Compression therapy involves using stockings, bandages or an adjustabled compression device that exert graduated pressure on the lower leg.
Compression therapy is the gold standard treatment for venous leg ulcers and venous hypertension and it can help to prevent the recurrence of leg ulcers. It can also help reduce the symptoms of chronic oedema and lymphoedema.
How does compression therapy work?
Compression therapy tackles the symptoms of venous insufficiency by assisting venous blood flow back to the heart. It also reduces oedema and the diameter of the vessels. The greatest pressure is applied at the ankle and gradually decreases. This, along with calf muscle pump action, increases circulation and prevents pooling of blood in the veins of the lower limb.
There are many compression products available, how do I select the right one?
Compression bandages fall into three main categories: long-stretch, short-stretch or multilayer. In addition, there are alternative two-layer systems, as well as a compression device that allows patient control. Each patient has different needs that need to be considered when choosing the correct product.
Long-stretch bandages stretch to more than 100% of their original length. They can be used as part of a multilayer system or over wool as a two-layer system. The bandage should not be fully stretched when it is applied so that it allows the calf muscle to exert pressure during movement. Long-stretch bandages provide compression when the leg is at rest.
Short-stretch bandages are made from non-elastic cotton and they push pressure back into the leg during movement, supporting the power of the calf-muscle pump. This action stimulates venous return, as it massages the deep veins of the leg. It is particularly good for oedema reduction. It does not exert excessive pressure when the leg is at rest and it may be better suited for more mobile patient. Frequent changes may be needed.
Multilayer systems usually involve three or four layers of wadding, long-stretch bandaging and elastic bandaging. The bandages may be applied in a spiral to maintain the compression gradient, but there are various methods of application. Compression bandaging needs to be applied by skilled practitioners as inexpert application can cause damage.
Compression hosiery, which can be made-to-measure, is also available and can be applied by the patient themselves. There are various products that can help with application as this can prove difficult. Wearing compression hosiery is important for preventing recurrence. Hosiery comes in three classes — light, medium and strong.
Are there any precautions when using compression?
It is important that Doppler tests are performed on the ankle and arm to make sure that the arteries are working normally. Damage can occur if compression is used in the presence of any peripheral arterial disease. Venous disease must also be properly diagnosed before it is used. It is important that compression bandages are applied correctly by skilled practitioners.
Patients should be thoroughly assessed before choosing a type of compression. Concordance can be a problem if patients find the compression garment/bandaging difficult to tolerate, thus it is important to involve the patient when choosing the treatment regimen. Compression hosiery should not be worn at night.
- Cosmetic appearance
- Ease of application
- Patient comfort