Delivering Compression to Treat Chronic Wounds in the UK & Ireland

  • Georgina GethinEmail author
  • Andrew Ross Cameron


Consensus opinion and systematic reviews supports the use of compression therapy as the ‘gold standard’ for the management of venous leg ulceration (VLU). However, although widely used, significant limitations to this treatment modality persist including; poor compliance, negative impact on quality of life, bandage bulk limiting footwear choices, high visibility to others, cost and the requirement in most cases for application by health care professionals. Additionally, based on results of over 48 RCTs healing outcomes are improved with compression, yet, overall healing rates leave significant scope for improvement. This chapter describes the various systems available in the United Kingdom and Ireland together with the indications and limitations for use.


Compression Venous ulceration Contraindications ABPI Compliance Healing 


  1. 1.
    O’Meara SM, Cullum N, Nelson EA, Dumville J. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;11:CD000265. Scholar
  2. 2.
    Ratliff CR, Yates S, McNichol L, Gray M. Compression for primary prevention, treatment, and prevention of recurrence of venous leg ulcers: an evidence-and consensus-based algorithm for care across the continuum. J Wound Ostomy Continence Nurs. 2016;43(4):347.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Franks P, Barker J, Collier M, Gethin G, Haesler E, Jawien A, et al. Management of patients with venous leg ulcers: challenges and current best practice. J Wound Care. 2016;25:S1.PubMedCrossRefGoogle Scholar
  4. 4.
    Guest JF, Ayoub N, McIlwraith T, Uchegbu I, Gerrish A, Weidlich D, et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015;5(12):e009283.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    de Carvalho MR, de Andrade IS, de Abreu AM, Ribeiro APL, Peixoto BU, de Oliveira BGRB. All about compression: a literature review. J Vasc Nurs. 2016;34(2):47–53.PubMedCrossRefGoogle Scholar
  6. 6.
    Reeder S, Maessen-Visch M, Langendoen S, de Roos K, Neumann H. The recalcitrant venous leg ulcer–a never ending story? Phlebologie. 2013;42(6):332–9.CrossRefGoogle Scholar
  7. 7.
    Woo KY, Sears K. Knowledge, attitude, and practice in the management of mixed arteriovenous leg ulcers. Int J Low Extrem Wounds. 2016;15(1):52–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Humphreys ML, Stewart AHR, Gohel MS, Taylor M, Whyman MR, Poskitt KR. Management of mixed arterial and venous leg ulcers. Br J Surg. 2007;94(9):1104–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Ghauri ASK, Nyamekye I, Grabs AJ, Farndon JR, Poskitt KR. The diagnosis and management of mixed arterial/venous leg ulcers in community-based clinics. Eur J Vasc Endovasc Surg. 1998;16(4):350–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Marin JA, Woo KY. Clinical characteristics of mixed arteriovenous leg ulcers: a descriptive study. J Wound Ostomy Cont Nurs. 2017;44(1):41–7.CrossRefGoogle Scholar
  11. 11.
    Haesler E. Evidence summary: managing lymphoedema: compression therapy. Wound Pract Res J Aust Wound Manag Assoc. 2016;24(4):233.Google Scholar
  12. 12.
    AnitaHobday. Use of compression therapy in patients with lymphoedema. Nurs Stand. 2016;30(27):50–60.CrossRefGoogle Scholar
  13. 13.
    Cooper G, Bagnall A. Prevalence of lymphoedema in the UK: focus on the southwest and West Midlands. Br J Community Nurs. 2016;21(Sup4):S6–S14.CrossRefGoogle Scholar
  14. 14.
    Moffatt CJ, Keeley V, Franks PJ, Rich A, Pinnington LL. Chronic oedema: a prevalent health care problem for UK health services. Int Wound J. 2017;14(5):772–81.PubMedCrossRefGoogle Scholar
  15. 15.
    Vlajinac H, Marinkovic J, Maksimovic M, Radak D. Factors related to venous ulceration: a cross-sectional study. Angiology. 2014;65(9):824–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Heinen MM, Persoon A, van de Kerkhof P, Otero M, van Achterberg T. Ulcer-related problems and health care needs in patients with venous leg ulceration: a descriptive, cross-sectional study. Int J Nurs Stud. 2007;44(8):1296–303.PubMedCrossRefGoogle Scholar
  17. 17.
