and surrounding tissues. Inflammation by leukocytes affecting the venous endothelium, promotes a complex cascade and activation of adhesion molecules expression, chemokines and cytokines released, altered growth factor responses, and activation of protease (e.g. tPA) and proteinase (e.g. MMPs) activity that causes dysregulation and compromise of tissue integrity with eventual dermal damage and ulcer development. A critical component to treating VLU is correcting the abnormal venous hemodynamics and compression therapy. Unfortunately, VLU recurrence ranges between 30–70%, and other modalities in therapy along with compression are required. The goal for adjuvant products is to restore the balance from an inflammatory chronic wound to that of a reparative wound that will promote provisional matrix and epithelialization. There are many products on the market that can be used as adjuvant to compression therapy, but it must be recognized that there is a paucity of clinical trials that have evaluated the clinical effectiveness of specific products with clearly defined end points, and most importantly a healed VLU with a low recurrence rate. This review will discuss the fundamentals of VLU inflammation, and evaluate the available literature that may have benefit in reducing inflammation and lead to effective VLU healing.

scholarly journals Venous ulcer treatment requires inelastic compression

Phlebologie ◽  
2018 ◽  
Vol 47 (01) ◽  
pp. 7-12 ◽  
Author(s):  
G. Mosti
Keyword(s):  
Healing Rate ◽  
Healing Process ◽  
Compression Therapy ◽  
Venous Hypertension ◽  
Leg Ulcers ◽  
Skin Damage ◽  
Foam Sclerotherapy ◽  
Compression Pressure ◽  
Inelastic Material ◽  
Hemodynamic Impairment

SummaryLeg ulcers have a venous pathophysiology in the vast majority of cases (1–4). Superficial or deep venous insufficiency and deep vein obstruction produce ambulatory venous hypertension due to venous reflux and venous pumping function impairment. The impaired venous hemodynamics is the key pathophysiologic mechanism leading to skin damage through several intermediate steps. Fibrin cuff formation around the microvessels, impairing gases (O2, CO2) exchange (5), white cells entrapment (6) causing skin necrosis, growth factors inhibition (7) producing a stagnation of the healing process have been considered involved in ulcer onset and maintenance. The treatment of venous leg ulcers (VLU) must be based on the correction of the hemodynamic impairment which can be achieved conservatively by means of compression therapy, walking and leg elevation or by means of invasive procedures (open surgery, endovascular procedures as endovenous Laser ablation, radiofrequency, foam sclerotherapy, conservative hemodynamic treatment). Compression therapy is frequently considered the first treatment option and it is the only therapeutical procedure which achieved the grade 1A in most recent guidelines or consensus documents (8–10). The crucial point is choosing the most effective compression modality. There are clear evidences that inelastic is more effective than elastic material in counteracting the venous hemodynamic impairment (11–14) that should „ensure” a superior effectiveness in promoting a higher healing rate of VLU, which are due to venous hemodynamic impairment. When looking at evidences we have some data showing that the higher the compression pressure the higher the healing rate (9, 15–17) and this is clearly in favors of inelastic bandages which exert a much higher pressure that elastic materials. On the other side we have many papers claiming a greater effectiveness of elastic stockings or elastic bandaged compared with inelastic material (18–30). Nevertheless studies comparing elastic and inelastic devices have so many flaws that their conclusions are hard to trust (31). Aim of this work is providing updated information about compression therapy effects on venous hemodynamic and the most effective compression modality to achieve the best outcome in VLU treatment.

scholarly journals Role of Four Layer Compression Dressings in Management of Chronic Venous Ulcers

2019 ◽  
Vol 5 (02) ◽  
pp. 42-45
Author(s):  
Luv Luthra ◽  
Rajendra Prasad ◽  
Ranjith Kumar ◽  
Nivedita Mitta ◽  
Tinku Varghese
Keyword(s):  
Lower Extremity ◽  
Healing Rate ◽  
Randomized Study ◽  
Compression Therapy ◽  
High Morbidity ◽  
Age Group ◽  
Duration Of Treatment ◽  
Medical College ◽  
Venous Ulcers

