Retrospective review on the effectiveness of compression therapy in venous leg ulcer healing at a wound care centre in Hong Kong

Introduction Compression therapy by inelastic bandages is highly effective in achieving venous leg ulcer healing. Inelastic bandages may be expensive as they need to be changed and discarded at every dressing change. In addition, correct application is difficult in the clinical practice, even by expert healthcare personnel. The aim of our work was to assess whether adjustable compression wraps are more cost effective and more effective than inelastic bandage to achieve venous leg ulcer healing. Methods Sixty-six venous leg ulcer patients were randomized to be treated by adjustable compression wrap (CircAid® JuxtaCure®) ( n = 33) and inelastic bandage (Coban 2 Layer®) ( n = 33). Study duration was 12 weeks. During weekly visits, the ulcers were cleansed and dressed with the same products, and the only variable was the compression device. Ulcer size, ulcer pain, patient’s perception of compression systems, and compression pressure were assessed during the visits, and the material cost was evaluated at the 12th week. Results Adjustable compression wraps were significantly cheaper than bandages (p < 0.0001) and were also more effective (not significantly) in achieving ulcer healing. To heal one ulcer patient, €228 had to be spent when applying an adjustable compression wrap and €381 if inelastic bandages were used. About 26/33 (78.8%) patients in the adjustable compression wrap group were healed after 12 weeks versus 23/33 (69.7%) in the inelastic bandage group (n.s.). Ulcer pain was reduced by both compression devices. Patient perception of compression pressure was similar with both compression devices. Compression pressure was similar at application but better maintained by adjustable compression wrap over time. Conclusions Adjustable compression wraps are significantly cheaper and more effective (not significantly) in achieving venous leg ulcer healing. Self-applicable, adjustable compression wraps are therefore a powerful, cost-effective alternative to inelastic bandages in treating venous leg ulcer.

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Adding topical pale sulfonated shale oil to compression therapy and moist wound care reduced venous leg ulcer size but had no effect on complete wound healing after 20 weeks

Evidence-Based Nursing ◽

10.1136/ebn.9.3.86 ◽

2006 ◽

Vol 9 (3) ◽

pp. 86-86 ◽

Cited By ~ 1

Author(s):

E A. Nelson

Keyword(s):

Wound Healing ◽

Wound Care ◽

Compression Therapy ◽

Leg Ulcer ◽

Shale Oil ◽

Venous Leg Ulcer ◽

Ulcer Size ◽

Complete Wound Healing

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Dutch Venous Ulcer guideline update

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514529693 ◽

2014 ◽

Vol 29 (1_suppl) ◽

pp. 153-156 ◽

Cited By ~ 9

Author(s):

M Birgitte Maessen-Visch ◽

Kees-Peter de Roos

Keyword(s):

Wound Care ◽

Cochrane Review ◽

Compression Therapy ◽

Leg Ulcer ◽

Clinical Severity ◽

Venous Disease ◽

Venous Leg Ulcer ◽

Time Model ◽

Compression Bandages ◽

Venous Clinical Severity Score

The revised guideline of 2013 is an update of the 2005 guideline “venous leg ulcer”. In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates.

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