From the Guidelines
For stasis wounds, compression stockings with a pressure of 30-40 mmHg are recommended, as they have been shown to be most effective in managing venous stasis ulcers and promoting healing. This recommendation is based on the most recent and highest quality study, which suggests that pressures of 30 to 40 mm Hg are advised for more severe disease 1. The use of compression therapy has been widely described as the best initial treatment for varicose veins, and it works by reducing venous stasis, containing edema, and improving lymphatic drainage 1.
When using compression therapy, it is essential to consider the severity of the disease and the patient's ability to tolerate the compression. For patients who cannot tolerate the higher level of compression initially, starting with 20-30 mmHg may be appropriate, with gradual progression to higher compression as tolerated 1. The compression should be graduated, with the highest pressure at the ankle and decreasing pressure moving up the leg.
Key points to consider when using compression therapy for stasis wounds include:
- Starting with a lower pressure and gradually increasing as tolerated
- Using graduated compression, with the highest pressure at the ankle
- Applying compression therapy after wound dressing and continuing even after the wound heals to prevent recurrence
- Putting on compression stockings in the morning before getting out of bed when leg swelling is minimal
- Removing the stockings at night and replacing them every 3-6 months as they lose elasticity with regular use 1.
Overall, the use of compression stockings with a pressure of 30-40 mmHg is a crucial component of the management of stasis wounds, and it should be used in conjunction with other therapies to promote healing and prevent recurrence 1.
From the Research
Compression Stocking Pressure for Stasis Wounds
- The optimal pressure range for compression therapy in reducing chronic leg oedema is between 40 and 60 mmHg, with higher pressures showing a negative correlation with volume reduction 2.
- Compression stockings exerting a pressure of around 30 mmHg are nearly as effective as high-pressure bandages with an initial pressure over 60 mmHg in reducing chronic leg oedema 2.
- There is no statistically significant difference in healing rates using elastic compression vs inelastic compression, four-layer vs <four-layer bandage systems, different four-layer bandage systems, or compression bandages vs compression stockings 3.
- The use of compression therapy is associated with a statistically significant difference in healing rates compared to no compression, with moderate-certainty evidence 3.
Key Findings
- Compression therapy is a key component of the management of patients with venous leg ulcers, along with wound care 4.
- The choice of compression device, such as bandages or stockings, may not significantly impact healing rates 3.
- The optimal pressure range for compression therapy should be considered when selecting a compression device for patients with stasis wounds 2.