A dual pressure indicator, two-layer compression system for treatment of venous leg ulcers: a review

2021 ◽  
Vol 30 (Sup12) ◽  
pp. S6-S12
Author(s):  
Hong Qian Tai ◽  
Lester Chong Rhan Chaen ◽  
Johnson Boey ◽  
Sally Kime ◽  
Rodrigo Rial ◽  
...  
Keyword(s):  
Patient Adherence ◽  
Compression Therapy ◽  
Google Scholar ◽  
Patient Acceptance ◽  
Leg Ulcers ◽  
Layer System ◽  
Time Saving ◽  
Compression System ◽  
Venous Leg Ulcers ◽  
Manual Search

Objective: Venous leg ulcers (VLUs) are considered the most frequent category of hard-to-heal limb ulcers. Although evidence-based care of VLUs suggests that compression therapy plays a pivotal role in the standard of care, patient adherence is considered low, with at least 33% non-compliance, either due to perceived problems from clinicians regarding their own competency in applying the bandages, or from the patient finding the wrapping bothersome. For many years, four-layer bandaging has been considered the ‘gold standard’, but application can be difficult and may also prove uncomfortable for patients. Accurate application may be facilitated by a stretch indicator which has been engineered to act as a surrogate for appropriate pressure application that can address the skill concern, while fewer layers can save clinicians' time and improve the quality of life of patients. Here, we review the literature supporting a two-layer system which combines elastic (long stretch) and inelastic (short stretch) components as well as both layers having graphic markers to define that the dressing has been applied at the proper tension. Method: An initial search was conducted on PubMed and then followed up by a manual search of Google Scholar to retrieve evidence of different levels, in order to evaluate the outcomes of use of the specific two-layer compression system with pressure indicators in the management of patients presenting with VLUs. Results: A total of four papers discussing the specific compression system in question were identified from 32 publications retrieved from PubMed, while a further six were retrieved from Google Scholar. These 10 publications were considered relevant to the two-layer system and were analysed for the outcomes of care, including wound healing, appropriate application, time-saving and better patient acceptance and adherence. Conclusion: Previous authors have demonstrated that two-layer systems are equivalent to four-layer systems. However, the ability to reproducibly apply appropriate compression has remained a question. The papers reviewed demonstrate that evidence suggests that the two-layer compression bandage system with indicators provides continuous, consistent and comfortable treatment that may be easier to apply with accurate pressure levels due to their indicator systems, and therefore, is a procedure that may increase patient adherence and acceptability to the wound therapy.

scholarly journals Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

2020 ◽  
Vol 10 (1) ◽  
pp. 29
Author(s):  
Joseph D. Raffetto ◽  
Daniela Ligi ◽  
Rosanna Maniscalco ◽  
Raouf A. Khalil ◽  
Ferdinando Mannello
Keyword(s):  
Endothelial Cell ◽  
Reactive Oxygen ◽  
Compression Therapy ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Nitrogen Species ◽  
Venous Leg Ulcers ◽  
Tissue Metabolites

Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. Treatment of VLU includes compression therapy and endovenous ablation to occlude the axial reflux. Other interventional approaches such as subfascial endoscopic perforator surgery and iliac venous stent have shown mixed results. With good wound care and compression therapy, VLU usually heals within 6 months. VLU healing involves orchestrated processes including hemostasis, inflammation, proliferation, and remodeling and the contribution of different cells including leukocytes, platelets, fibroblasts, vascular smooth muscle cells, endothelial cells, and keratinocytes as well as the release of various biomolecules including transforming growth factor-β, cytokines, chemokines, MMPs, tissue inhibitors of MMPs (TIMPs), elastase, urokinase plasminogen activator, fibrin, collagen, and albumin. Alterations in any of these physiological wound closure processes could delay VLU healing. Also, these histological and soluble biomarkers can be used for VLU diagnosis and assessment of its progression, responsiveness to healing, and prognosis. If not treated adequately, VLU could progress to non-healed or granulating VLU, causing physical immobility, reduced quality of life, cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant VLU shows prolonged healing time with advanced age, obesity, nutritional deficiencies, colder temperature, preexisting venous disease, deep venous thrombosis, and larger wound area. VLU also has a high, 50–70% recurrence rate, likely due to noncompliance with compression therapy, failure of surgical procedures, incorrect ulcer diagnosis, progression of venous disease, and poorly understood pathophysiology. Understanding the molecular pathways underlying VLU has led to new lines of therapy with significant promise including biologics such as bilayer living skin construct, fibroblast derivatives, and extracellular matrices and non-biologic products such as poly-N-acetyl glucosamine, human placental membranes amnion/chorion allografts, ACT1 peptide inhibitor of connexin 43, sulodexide, growth factors, silver dressings, MMP inhibitors, and modulators of reactive oxygen and nitrogen species, the immune response and tissue metabolites. Preventive measures including compression therapy and venotonics could also reduce the risk of progression to chronic venous insufficiency and VLU in susceptible individuals.