Abstract Introduction Nonhealing venous ulcers are one of the most common forms of lower extremity ulcers in the present population. It is cumbersome to treat and is associated with high-morbidity and immense treatment expenses. The current treatments include compression therapy. Four-layer compression dressings have proven to be an effective treatment for venous ulcers. Objective This study aimed to evaluate the efficacy of four-layer compression dressings and to study the rate of healing and duration of treatment with four-layer compression dressings. Materials and Methods A prospective randomized study conducted at MS Ramaiah Medical college which included 70 patients who completed the course of weekly dressings depending on the size of ulcer. The regular four-layer dressings were done by a trained podiatrist in vascular outpatient department (OPD) once a week. The area of the ulcer was calculated using the modified Gilmen formula. Results A total of 70 patients who were compliant with the treatment were included in the study. A considerable percentage (74%) of patients were male and all the ulcers were located at the gaiter area. Most belonged to the age group between 41 to 50 years (25%). The healing rate of ulcers at the end of 4, 8 and 12 weeks were 46.87, 28.12, and 25%, respectively. At the end of 12 weeks, all the ulcers healed.

The Post-Thrombotic Syndrome

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 216-220 ◽  
Author(s):  
Susan R. Kahn
Keyword(s):  
Risk Factors ◽  
Anticoagulation Therapy ◽  
Compression Therapy ◽  
Secondary Prophylaxis ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Venous Ulcers ◽  
Risk Determinants

AbstractThe post-thrombotic syndrome (PTS) is an important chronic complication of deep vein thrombosis (DVT). The present review focuses on risk determinants of PTS after DVT and available means to prevent and treat PTS. More than one-third of patients with DVT will develop PTS, and 5% to 10% of patients develop severe PTS, which can manifest as venous ulcers. PTS has an adverse impact on quality of life as well as significant socioeconomic consequences. The main risk factors for PTS are persistent leg symptoms 1 month after acute DVT, anatomically extensive DVT, recurrent ipsilateral DVT, obesity, and older age. Subtherapeutic dosing of initial oral anticoagulation therapy for DVT treatment may also be linked to subsequent PTS. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will prevent cases of PTS. Daily use of elastic compression stockings for 2 years after proximal DVT appears to reduce the risk of PTS; however, uncertainty remains regarding optimal duration of use, optimal compression strength, and usefulness after distal DVT. The cornerstone of managing PTS is compression therapy, primarily using elastic compression stockings. Venoactive medications such as aescin and rutosides may provide short-term relief of PTS symptoms. Further studies to elucidate the pathophysiology of PTS, to identify clinical and biological risk factors, and to test new preventive and therapeutic approaches to PTS are needed.

scholarly journals A randomized trial of surgery alone versus surgery plus compression in the treatment of venous leg ulcers in patients with primary venous insufficiency

2020 ◽  
Vol 77 (8) ◽  
pp. 811-815
Author(s):  
Dragan Milic ◽  
Sasa Zivic ◽  
Mladjan Golubovic ◽  
Dragan Bogdanovic ◽  
Milan Lazarevic ◽  
...  
Keyword(s):  
Ulcer Healing ◽  
Venous Insufficiency ◽  
Healing Rate ◽  
Surgical Intervention ◽  
Compression Therapy ◽  
Healing Time ◽  
Leg Ulcers ◽  
Compression Device ◽  
Group A ◽  
Group B

