Best Compressive Therapy for Venous Ulcers
The mainstay of treatment for venous ulcers is compression therapy, with inelastic compression of 30-40 mmHg being more effective than elastic bandaging for wound healing. 1
Compression Therapy Options and Effectiveness
Pressure Recommendations
- For venous ulcers, a minimum pressure of 20-30 mmHg is recommended, with higher pressures of 30-40 mmHg advised for more severe disease 1
- Inelastic compression of 30-40 mmHg has been demonstrated to be more effective than elastic bandaging for wound healing 1
- For patients with ankle-brachial indices between 0.9 and 0.6, reduced compression to 20-30 mmHg is still successful and safe for venous leg ulcer healing 1
Compression Systems
- Multilayer compression systems are more effective than single-component compression systems 2
- Four-layer bandage systems produce higher initial pressures at the ankle (approximately 42.5 mmHg) compared to traditional adhesive plaster bandaging (29.8 mmHg) 3
- Four-layer bandage systems maintain pressure for one week, while adhesive plaster bandaging pressure drops significantly to 10.4 mmHg within 24 hours 3
- Velcro inelastic compression devices have been shown to be as effective as 3- or 4-layer inelastic bandages 1
Placement and Application
- Improved ejection fraction in refluxing vessels and higher extrinsic pressures are achieved when higher pressures are exerted at the calf over the distal ankle (negative graduated compression bandage) 1
- The alternative graduated compression bandage, which applies more force at the distal ankle over the calf, demonstrated inferior ejection fraction and lower extrinsic pressures 1
- Improved pressures and ejection fractions were observed when placing the compression bandage over the calf versus the distal leg 1
Clinical Outcomes
- A systematic review of 7 randomized controlled trials reported that chronic venous ulcers healed more quickly with compression compared with primary dressings alone, non-compression bandages, and usual care without compression 1
- In a study comparing four-layer bandage systems to traditional adhesive plaster bandaging, 110 of 148 venous ulcers healed completely within 12 weeks (mean 6.3 weeks) using the four-layer system 3
- A meta-analysis comparing four-layer to short-stretch compression found similar complete healing rates at 24 weeks (69.07% vs. 62.23%), but the four-layer system showed a trend toward faster healing time (73.6 days vs. 83.8 days) 4
Special Considerations
- Caution is advised when the ankle-brachial index is <0.6, as this indicates an arterial anomaly requiring revascularization before compression therapy 1
- Approximately 16% of patients with venous leg ulcers have concomitant arterial occlusive disease, which is frequently not recognized 1
- Treatment adherence should be encouraged with proper fitting, education, and detailed instructions 1
- For healed venous ulcers, continued use of medical compression stockings significantly reduces the recurrence rate 2
Comprehensive Management
- In addition to compression therapy, other important measures for treating venous ulcers include maintaining a moist environment to optimize wound healing, providing a protective covering, controlling dermatitis, and aggressively preventing and treating infection 1
- For patients with postthrombotic syndrome and venous ulcers, a supervised exercise training program consisting of leg strength training and aerobic activity for at least 6 months is reasonable for those able to tolerate it 1
- For refractory venous ulcers, surgical or endovascular procedures may be considered to decrease post-thrombotic morbidity attributable to deep venous obstruction or venous valve incompetence 1
- The relapse rate of venous leg ulcers can be significantly reduced by combining compression therapy with surgical treatment of varicose veins compared to compression therapy alone 2