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Compression Therapy

  • Joshua S. Mervis
  • Hadar Lev-TovEmail author
Chapter
  • 31 Downloads
Part of the Updates in Clinical Dermatology book series (UCD)

Abstract

Compression therapy is the primary treatment for chronic venous insufficiency (CVI) and venous leg ulcers (VLUs). In the outpatient clinic, dermatologists often use compression to treat CVI-related sequelae, such as varicose veins, edema, venous dermatitis, and lipodermatosclerosis. Various compression modalities are available, including stockings, elastic and inelastic bandages, pneumatic pumps, and specialized garments. The different compression systems have pros and cons that may make certain types of compression more or less appropriate depending on clinical and social factors. Patient compliance has historically been one of the biggest challenges with compression, and new devices have sought to make compression more comfortable and acceptable to patients. Finally, evidence is emerging for use of compression therapy in wounds other than VLUs and is well established for treatment of lymphedema. Thus, a thorough understanding of compression is important for all dermatologists and, in particular, those with an affinity for wound care.

Keywords

Compression Bandages Stockings Venous leg ulcer Venous ulcer Wounds Chronic Wound healing Venous insufficiency Edema 

Abbreviations

4LB

4-layer bandage

ABI

Ankle-brachial index

CHF

Congestive heart failure

CVI

Chronic venous insufficiency

IPC

Intermittent pneumatic compression

SSB

Short-stretch bandage

VLU

Venous leg ulcer

References

  1. 1.
    Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333–46.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Williams KJ, Ayekoloye O, Moore HM, Davies AH. The calf muscle pump revisited. J Vasc Surg Venous Lymphat Disord. 2014;2(3):329–34.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Alavi A, Sibbald RG, Phillips TJ, Miller OF, Margolis DJ, Marston W, et al. What’s new: management of venous leg ulcers: approach to venous leg ulcers. J Am Acad Dermatol. 2016;74(4):627–40. quiz 41-2Google Scholar
  4. 4.
    Ibegbuna V, Delis KT, Nicolaides AN, Aina O. Effect of elastic compression stockings on venous hemodynamics during walking. J Vasc Surg. 2003;37(2):420–5.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mosti G, Partsch H. Inelastic bandages maintain their hemodynamic effectiveness over time despite significant pressure loss. J Vasc Surg. 2010;52(4):925–31.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Agu O, Baker D, Seifalian AM. Effect of graduated compression stockings on limb oxygenation and venous function during exercise in patients with venous insufficiency. Vascular. 2004;12(1):69–76.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sheldon RD, Roseguini BT, Laughlin MH, Newcomer SC. New insights into the physiologic basis for intermittent pneumatic limb compression as a therapeutic strategy for peripheral artery disease. J Vasc Surg. 2013;58(6):1688–96.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Beidler SK, Douillet CD, Berndt DF, Keagy BA, Rich PB, Marston WA. Inflammatory cytokine levels in chronic venous insufficiency ulcer tissue before and after compression therapy. J Vasc Surg. 2009;49(4):1013–20.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chen AH, Frangos SG, Kilaru S, Sumpio BE. Intermittent pneumatic compression devices -- physiological mechanisms of action. Eur J Vasc Endovasc Surg. 2001;21(5):383–92.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kessler CM, Hirsch DR, Jacobs H, MacDougall R, Goldhaber SZ. Intermittent pneumatic compression in chronic venous insufficiency favorably affects fibrinolytic potential and platelet activation. Blood Coagul Fibrinolysis. 1996;7(4):437–46.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Christen Y, Wütschert R, Weimer D, de Moerloose P, Kruithof EK, Bounameaux H. Effects of intermittent pneumatic compression on venous haemodynamics and fibrinolytic activity. Blood Coagul Fibrinolysis. 1997;8(3):185–90.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Arpaia G, Bavera PM, Caputo D, Mendozzi L, Cavarretta R, Rovaris M, et al. Effects of elastic compression on hypomobility edema and fibrinolysis activation in multiple sclerosis. Panminerva Med. 2011;53(3 Suppl 1):71–4.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Melhuish JM, Clark M, Williams R, Harding KG. The physics of sub-bandage pressure measurement. J Wound Care. 2000;9(7):308–10.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Mosti G, Partsch H. High compression pressure over the calf is more effective than graduated compression in enhancing venous pump function. Eur J Vasc Endovasc Surg. 2012;44(3):332–6.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mosti G, Partsch H. Occupational leg oedema is more reduced by antigraduated than by graduated stockings. Eur J Vasc Endovasc Surg. 2013;45(5):523–7.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ashby RL, Gabe R, Ali S, Adderley U, Bland JM, Cullum NA, et al. Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (venous leg ulcer study IV, VenUS IV): a randomised controlled trial. Lancet. 2014;383(9920):871–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kirsner RS, Margolis DJ. Stockings before bandages: an option for venous ulcers. Lancet. 2014;383(9920):850–1.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Nelson EA, Bell-Syer SE. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2014;9:CD002303.Google Scholar
