Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications - a review of present guidelines

2017 ◽  
Vol 31 (9) ◽  
pp. 1562-1568 ◽  
Author(s):  
A. Andriessen ◽  
J. Apelqvist ◽  
G. Mosti ◽  
H. Partsch ◽  
C. Gonska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Compression Therapy ◽  
Leg Ulcers ◽  
Venous Leg Ulcers

scholarly journals Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

2020 ◽  
Vol 10 (1) ◽  
pp. 29
Author(s):  
Joseph D. Raffetto ◽  
Daniela Ligi ◽  
Rosanna Maniscalco ◽  
Raouf A. Khalil ◽  
Ferdinando Mannello
Keyword(s):  
Endothelial Cell ◽  
Reactive Oxygen ◽  
Compression Therapy ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Nitrogen Species ◽  
Venous Leg Ulcers ◽  
Tissue Metabolites

Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. Treatment of VLU includes compression therapy and endovenous ablation to occlude the axial reflux. Other interventional approaches such as subfascial endoscopic perforator surgery and iliac venous stent have shown mixed results. With good wound care and compression therapy, VLU usually heals within 6 months. VLU healing involves orchestrated processes including hemostasis, inflammation, proliferation, and remodeling and the contribution of different cells including leukocytes, platelets, fibroblasts, vascular smooth muscle cells, endothelial cells, and keratinocytes as well as the release of various biomolecules including transforming growth factor-β, cytokines, chemokines, MMPs, tissue inhibitors of MMPs (TIMPs), elastase, urokinase plasminogen activator, fibrin, collagen, and albumin. Alterations in any of these physiological wound closure processes could delay VLU healing. Also, these histological and soluble biomarkers can be used for VLU diagnosis and assessment of its progression, responsiveness to healing, and prognosis. If not treated adequately, VLU could progress to non-healed or granulating VLU, causing physical immobility, reduced quality of life, cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant VLU shows prolonged healing time with advanced age, obesity, nutritional deficiencies, colder temperature, preexisting venous disease, deep venous thrombosis, and larger wound area. VLU also has a high, 50–70% recurrence rate, likely due to noncompliance with compression therapy, failure of surgical procedures, incorrect ulcer diagnosis, progression of venous disease, and poorly understood pathophysiology. Understanding the molecular pathways underlying VLU has led to new lines of therapy with significant promise including biologics such as bilayer living skin construct, fibroblast derivatives, and extracellular matrices and non-biologic products such as poly-N-acetyl glucosamine, human placental membranes amnion/chorion allografts, ACT1 peptide inhibitor of connexin 43, sulodexide, growth factors, silver dressings, MMP inhibitors, and modulators of reactive oxygen and nitrogen species, the immune response and tissue metabolites. Preventive measures including compression therapy and venotonics could also reduce the risk of progression to chronic venous insufficiency and VLU in susceptible individuals.

Neurovascular changes after four-layer compression bandaging in people with chronic venous leg ulcers

2007 ◽  
Vol 22 (2) ◽  
pp. 49-55 ◽  
Author(s):  
R Ogrin ◽  
P Darzins ◽  
Z Khalil
Keyword(s):  
Wound Healing ◽  
Wound Repair ◽  
Statistical Significance ◽  
Sensory Nerve ◽  
Compression Therapy ◽  
Clinical Problem ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Perfusion Measurement ◽  
Compression Bandaging

Objectives: Venous leg ulcers represent a major clinical problem, with poor rates of healing. Ideal treatment is compression bandaging. The effect of compression on neurovascular tissues involved in wound repair is unclear. This study aims to assess the effect of four-layer compression therapy (40 mmHg) on neurovascular function and wound healing in people with chronic venous leg ulcers – 15 people (55 years or older) with venous leg ulcers for more than six weeks. Methods: Basal microvascular perfusion measurement (MPM), oxygen tension (tc pO2) measured at sensor temperatures of 39°C and 44°C and sensory nerve function using electrical cutaneous perception thresholds (ECPT) at 5, 250 and 2000 Hz (corresponding to C, A δ and A β fibres) were assessed adjacent to the ulcer site, and at a mirror location on the non-ulcerated limb. Testing was undertaken before and after therapy for 5–12 weeks of four-layer compression bandaging. Results: There was significant improvement in tc pO2 at 44°C and ECPT at 2000 Hz ( P<0.05) compared with pre-intervention. Changes in basal MPM, tc pO2 at 39°C and ECPT at 5 and 250 Hz after compression therapy did not reach statistical significance. Conclusion: Four-layer compression bandaging in people with venous leg ulcers improved some components of neurovascularture in people with chronic venous leg ulcers. Whether this improvement has contributed to wound healing in this study requires further investigation.

