1. Goldman, Robert J. MD

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Compression is the cornerstone of therapy for patients with venous ulcers. This treatment modality is reported to improve the rate of ulcer healing, reduce the incidence of recurrence, and prolong the time to first recurrence.


Between 50% and 60% of patients heal with compression therapy alone during a 6-month period. Some of the physiologic changes found to occur with compression therapy include improvement of lymphatic drainage, reduction of superficial venous pressure, improvement of blood flow velocity through unoccluded deep and superficial veins, and reduction of reflux in deep veins.


In studies, venous ulcers that demonstrated healing after 4 weeks of compression therapy were likely to be completely healed by 24 weeks. When healing was not evidenced after 4 weeks of compression, the venous ulcer tended to remain problematic.


The clinician should keep in mind these 5 essential tips when using compression therapy:


1. Compression is used with caution with peripheral arterial disease (ie, ankle-brachial index less than 0.8 in a nondiabetic patient).


2. Inelastic compression (eg, Unna boot) reduces edema by the ankle pump mechanism; therefore, it is designed primarily for ambulatory patients.


3. There is nothing sacred about changing compression dressings weekly: If wounds have overlying eschar or copious drainage, dressing changes must be made as often as necessary to manage drainage.


4. Elastic "long-stretch" compression (eg, Coban, Profore) is straightforward for nonprofessionals to apply and, therefore, most amenable to frequent dressing changes. Note that elastic compression requires adequate padding (including a toe-to-knee gauze underlayer). The greatest compression is usually over the instep. Use extra padding on this area for comfort and to minimize risk of pressure necrosis.


5. Pain associated with uncomplicated, well-perfused venous ulcers can be an obstacle for therapeutic compression (ie, 40 mm Hg or more). Use adequate pain medication as appropriate and taper up to therapeutic levels of compression.