Prepared by William Marston, MD
Corresponding chapter in Handbook of Venous Disorders: Chapter 30
O'Meara S, Cullum NA, Nelson EA. Compression for venous leg ulcers. Cochrane Database Syst Rev 2009;(1):CD000265.
Comment: This is the latest Cochrane review of the extensive literature on compression methods for the treatment of venous leg ulcers. The authors review the results of 39 trials and provide summary analysis of the outcomes of these trials in aggregate.
Vanscheidt W, Ukat A, Partsch H. Dose-response of compression therapy for chronic venous edema--higher pressures are associated with greater volume reduction: two randomized clinical studies. J Vasc Surg 2009;49:395-402.
Comment: This study provides the best information to date on the relationship between the amount of compression (in this case applied byan intermittent pneumatic device) applied to the leg and volume reduction inpatients with CVI.
Partsch B, Partsch H. Calf compression pressure required to achieve venous closure from supine to standing positions. J Vasc Surg 2005;42:734-8.
Comment: Investigation of the effect of varying amount of static pressure on the size of the superficial and deep veins in varying positions. Determined that in the supine position, 50 mm Hg and in the standing position 70 mm Hg of pressure is required to occlude the deep veins.
Moffatt CJ, Edwards L, Collier M, Treadwell T, Miller M, Shafer L, Sibbald G, Brassard A, McIntosh A, Reyzelman A, Price P, Kraus SM, Walters SA, Harding K. A randomised controlled 8-week crossover clinical evaluation of the 3M Coban 2 Layer Compression System versus Profore to evaluate the product performance in patients with venous leg ulcers. Int Wound J 2008;5:267-79.
Comment: Randomized study addressing one of the most common problems related to bandaging for venous leg ulcers, bandage slippage. In this study a 2-layer compression system was found to perform better in terms of slippage in comparison to a 4 layer system resulting in increased patient preference. Healing rates were similar in the two groups.
Cardinal M, Eisenbud DE, Phillips T, Harding K. Early healing rates and wound area measurements are reliable predictors of later complete wound closure. Wound Repair Regen 2008;16:19-22.
Comment: Importance of the improvement of the wound in the first 4 weeks of compression therapy in predicting complete wound healing within 12 weeks is documented. Thus, if the venous leg ulcer is not improving nicely after a month of compression, it is time to re-evaluate and consider additional therapies.