Compression therapy in leg ulcers

The purpose of this article is to give a review on different compression modalities for the management of leg ulcers and to evaluate their efficacy based on evidence coming from clinical trials and experimental studies. Interface pressure-peaks on the leg during walking exceeding 50–60 mmHg reduce venous reflux and increase venous pumping function. This may be achieved by stiff compression textiles like multicomponent bandages especially when containing cohesive material or by zinc paste bandages. These compression types exert high stiffness which is characterized by a tolerable resting pressure and high pressure peaks during walking (“working pressure”), but need to be applied by well trained and experienced staff. Short-stretch adjustable Velcro-wraps and (double) compression stockings may be promising alternatives allowing self-management. In patients with arterial occlusive disease (ABPI 0,6–0,8) modified compression using stiff material applied with reduced pressure (<40 mmHg) under careful control may increase both, arterial flow and venous pumping function.ConclusionIn addition to the principles of modern wound management and to endovenous procedures abolishing superficial venous reflux compression therapy in combination with mobilization and walking exercises is still the basic treatment modality of leg ulcers.

► The dosage of compression therapy corresponding to the pressure on the leg has been widely ignored in previous research.
► Measurement of compression pressure is not only an important prerequisite to compare the effects of different compression materials in clinical trials but is also helpful for training purposes to apply appropriate bandages.
► In experimental studies a dose –response relation can be evaluated relating compression pressure to the effect of compression on oedema, venous reflux and pumping function or on arterial and microcirculatory parameters.
► Such experiments help to better understand the importance of compression therapy in ulcer healing.