Do Not Order Compression Stockings for a Painful Pressure Wound on the Leg
Compression stockings are contraindicated when there is an active pressure wound, as they can cause medical device-related pressure injury and worsen existing skin breakdown. 1
Key Contraindications and Safety Concerns
Absolute Contraindications for Compression Therapy
Active pressure wounds represent a direct contraindication to compression stockings because the external pressure can exacerbate tissue damage and impede wound healing 1
Compression therapy should be avoided when the ankle-brachial index is <0.6, as this indicates arterial insufficiency requiring revascularization rather than compression 2, 3
Known complications of compression therapy include skin breakdown, discomfort, and allergic reactions—all of which are particularly problematic in patients with existing wounds 2, 3
High-Risk Features That Increase Pressure Injury Risk
Patients with fragile skin, pronounced bony prominences or tendons, calf atrophy, foot drop, neuropathy/absent sensation, limited movement, cognitive impairment, or those receiving end-of-life care are at elevated risk for compression-related pressure injuries 1
Older age is an independent risk factor for developing medical device-related pressure injuries from compression therapy 1
Peripheral arterial disease significantly increases the risk of compression-induced tissue damage 1
Clinical Algorithm for Decision-Making
Step 1: Identify the Wound Type
- If the wound is a pressure injury (as stated in your question): Do not apply compression stockings 1
- If the wound is a venous leg ulcer with confirmed venous insufficiency: Compression may be appropriate after arterial assessment 2, 4, 5
Step 2: Assess Arterial Perfusion
- Measure ankle-brachial index before any compression therapy 2, 3
- If ABI <0.6: Absolute contraindication to compression 2, 3
- If ABI 0.6-0.9: Reduced compression (20-30 mmHg) may be safe only for venous ulcers, not pressure wounds 2, 3
Step 3: Evaluate Skin Integrity
- Active pressure wounds require wound healing interventions (pressure relief, appropriate dressings, nutritional support) rather than compression 1
- Compression can only be considered after complete wound healing and resolution of underlying pressure-related factors 1
Common Clinical Pitfall
The most critical error is confusing a pressure wound with a venous leg ulcer. While compression therapy is the cornerstone of venous leg ulcer management (with moderate-certainty evidence showing improved healing rates and reduced pain) 5, applying compression to a pressure wound will worsen tissue damage and delay healing 1. Pressure wounds require pressure redistribution and offloading, which is the opposite therapeutic approach from compression.