Neurovascular changes after four-layer compression bandaging in people with chronic venous leg ulcers

2007 ◽  
Vol 22 (2) ◽  
pp. 49-55 ◽  
Author(s):  
R Ogrin ◽  
P Darzins ◽  
Z Khalil
Keyword(s):  
Wound Healing ◽  
Wound Repair ◽  
Statistical Significance ◽  
Sensory Nerve ◽  
Compression Therapy ◽  
Clinical Problem ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Perfusion Measurement ◽  
Compression Bandaging

Objectives: Venous leg ulcers represent a major clinical problem, with poor rates of healing. Ideal treatment is compression bandaging. The effect of compression on neurovascular tissues involved in wound repair is unclear. This study aims to assess the effect of four-layer compression therapy (40 mmHg) on neurovascular function and wound healing in people with chronic venous leg ulcers – 15 people (55 years or older) with venous leg ulcers for more than six weeks. Methods: Basal microvascular perfusion measurement (MPM), oxygen tension (tc pO2) measured at sensor temperatures of 39°C and 44°C and sensory nerve function using electrical cutaneous perception thresholds (ECPT) at 5, 250 and 2000 Hz (corresponding to C, A δ and A β fibres) were assessed adjacent to the ulcer site, and at a mirror location on the non-ulcerated limb. Testing was undertaken before and after therapy for 5–12 weeks of four-layer compression bandaging. Results: There was significant improvement in tc pO2 at 44°C and ECPT at 2000 Hz ( P<0.05) compared with pre-intervention. Changes in basal MPM, tc pO2 at 39°C and ECPT at 5 and 250 Hz after compression therapy did not reach statistical significance. Conclusion: Four-layer compression bandaging in people with venous leg ulcers improved some components of neurovascularture in people with chronic venous leg ulcers. Whether this improvement has contributed to wound healing in this study requires further investigation.

Active debridement of venous leg ulcers: a literature review to inform clinical practice

2019 ◽  
Vol 24 (Sup6) ◽  
pp. S24-S29
Author(s):  
Lucy Hall ◽  
Una Adderley
Keyword(s):  
Literature Review ◽  
Research Evidence ◽  
Compression Therapy ◽  
Routine Practice ◽  
Leg Ulcers ◽  
Qualitative And Quantitative ◽  
Venous Leg Ulcers ◽  
Quantitative Studies ◽  
Infection Source ◽  
Robust Evidence

Community nurses often care for patients with sloughy venous leg ulcers. Slough is viewed as a potential infection source and an impediment to healing, but it is unclear if active debridement of slough promotes healing. Using a clinical scenario as a contextual basis, this literature review sought research evidence to answer this clinical question. A strategy based on the ‘4S’ approach was used to identify research evidence. The retrieved evidence included one systematic review, three clinical guidelines and six qualitative and quantitative studies. The analysis suggested that there is no robust evidence to support the routine practice of active debridement of venous leg ulcers to promote healing, and that debridement is associated with increased pain. Since autolytic debridement can be achieved through the application of graduated compression therapy, active debridement may offer no additional benefit.

A systematic review of compression therapy for venous leg ulcers

1998 ◽  
Vol 3 (4) ◽  
pp. 301-313 ◽  
Author(s):  
Simon J Palfreyman ◽  
Rona Lochiel ◽  
Jonathan A Michaels
Keyword(s):  
Systematic Review ◽  
Compression Therapy ◽  
Leg Ulcers ◽  
Venous Leg Ulcers

scholarly journals Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence

2009 ◽  
Vol 6 (5) ◽  
pp. 386-393 ◽  
Author(s):  
Christine Moffatt ◽  
Dheerendra Kommala ◽  
Nathalie Dourdin ◽  
Yoonhee Choe
Keyword(s):  
Compression Therapy ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Prevention Of Recurrence

scholarly journals The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy

2010 ◽  
Vol 51 (3) ◽  
pp. 655-661 ◽  
Author(s):  
Dragan J. Milic ◽  
Sasa S. Zivic ◽  
Dragan C. Bogdanovic ◽  
Milan M. Jovanovic ◽  
Radmilo J. Jankovic ◽  
...  
Keyword(s):  
Compression Therapy ◽  
Leg Ulcers ◽  
Venous Leg Ulcers

Practical aspects of compression therapy – Update 2016

Phlebologie ◽  
2016 ◽  
Vol 45 (04) ◽  
pp. 224-228 ◽  
Author(s):  
K. Heyer ◽  
K. Protz
Keyword(s):  
Complex Form ◽  
Compression Therapy ◽  
Current Status ◽  
Theoretical Knowledge ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
The Status ◽  
The Individual

SummaryCompression therapy is a complex form of therapy. It requires equally practical abilities and theoretical knowledge, as well as an understanding of available materials and the methods in question. All these mentioned aspects of today’s practical compression therapy show deficits.This article shows the current status of treatment of patients with venous leg ulcers in Germany. Based on this, strategies are described, which aim to improve the status of information of the patients, the expertise of the users and the further spread of modern and specialized materials.It is possible and appropriate to better the individual status of treatment of patients through further qualification of carers. This should include the proper usage of materials and methods.

An audience survey of practice relating to pain in the management of chronic venous leg ulcers

2020 ◽  
Vol 25 (Sup12) ◽  
pp. S20-S24
Author(s):  
Leanne Atkin ◽  
Robin Martin
Keyword(s):  
Pain Management ◽  
Lower Limb ◽  
Management Strategy ◽  
Compression Therapy ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Pain Management Strategy

Venous leg ulcers (VLU) respond well to compression, yet many ulcers remain unhealed after 1 year. Practitioners could be reluctant to apply compression to patients with significant ulcer pain. This study aimed to capture the views of practitioners on compression therapy for patients with painful VLU. A survey was conducted at a UK meeting in 2019 using handheld voting pads to capture the anonymous responses to four questions to which a mean of 90 practitioners responded. Nearly 40% of practitioners treat six or more patients a day with painful lower-limb ulcers. Some 80% felt confident in managing patients with painful ulcers; yet, most practitioners suggested they would refer onward for pain management. Some 40% would omit or reduce compression therapy as a pain management strategy. This survey supports the need for technological solutions that reduce VLU pain so that patients receive effective compression therapy.

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