Active debridement of venous leg ulcers: a literature review to inform clinical practice

2019 ◽  
Vol 24 (Sup6) ◽  
pp. S24-S29
Author(s):  
Lucy Hall ◽  
Una Adderley
Keyword(s):  
Literature Review ◽  
Research Evidence ◽  
Compression Therapy ◽  
Routine Practice ◽  
Leg Ulcers ◽  
Qualitative And Quantitative ◽  
Venous Leg Ulcers ◽  
Quantitative Studies ◽  
Infection Source ◽  
Robust Evidence

Community nurses often care for patients with sloughy venous leg ulcers. Slough is viewed as a potential infection source and an impediment to healing, but it is unclear if active debridement of slough promotes healing. Using a clinical scenario as a contextual basis, this literature review sought research evidence to answer this clinical question. A strategy based on the ‘4S’ approach was used to identify research evidence. The retrieved evidence included one systematic review, three clinical guidelines and six qualitative and quantitative studies. The analysis suggested that there is no robust evidence to support the routine practice of active debridement of venous leg ulcers to promote healing, and that debridement is associated with increased pain. Since autolytic debridement can be achieved through the application of graduated compression therapy, active debridement may offer no additional benefit.

scholarly journals Risk Factors for Delayed Healing and Recurrence of Chronic Venous Leg Ulcers—An Analysis of 1324 Legs

2005 ◽  
Vol 29 (1) ◽  
pp. 74-77 ◽  
Author(s):  
M.S. Gohel ◽  
M. Taylor ◽  
J.J. Earnshaw ◽  
B.P. Heather ◽  
K.R. Poskitt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Delayed Healing

A systematic review of compression therapy for venous leg ulcers

1998 ◽  
Vol 3 (4) ◽  
pp. 301-313 ◽  
Author(s):  
Simon J Palfreyman ◽  
Rona Lochiel ◽  
Jonathan A Michaels
Keyword(s):  
Systematic Review ◽  
Compression Therapy ◽  
Leg Ulcers ◽  
Venous Leg Ulcers

scholarly journals Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence

2009 ◽  
Vol 6 (5) ◽  
pp. 386-393 ◽  
Author(s):  
Christine Moffatt ◽  
Dheerendra Kommala ◽  
Nathalie Dourdin ◽  
Yoonhee Choe
Keyword(s):  
Compression Therapy ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Prevention Of Recurrence

scholarly journals The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy

2010 ◽  
Vol 51 (3) ◽  
pp. 655-661 ◽  
Author(s):  
Dragan J. Milic ◽  
Sasa S. Zivic ◽  
Dragan C. Bogdanovic ◽  
Milan M. Jovanovic ◽  
Radmilo J. Jankovic ◽  
...  
Keyword(s):  
Compression Therapy ◽  
Leg Ulcers ◽  
Venous Leg Ulcers

Risk Factors for Healing and Recurrence of Chronic Venous Leg Ulcers

2000 ◽  
Vol 15 (2) ◽  
pp. 49-52 ◽  
Author(s):  
J. R. Barwell ◽  
A. S. K. Ghauri ◽  
M. Taylor ◽  
J. Deacon ◽  
C. Wakely ◽  
...  
Keyword(s):  
Risk Factors ◽  
Leg Ulcers ◽  
Venous Leg Ulcers

Practical aspects of compression therapy – Update 2016

Phlebologie ◽  
2016 ◽  
Vol 45 (04) ◽  
pp. 224-228 ◽  
Author(s):  
K. Heyer ◽  
K. Protz
Keyword(s):  
Complex Form ◽  
Compression Therapy ◽  
Current Status ◽  
Theoretical Knowledge ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
The Status ◽  
The Individual

SummaryCompression therapy is a complex form of therapy. It requires equally practical abilities and theoretical knowledge, as well as an understanding of available materials and the methods in question. All these mentioned aspects of today’s practical compression therapy show deficits.This article shows the current status of treatment of patients with venous leg ulcers in Germany. Based on this, strategies are described, which aim to improve the status of information of the patients, the expertise of the users and the further spread of modern and specialized materials.It is possible and appropriate to better the individual status of treatment of patients through further qualification of carers. This should include the proper usage of materials and methods.

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