Compression Therapy

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 compromised vascular status and the use of compression. The purpose of the ankle-brachial index (ABI) test is to support the diagnosis of vascular disease by providing an objective indicator of arterial perfusion to a lower extremity.

By: Karen Bauer, NP-C, CWS How often should ankle-brachial indexes (ABIs) be repeated? If someone has a stage 3 pressure injury to the top of the foot, should compression be held on that extremity? The Wound, Ostomy and Continence Nursing Society guidelines suggest ABIs every 3 months routinely, while the Society for Vascular Surgery guidelines recommend that post endovascular repair, ABIs are done at 6 and 12 months (then yearly). For open revascularization, surveillance studies can be at 3, 6, and 12 months. Ultimately, many factors play into this. If the ulcer is closing and the limb remains stable, you might forgo frequent ABIs, but if the ulcer is not closing, or the patient has new or persistent ischemic symptoms, you should check ABIs more frequently. As far as compression with a dorsal foot pressure injury is concerned, as long as arterial status has been ascertained, compression can be utilized. The original source of pressure should be removed (shoe? ankle-foot orthotic?). If there is a venous component, cautious compression will aid in ulcer resolution.

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS Arterial ulcers can cause much pain for patients and consternation for the wound care professionals tasked with managing them. Arterial ulcers can be a catch-22 in that many patients with arterial ulcers present with edema, but due to the nature of their problem cannot be safely compressed.

Venous ulcers are known to be complex and costly. There is an array of evidence-based treatment options available to help formulate a comprehensive treatment plan toward wound closure. Health care professionals should utilize treatment options while encompassing a holistic approach to venous ulcer management. Involving the patient and/or caregiver in developing a treatment plan will increase the chances of successful wound healing outcomes. Wound closure is the primary goal of a treatment plan; however, preventing recurrence and infection should be considered just as important.

By Janet Wolfson PT, CLWT, CWS, CLT-LANA Acute care wound or edema professionals are bombarded with multiple kinds of edema that can be treated in many ways—and with many choices of compression garments. What to choose?

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA Reflecting back on "In the Trenches With Lymphedema," WoundSource's June Practice Accelerator webinar, many people sent in questions. I have addressed some regarding compression use here.

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS Compression therapy is the “gold standard” for the treatment of venous ulcers. However, compression therapy is not a one-size-fits-all treatment and the clinician must decide on the right type of compression therapy for the individual client in order to prevent complications from occurring, such as ischemia and necrosis.

By Alton R. Johnson Jr, DPM Four weeks ago, I was granted the privilege to treat a patient with type 2 diabetes with neuropathy who presented to the wound care center after developing a full-thickness pressure ulceration on the lateral aspect of her right leg as a result of an ill-fitted brace used four weeks earlier. The first clinical feature I noticed about the patient's lower extremity compared with the previous encounter was marked increased pitting edema. As a sequela of the lack of compression, the patient's lower extremity edema had increased, causing the wound to break down further in comparison with our last encounter with her. I first asked the patient why she discontinued the multipurpose tubular bandage that was dispensed and applied to her right extremity during the last visit. Her immediate response was that the home health aide had disposed of it by mistake; however, the patient stated that the aide used an available non-compressive stockinette instead.

Compression therapy is a well-established treatment modality for a number of conditions, including venous disorders, thrombosis, lymphedema, and lipedema. It is also very effective in treating various kinds of edema.1 Based on patient diagnostic data, many patients with these conditions can benefit from targeted compression therapy.

By the WoundSource Editors Edema is the abnormalaccumulation of excess fluid within tissue. The swelling associated with edema can be localized to a small area following an acute injury, it can affect an entire limb or a specific organ, or it can be generalized throughout the entire body. Edema is not a disease, but rather a symptom that can indicate general health status, side effects of medications, or serious underlying medical conditions.