John D. DesJardins, Ph.D
Anne Marie Holter
Compression is the standard of care for the management of venous leg ulcers (VLUs) resulting from chronic venous insufficiency.1,5 Compression therapy products range from elastic stockings to multi-layered wraps and are designed to provide therapeutic levels of compression to reduce venous hypertension.2,3 To date, a majority of the compression research has focused on the effect different types of compression products have on the large vasculature structures (macro-circulation).4 There has been minimal research looking at the impact of different forms of compression on the micro-circulation of the skin and the function of the lymphatics. It has been documented that bandages that create greater pressure variations are superior for wound healing and edema management.4 Fuzzy Wale Compression (FWC) elastic stockings have previously been shown to produce alternating areas of low level static compression when applied with Active Fluid Management (AFM) dressings and were shown anecdotally to have a positive impact on healing for previously recalcitrant wounds.5 We hypothesized that alternating areas of different levels of static compression may have an enhanced effect on the micro-circulation of the tissue. Additional in-vitro leg model testing was performed to show baseline measurement of compression forces at the skin surface with application of FWC elastic stockings and AFM dressing alone and in combination with 2-layer cohesive wraps, 4-layer multi-layer compression system and with a multi-component lymphedema wrap. Differential pressure readings were recorded both visually and numerically providing a pressure map at the simulated skin interface for each compression application. Addition of compression bandage layers produced greater pressure ranges; however, the alternating compression profile remained. This testing suggests the addition of the FWC elastic stocking under compression may further enhances the circulatory effect of compression therapy both macro-circulation and micro-circulation. Additional in-vivo testing is necessary to confirm these circulatory variations in human subjects.
1. O’Donnell TF et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum. J Vasc Surg. 2014 Aug; 60(2 Suppl):3S-59S
2. Partsch, H. Compression therapy of venous ulcers: Hemodynamic effects depend on interface pressure and stiffness. EWMA Journal 2006, Volume 6(2).
3. MacGregor, Lisa. Principles of Compression in venous disease, a practitioner's guide to treatment and prevention of venous leg ulcers; Wounds International. 2013.
4. Partsch H, Moffatt C. An overview of the science behind compression bandaging for lymphedema. Best Practice for the management of lymphedema. 2nd ed.
5. Ehmann, Suzie. Bridging the gap between compression and exudate management in lower extremity wounds. Poster presented at Symposium for Advanced Wound Care; October 20-22; Las Vegas, NV.