By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS
Patients who come in with venous insufficiency ulcers and lower extremity arterial disease (LEAD) should be evaluated for...
By Bradley W. Lind and James McGuire DPM, PT, CPed, FAPWHc
Venous leg ulcers are a type of lower extremity wound complicated by excess fluid production, periwound edema, and high bioload produced by venous insufficiency often leading to secondary lymphedema. The Coban™ 2 Layer Compression Therapy System, created by 3M Health Care, was designed to achieve sustained therapeutic compression, while improving the ease of application, and reducing slippage of the dressing during wear. The reduction in layers of the dressing also allows the patient to wear their own footwear and avoid the purchase of a surgical shoe.
Coban™ 2 is indicated for the treatment of venous leg ulcers caused by chronic venous insufficiency or lymphedema, and other clinical situations where compression is indicated. To prevent arterial occlusion by the dressing it is recommended that patients have an ABI of 0.8 or higher. For patients with ABIs between 0.5 and 0.8, 3M Health Care also manufactures the Coban™ 2 Layer Lite Compression Therapy System. Coban™ 2 is contraindicated in patients with decompensated heart insufficiency. The product is to be used for one single use, as the repeated stretching could impair the integrity of the device.
There are two parts to the Coban™ 2 system, which come individually wrapped in a kit. There is an inner foam-lined layer and an outer compressive layer. The foot should be held at a 90° angle during application to prevent folding of the dressing during ambulation. The foam side of the first layer is placed against the skin with a slight stretch, and wrapped with minimal overlap from just behind the fifth metatarsal head, to just below the knee, with minimal (1/4-1/3) overlap. When we apply the dressing we wrap the mid-foot once, come around the heel very low, and then turn and go up the leg. The first layer is applied with the plantar aspect of the heel open otherwise it will not conform completely to the heel and the dressing will be too thick to allow the patients to wear their own shoe.
The second, or compression layer, is designed to be used at full stretch, starting at the same position as the comfort layer, with 50% overlap up to the knee. This layer is thinner and can be applied over the heel without increasing bulk to prevent shoe wear. A Cochrane review revealed that dual component systems containing elastic healed more ulcers in a year than single layer systems without elastic.1
A brief video on how to apply the Coban™ 2 Layer Compression Therapy System can be found here.
Patients should be told to notify their health care provider immediately if they experience any numbness, tingling, swelling, discoloration, or pain while using the system.
The Coban™ 2 system is latex-free, increasing the patient population which can use the product safely. The system can also be left on the skin for up to seven days, allowing for weekly clinic visits and less hands-on nursing time if the patient is seen by home care.2 The second layer bandage is designed to be used under full tension, which takes the guesswork out of the application often seen in other elastic compression systems. It takes very little effort to stretch the material to full length and gives the patient or the clinician more consistency with each new wrapping. We have found full tension to be difficult for many patients to tolerate for prolonged periods of time at first, and we often have to ease into full tension over time as the patient gets used to wearing prolonged compression dressings.
Clinicians should be mindful of how cost-effective the product is. Compared to traditional short stretch bandage treatment, Coban™ 2 had a 19.5% higher efficacy rate, with 2.3 more symptom free months per year, saving over $2,000.3
To learn more about this company and product visit http://www.woundsource.com/company/3m-health-care
1. O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for Venous Leg Ulcers. Cochrane Database of Systematic Reviews. 2012;11: CD000265. DOI: 10.1002/14651858.CD000265.pub3.
2. Mostii G, Crespi A, Mattaliano V. Prospective, Multicenter, Randomized Controlled Trial Comparing a New Two-Component Compression System, to Zinc-Oxide Bandage in Venous Leg Ulcers. Wounds. 2011;23(5):126-134.
3. Nuijten M, Vos A, Wigbers-van Wezel M. The Cost-Effectiveness of Coban 2 for the Treatment of Venous Leg Ulcers in the Netherlands. Value In Health. 2012;15(7):A355.
About the Authors:
Bradley Lind is a third year student at the Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania. He received a Bachelor of Science in Molecular and Cellular Biology from the University of Arizona in 2012. His previous research includes vertical transmission of HIV-1 under the direction of Nafees Ahmad, PhD. Bradley's interests in podiatric medicine are diversified, including diabetic limb salvage, rearfoot reconstruction, and Charcot neuropathy. He is the president of the American Public Health Association at TUSPM, which offers free general foot screenings at community events in Philadelphia throughout the year.
Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.