The goal: Compression that is high enough to promote healing while limiting the potential for complications.
Compression therapy is considered the gold standard treatment for venous ulcers, and it provides several essential mechanisms in the treatment of venous insufficiency, including reducing vessel diameter, aiding venous return, and reducing edema.
Patients with chronic venous insufficiency may have incompetent valves and/or calf pump dysfunction, which can result in venous blood pressure consistently exceeding 40mm of Hg while walking. Patients who do not have this condition demonstrate a venous blood pressure of 22mm of Hg pressure while walking.
Venous hypertension and progressive edema over time will result in skin changes, such as fibrosis of the skin caused by chronic inflammation, which gives the skin a woody appearance and texture. Other changes—such as scarring, hyperpigmentation, scaling, or weeping—can also contribute to ulceration. Compression is a vital part of the treatment plan for venous ulcers
The type of compression to use for healing a venous ulcer is based on the provider’s assessment for the individual patient. The goal is compression that is high enough to promote healing while limiting the potential for complications. The first thing that must be ruled out is significant arterial disease. This can be done by performing an Ankle Brachial Index (ABI). Compression is the recommended treatment for an ABI of greater than 0.8 or modified compression for greater than 0.5 and less than 0.8.
The evidence is clear that compression increases ulcer healing rates compared with no compression. Adequate compression can be defined as pressure of 30-40mm of Hg applied at the ankle. In general, a device which includes multiple (2-4) components is the most effective at achieving this level of compression. When modified compression is needed, a paste wrap is a viable alternative.