    Apollonio A, Antignani PL, Di Salvo M, Failla G, Guarnera G, Mosti G, et al. A large Italian observational multicentre study on vascular ulcers of the lower limbs (Studio Ulcere Vascolari). Int Wound J. 2016;13(1):27–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Price P, Harding K. Measuring health related quality of life in patients with chronic leg ulcers. Wounds. 1996;8:91–4.Google Scholar
  19. 19.
    Rich A, McLachlan L. How living with a leg ulcer affects people's daily life: a nurse-led study. J Wound Care. 2003;12(2):51–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Hopman WM, Vandenkerkhof EG, Carley ME, Harrison MB. Health-related quality of life at healing in individuals with chronic venous or mixed-venous leg ulceration: a longitudinal assessment. J Adv Nurs. 2016;72(11):2869–78.PubMedCrossRefGoogle Scholar
  21. 21.
    Posnett J, BA D, Gottrup F, MD D, MSc HL, Saal G, BA M. The resource impact of wounds on health-care providers in Europe. J Wound Care. 2009;18(4):154.PubMedCrossRefGoogle Scholar
  22. 22.
    Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018;15(1):29–37.PubMedCrossRefGoogle Scholar
  23. 23.
    Harrison MB, VanDenKerkhof EG, Hopman WM, Graham ID, Carley ME, Nelson EA. The Canadian Bandaging Trial: Evidence-informed leg ulcer care and the effectiveness of two compression technologies. BMC Nurs. 2011;10:20.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Scriven JM, Taylor LE, Wood AJ, Bell PR, Naylor AR, London NJ. A prospective randomised trial of four-layer versus short stretch compression bandages for the treatment of venous leg ulcers. Ann R Coll Surg Engl. 1998;80(3):215–20.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Harding K. Challenging passivity in venous leg ulcer care – the ABC model of management. Int Wound J. 2016;13(6):1378–84.PubMedCrossRefGoogle Scholar
  26. 26.
    Rockson SG. Intermittent pneumatic compression therapy. In: Lee B-B, Rockson SG, Bergan J, editors. Lymphedema: a concise compendium of theory and practice. Cham: Springer International Publishing; 2018. p. 443–8.CrossRefGoogle Scholar
  27. 27.
    Liu R, Guo X, Lao TT, Little T. A critical review on compression textiles for compression therapy: textile-based compression interventions for chronic venous insufficiency. Text Res J. 2017;87(9):1121–41.CrossRefGoogle Scholar
  28. 28.
    Thomas S. The production and measurement of sub-bandage pressure: Laplace’s Law revisited. J Wound Care. 2014;23(5):234–46.PubMedCrossRefGoogle Scholar
  29. 29.
    Mosti G. Compression in mixed ulcers. Veins and Lymphatics, [S.l.], June 2016. ISSN 2279-7483. Accessed 10 Oct 2018.
  30. 30.
    Mosti G, Iabichella ML, Partsch H. Compression therapy in mixed ulcers increases venous output and arterial perfusion. J Vasc Surg. 2012;55(1):122–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Mosti G, Cavezzi A, Massimetti G, Partsch H. Recalcitrant venous leg ulcers may heal by outpatient treatment of venous disease even in the presence of concomitant arterial occlusive disease. Eur J Vasc Endovasc Surg. 2016;52(3):385–91.PubMedCrossRefGoogle Scholar
  32. 32.
    Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248–52.PubMedCrossRefGoogle Scholar
  33. 33.
    Beebe HG, Bergan JJ, Bergqvist D, Eklof B, Eriksson I, Goldman MP, et al. Classification and grading of chronic venous disease in the lower limbs. a consensus statement. Eur J Vasc Endovasc Surg. 1996;12(4):487–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Attaran RR, Ochoa Chaar CI. Compression therapy for venous disease. Phlebology. 2016;32(2):81–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Partsch H, Clark M, Mosti G, Steinlechner E, Schuren JAN, Abel M, et al. Classification of compression bandages: practical aspects. Dermatol Surg. 2008;34(5):600–9.PubMedGoogle Scholar
  36. 36.
