Wound & Skin Care: Understanding compression for venous leg ulcers
Kevin Y. Woo PhD, RN, FAPWCA
Barbara G. Cowie MN, RN, GNC(C), NCA

January 2013 
Volume 43  Number 1
Pages 66 - 68
  PDF Version Available!

LEG ULCERATION is a common chronic health condition often associated with a prolonged healing trajectory and frequent recurrence. Approximately 1.5 to 3.0 per 1,000 adults have active leg ulcers, and the prevalence continues to grow due to an aging population.1,2In our recent regional survey of 1,331 individuals receiving home care services, 21% of home care was related to lower extremity ulcerations.3The disease burden of leg ulcers on patients is significant; many patients living with chronic leg ulcers experience diminished quality of life, pain, psychosocial maladjustment, limited work capacity, and physical disabilities.4,5 Although chronic leg ulcers involve an array of pathologies, chronic venous disease is responsible for up to 70% of all cases.6This article will review the types of compression bandages for venous leg ulcers and their mechanisms.The mainstay of treatment for venous leg ulcers is compression, which reduces venous congestion (level of evidence, A; see Levels of evidence). The principle of compression therapy is simple: The use of external pressure from bandages or wraps moves fluid from the interstitial space back into the intravascular compartment and prevents reflux.7Compression bandages are classified as either elastic (long stretch with maximal extensibility >100%) or inelastic or rigid (short stretch with maximal extensibility <100%), (see Types of compression.) Elastic bandages contain elastomeric fibers.7,8 Easy to stretch, they produce a sustained squeeze of tissue as they recoil back to their original length. In contrast, inelastic bandages form a rigid covering that resists the lateral expansion of the calf muscle during active contractions. Instead, the subbandaging pressure (the actual compression pressure underneath the bandages) travels inward, enhancing the action of the calf muscle pump and venous return. Inelastic bandages have the advantage of generating high pressure only when the patient is mobile and active. Residual pressure

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