Compression bandaging

Provided that arterial disease has been excluded, the treatment of choice in venous ulceration is compression bandaging combined with exercise. Bandaging works by providing active counterpressure to the hypertensive venous blood and by improving the function of the muscle pump.

A suitable compression system should:

• be capable of providing graduated compression from ankle to knee
• be capable of sustaining the pressure for 7 days
• provide reproducible, safe compression
• be comfortable for the patient and allow them to wear outdoor shoes
• be accepted by the patient

Before applying the bandage, measure the person's ankle circumference and apply below-knee, graduated multi-layer high compression bandaging and replace weekly (1).

An external pressure of 35-40 mm Hg at the ankle is necessary for best results. Compression is best achieved via 3 or 4 layer compression bandaging. Healing rates of between 50-80% are achieved at 12 weeks with 3 or 4 layer compression bandages. In comparing 4 layer bandaging to usual care (2):

• at 12 weeks leg ulcers were healed in more patients in the 4 layer bandaging group than the usual care group (54% v 34%, p<0.001) - this difference remained after adjusting for ulcer area and duration, patient age, deep venous thrombosis, rheumatoid arthritis and diabetes
• study conclusions were that, in patients with venous leg ulcers, 4 layer bandaging reduced healing time and was associated with lower costs in nursing time than usual care

Compression must not be used if the ABPI is less than 0.8 or there is active phlebitis, deep vein thrombosis, or cellulitis (1).

If the leg ulcer is infected, do not start compression therapy until infection has resolved (1).

Reference:

• 1. Clinical Knowledge Summaries 2008. Leg ulcer-venous
• 2. O'Brien JF et al. Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers. Br J Surg 2003;90:794-8.
• 3. Drug Information Letter (1996), North West (Liverpool) Drug Information Service, 109, 1-4.