    Partsch H. The static stiffness index: a simple method to assess the elastic property of compression material in vivo. Dermatol Surg. 2006;31(6):625–30.CrossRefGoogle Scholar
  37. 37.
    Mosti G, Mattaliano V, Partsch H. Inelastic compression increases venous ejection fraction more than elastic bandages in patients with superficial venous reflux. Phlebology. 2008;23(6):287–94.PubMedCrossRefGoogle Scholar
  38. 38.
    Mosti G. Venous ulcer treatment requires inelastic compression. Phlebologie. 2018;47(01):7–12.CrossRefGoogle Scholar
  39. 39.
    Armstrong DG, Meyr A. Compression therapy for the treatment of chronic venous insufficiency. U: UpToDate, Mills JL, Eidt JF ur UpToDate [Internet]. 2017.Google Scholar
  40. 40.
    Mosti G, Partsch H. A new two component compression system turning an elastic bandage into an inelastic compression device: interface pressure, stiffness, and haemodynamic effectiveness. Eur J Vasc Endovasc Surg. 2018;55(1):126–31.PubMedCrossRefGoogle Scholar
  41. 41.
    Mosti G. Progressive or degressive compression pressure profile in patients with chronic venous disorders of the lower limb. Veins Lymphatics. 2014;3(1).
  42. 42.
    Kakkos SK, Timpilis M, Patrinos P, Nikolakopoulos KM, Papageorgopoulou CP, Kouri AK, et al. Acute effects of graduated elastic compression stockings in patients with symptomatic varicose veins: a randomised double blind placebo controlled trial. Eur J Vasc Endovasc Surg. 2018;55(1):118–25.PubMedCrossRefGoogle Scholar
  43. 43.
    NICE. The Juxta-CURES adjustable compression system for treating venous leg ulcers. Available from:
  44. 44.
    Damstra RJ, Partsch H. Prospective, randomized, controlled trial comparing the effectiveness of adjustable compression Velcro wraps versus inelastic multicomponent compression bandages in the initial treatment of leg lymphedema. J Vasc Surg Venous Lymphatic Disord. 2013;1(1):13–9.CrossRefGoogle Scholar
  45. 45.
    Dissemond J, Assenheimer B, Bültemann A, Gerber V, Gretener S, Kohler-von Siebenthal E, et al. Compression therapy in patients with venous leg ulcers. J Dtsch Dermatol Ges. 2016;14(11):1072–87.PubMedCrossRefGoogle Scholar
  46. 46.
    Appel J. Compression wrap and garment. Google Patents; 2007.Google Scholar
  47. 47.
    Mosti G, Cavezzi A, Partsch H, Urso S, Campana F. Adjustable Velcro® compression devices are more effective than inelastic bandages in reducing venous edema in the initial treatment phase: a randomized controlled trial. Eur J Vasc Endovasc Surg. 2015;50(3):368–74.PubMedCrossRefGoogle Scholar
  48. 48.
    Williams AF. A review of the evidence for adjustable compression wrap devices. J Wound Care. 2016;25(5):242–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Williams A. An updated review of the evidence for adjustable compression wrap devices in the lower limb. Nurse Prescr. 2017;15(Sup10):6–13.CrossRefGoogle Scholar
  50. 50.
    Protz K, Heyer K, Verheyen-Cronau I, Augustin M. Loss of interface pressure in various compression bandage systems over seven days. Dermatology. 2014;229(4):343–52.PubMedCrossRefGoogle Scholar
  51. 51.
    Ehmann S, Bock K. Case report to demonstrate the need for selection criteria for optimal adjustable Velcro wrap prescription. J Wound Care. 2018;27(Sup1):S10–S7.PubMedCrossRefGoogle Scholar
  52. 52.
    Andriessen A, Apelqvist J, Mosti G, Partsch H, Gonska C, Abel M. Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications - a review of present guidelines. Eur J Dermatol Venereol. 2017. [Epub ahead of print].
  53. 53.
    Partsch H, Mortimer P. Compression for leg wounds. Br J Dermatol. 2015;173(2):359–69.PubMedCrossRefGoogle Scholar
  54. 54.
