The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy

The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy


Background

Venous leg ulcers (VLU) have a huge social and economic impact. An estimated 1.5% of European adults will suffer a venous ulcer at some point in their lives. Despite the widespread use of bandaging with high pressure in the treatment of this condition, recurrence rates range between 25% to 70%. Numerous studies have suggested that the compression system should provide sub-bandage pressure values in the range from 35 mm Hg to 45 mm Hg in order to achieve the best possible healing results.

Methods

An open, randomized, prospective, single-center study was performed in order to determine the healing rates of VLU when treated with different compression systems and different sub-bandage pressure values. One hundred thirty-one patients (72 women, 59 men; mean age, 59-years-old) with VLU (ulcer surface >3 cm2; duration >3 months) were randomized into three groups: group A – 42 patients who were treated using an open-toed, elastic, class III compression device knitted in tubular form (Tubulcus, Laboratoires Innothera, Arcueil, France); group B – 46 patients treated with the multi-component bandaging system comprised of Tubulcus and one elastic bandage (15 cm wide and 5 cm long with 200% stretch, Niva, Novi Sad, Serbia); and group C – forty-three patients treated with the multi-component bandaging system comprised of Tubulcus and two elastic bandages. Pressure measurements were taken with the Kikuhime device (TT MediTrade, Soro, Denmark) at the B1 measuring point in the supine, sitting, and standing positions under the three different compression systems.

Results

The median resting values in the supine and standing positions in examined study groups were as follows: group A – 36.2 mm Hg and 43.9 mm Hg; group B – 53.9 mm Hg and 68.2 mm Hg; group C – 74.0 mm Hg and 87.4 mm Hg. The healing rate during the 26-week treatment period was 25% (13/42) in group A, 67.4% (31/46) in group B, and 74.4% (32/43) in group C. The success of compression treatment in group A was strongly associated with the small ulcer surface (<5 cm2) and smaller calf circumference (CC; <38 cm). On the other hand, compliance in group A was good. In groups B and C, compliance was poor in patients with small CC, but the healing rate was high, especially in patients with large ulcers and a large CC (>43 cm).

Conclusion

The results obtained in this study indicate that better healing results are achieved with two or multi-component compression systems than with single-component compression systems and that a compression system should be individually determined for each patient according to individual characteristics of the leg and CC. Target sub-bandage pressure value (B1 measuring point in the sitting position) of the compression system needed for the ulcer healing could be determined according to a simple formula, CC + CC/2.

Compression therapy remains the most widely used treatment for venous leg ulcer (VLU), and it has been utilized in different forms for more than 4 centuries. The application of external pressure to the calf muscle raises the interstitial pressure resulting in improved venous return and reduction in the venous hypertension. Published healing rates of venous ulcers obtained with compression therapy vary widely from 40% to 95%1-4 and numerous studies have suggested that compression systems with sub-bandage pressure values from 35 mm Hg to 45 mm Hg provide the best possible healing results.5-7 Unfortunately, until today, there is no standard compression therapy that is universally successful in the treatment of patients with VLU. Although many studies have proved the efficacy of compression therapy in the treatment of these patients, there is still no agreement on what type of compression and sub-bandage pressure values should be used in order to achieve the best possible healing results.


Credit:

Presented at the Twenty-first Annual Meeting of the American Venous Forum, Phoenix, Ariz, Feb 11-14, 2009.

. Author links open the author workspace.Dragan J.MilicPhDa. Numbers and letters correspond to the affiliation list. Click to expose these in author workspaceOpens the author workspaceOpens the author workspace. Author links open the author workspace.Sasa S.ZivicMDa. Numbers and letters correspond to the affiliation list. Click to expose these in author workspace. Author links open the author workspace.Dragan C.BogdanovicMDb. Numbers and letters correspond to the affiliation list. Click to expose these in author workspace. Author links open the author workspace.Milan M.JovanovicPhDa. Numbers and letters correspond to the affiliation list. Click to expose these in author workspace. Author links open the author workspace.Radmilo J.JankovicPhDb. Numbers and letters correspond to the affiliation list. Click to expose these in author workspace. Author links open the author workspace.Zoran D.MilosevicPhDb. Numbers and letters correspond to the affiliation list. Click to expose these in author workspace. Author links open the author workspace.Dragan M.StamenkovicMDc. Numbers and letters correspond to the affiliation list. Click to expose these in author workspace. Author links open the author workspace.Marija S.TrenkicMDa. Numbers and letters correspond to the affiliation list. Click to expose these in author workspace


Received 3 August 2009, Accepted 3 October 2009, Available online 4 January 2010.