Background/Aim.Venous leg ulcers (VLU) are a significant health problem worldwide. It is well known that VLU are difficult to treat and that they have high tendency for recurrence. Compression therapy is the preferred treatment modality but there is growing evidence that correction of underlying venous disorder in early stages of the disease in addition to compression treatment may improve ulcer healing and reduce recurrence rate. Methods. An open, prospective, randomized, single-center study, with a 6-months follow-up was performed to determine the efficacy of two different treatment modalities (surgery alone versus surgery plus compression) in the treatment of VLU in patients with primary venous insufficiency. Patients with secondary venous insufficiency and/or thrombosis were excluded from the study. Overall, 71 patients were randomized (37 men, 34 women; mean age 60 years) into two groups: the group A ? 34 patients who underwent surgical intervention (stripping) and postoperatively were treated with simple wound dressing only, and the group B ? 37 patients who underwent surgical intervention (stripping) and wore a heelless open-toed elastic class III compression device knitted in tubular form ?Tubulcus? (Laboratoires Innothera, Arcueil, France). All patients in group B were instructed to wear compression device continuously during the day and night. The study was performed at the Clinic for Cardiovascular and Transplant Surgery, Clinical Centre Nis (Serbia) with primary endpoint of the study being complete ulcer healing at 180 days. Results. The healing rate was 29.41% (10/34) in the group A, and 56.76% (21/37) in the group B (p < 0.01). Mean healing time in the group A was 141 ?15 days, and in the group B it was 98 ?12 days (Log-rank life table analysis: p < 0.001). Conclusion. This study suggests that for VLU in patients with primary venous insufficiency, surgery plus compression therapy provides higher healing rate and faster healing time compared to surgery only.

Ankle Motility is a Risk Factor for Healing of Chronic Venous Leg Ulcers

2001 ◽  
Vol 16 (1) ◽  
pp. 38-40 ◽  
Author(s):  
J. R. Barwell ◽  
M. Taylor ◽  
J. Deacon ◽  
C. Davies ◽  
M. R. Whyman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Pump Power ◽  
Ulcer Healing ◽  
Independent Risk Factor ◽  
Healing Rate ◽  
Leg Ulcer ◽  
Venous Leg Ulcer ◽  
Compression Bandaging ◽  
Venous Ulcers ◽  
Ulcer Healing Rate

Objective: To investigate the effect of ankle motility on chronic venous leg ulcer healing, and to relate this to calf pump function and muscle bulk. Methods: This was a prospective cohort study undertaken in a leg ulcer clinic. Ankle motility, calf-ankle circumference ratio and calf pump power (derived from digital photoplethysmography) were assessed as to their effect on ulcer healing rate. Thirty consecutive patients undergoing multi-layer compression bandaging for open chronic venous ulcers were included. Results: Ankle motility was an independent risk factor for ulcer healing ( p = 0.001, hazard ratio 1.08, 95% CI 1.03–1.13). Ankle motility correlated with calf-ankle circumference ratio ( r = 0.48, p<0.01). No relationship was found between photoplethysmography-derived calf pump power, ankle motility or ulcer healing rate. Conclusions Ulcers in legs with poor ankle motility are slower to heal and this may be related to reduced calf muscle bulk. Ankle exercises or physiotherapy could be considered in such patients.

scholarly journals Mechanism of Action of Elastic Compression Therapy in Phlebolymphology

2021 ◽  
Vol 4 (4) ◽  
Keyword(s):  
Mechanism Of Action ◽  
Constant Pressure ◽  
Compression Therapy ◽  
Physical Structure ◽  
Elastic Compression ◽  
Venous Ulcers

Compression is the best therapy in the treatment of venous ulcers. The intensity of the bandage compression essentially depends on four factors: the physical structure and elastomeric properties of the bandage, the shape of the limb the bandage is applied to, the ability and experience of the doctor or nurse who applies it and the ability of the patient to deambulate [1, 2]. The development of construction technologies can help reduce the variability of inter- and intra-bandage tension: one of the most promising possibilities is the manufacturing of a vari-stretch elastomer, capable of exerting a relatively constant pressure regardless of limited variations in extension.

Sign in / Sign up

Export Citation Format

Share Document