    Hague A, Pherwani A, Rajagopalan S. Role of compression therapy in pathophysiology of the venous system in lower limbs. Surgeon. 2017;15(1):40–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Protz K, Heyer K, Dörler M, Stücker M, Hampel-Kalthoff C, Augustin M. Compression therapy: scientific background and practical applications. J Dtsch Dermatol Ges. 2014;12(9):794–801.PubMedGoogle Scholar
  56. 56.
    Zarchi K, Jemec GE. Delivery of compression therapy for venous leg ulcers. JAMA Dermatol. 2014;150(7):730–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Milic DJ, Zivic SS, Bogdanovic DC, Jovanovic MM, Jankovic RJ, Milosevic ZD, et al. The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy. J Vasc Surg. 2010;51(3):655–61.PubMedCrossRefGoogle Scholar
  58. 58.
    Tidhar D, Keren E, Brandin G, Yogev M, Armer JM. Effectiveness of compression bandaging education for wound care nurses. J Wound Care. 2017;26(11):625–31.PubMedCrossRefGoogle Scholar
  59. 59.
    Partsch H, Clark M, Bassez S, Benigni J-P, Becker F, Blazek V, et al. Measurement of lower leg compression in vivo: recommendations for the performance of measurements of interface pressure and stiffness. Dermatol Surg. 2006;32(2):224–33.PubMedGoogle Scholar
  60. 60.
    Mosti G, Partsch H. Self-management by firm, non-elastic adjustable compression wrap device [Translation of Druckmessungen unter Klettverschluss-Kompression-Selbstbehandlung durch feste, unelastische Beinwickelung]. Veins Lymphatics. 2017;6(3):88–90.Google Scholar
  61. 61.
    Moffatt C, Kommala D, Dourdin N, Choe Y. Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence. Int Wound J. 2009;6(5):386–93.Google Scholar
  62. 62.
    Rustempašić N. Causes and consequences of patient noncompliance to compression therapy of leg venous ulcers. Folia Med Fac Med Univ Saraeviensis. 2012;47(1):14–20.Google Scholar
  63. 63.
    Weller CD, Buchbinder R, Johnston RV. Interventions for helping people adhere to compression treatments for venous leg ulceration. Cochrane Database Syst Rev. 2016;3:CD008378.Google Scholar
  64. 64.
    Edwards H, Courtney M, Finlayson K, Shuter P, Lindsay E. A randomised controlled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers. J Clin Nurs. 2009;18(11):1541–9.Google Scholar
  65. 65.
    Heinen M, Borm G, van der Vleuten C, Evers A, Oostendorp R, van Acherberg T. The Lively Legs self-management programme increased physical activity and reduced wound days in leg ulcer patients: Results from a randomised controlled trial. Int J Nurs Stud. 2012;49(2):151–61.PubMedCrossRefGoogle Scholar
  66. 66.
    De Carvalho MR, Peixoto BU, Silveira IA, Oliveria B. A meta-analysis to compare four-layer to short-stretch compression bandaging for venous leg ulcer healing. Ostomy Wound Manage. 2018;64(5):30–7.PubMedCrossRefGoogle Scholar
  67. 67.
    Guest JF, Charles H, Cutting KF. Is it time to re-appraise the role of compression in non-healing venous leg ulcers? J Wound Care. 2013;22(9):453–60.PubMedCrossRefGoogle Scholar
  68. 68.
    Partsch H. Commentary. J Wound Care. 2013;22(9):461.PubMedCrossRefGoogle Scholar
  69. 69.
    Gethin G, Killeen F, Devane D. Heterogeneity of wound outcome measures in RCTs of treatments for VLUs: a systematic review. J Wound Care. 2015;24(5):211–2, 4, 6 passim.Google Scholar
  70. 70.
    Hodgson R, Allen R, Broderick E, Bland J, Dumville J, Ashby R, et al. Funding source and the quality of reports of chronic wounds trials: 2004 to 2011. Trials. 2014;15(1):19.PubMedPubMedCentralCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.National University of Ireland GalwayGalwayIreland
  2. 2.The University of QueenslandSt LuciaAustralia

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