  19. 19.
    Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American venous forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Palfreyman SJ, Michaels JA. A systematic review of compression hosiery for uncomplicated varicose veins. Phlebology. 2009;24(Suppl 1):13–33.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Shingler S, Robertson L, Boghossian S, Stewart M. Compression stockings for the initial treatment of varicose veins in patients without venous ulceration. Cochrane Database Syst Rev. 2013;12:CD008819.Google Scholar
  22. 22.
    Lim CS, Davies AH. Graduated compression stockings. CMAJ. 2014;186(10):E391–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Benigni JP, Sadoun S, Allaert FA, Vin F. Efficacy of class 1 elastic compression stockings in the early stages of chronic venous disease. A comparative study. Int Angiol. 2003;22(4):383–92.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Partsch H. The static stiffness index: a simple method to assess the elastic property of compression material in vivo. Dermatol Surg. 2005;31(6):625–30.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Partsch H, Mortimer P. Compression for leg wounds. Br J Dermatol. 2015;173(2):359–69.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Mosti G, Mattaliano V, Partsch H. Influence of different materials in multicomponent bandages on pressure and stiffness of the final bandage. Dermatol Surg. 2008;34(5):631–9.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Harrison MB, Vandenkerkhof EG, Hopman WM, Graham ID, Carley ME, Nelson EA, et al. The Canadian bandaging trial: evidence-informed leg ulcer care and the effectiveness of two compression technologies. BMC Nurs. 2011;10:20.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;11:CD000265.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Nelson EA, Harrison MB, Team CBT. Different context, different results: venous ulcer healing and the use of two high-compression technologies. J Clin Nurs. 2014;23(5–6):768–73.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Keller A, Müller ML, Calow T, Kern IK, Schumann H. Bandage pressure measurement and training: simple interventions to improve efficacy in compression bandaging. Int Wound J. 2009;6(5):324–30.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Moffatt C. Variability of pressure provided by sustained compression. Int Wound J. 2008;5(2):259–65.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Nelson EA, Ruckley CV, Barbenel JC. Improvements in bandaging technique following training. J Wound Care. 1995;4(4):181–4.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Zarchi K, Jemec GB. Delivery of compression therapy for venous leg ulcers. JAMA Dermatol. 2014;150(7):730–6.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Partsch H. Intermittent pneumatic compression in immobile patients. Int Wound J. 2008;5(3):389–97.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Nelson EA, Hillman A, Thomas K. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database Syst Rev. 2014;5:CD001899.Google Scholar
  37. 37.
    Comerota AJ. Intermittent pneumatic compression: physiologic and clinical basis to improve management of venous leg ulcers. J Vasc Surg. 2011;53(4):1121–9.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Raju S, Hollis K, Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy. Ann Vasc Surg. 2007;21(6):790–5.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Sippel K, Seifert B, Hafner J. Donning devices (foot slips and frames) enable elderly people with severe chronic venous insufficiency to put on compression stockings. Eur J Vasc Endovasc Surg. 2015;49(2):221–9.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Suehiro K, Morikage N, Murakami M, Yamashita O, Samura M, Hamano K. Putting a class I stocking over a class I stocking does not make a class II stocking. Ann Vasc Dis. 2012;5(4):435–8.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Ziaja D, Kocełak P, Chudek J, Ziaja K. Compliance with compression stockings in patients with chronic venous disorders. Phlebology. 2011;26(8):353–60.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Van Hecke A, Grypdonck M, Defloor T. A review of why patients with leg ulcers do not adhere to treatment. J Clin Nurs. 2009;18(3):337–49.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and Management of Lower-Extremity Ulcers. N Engl J Med. 2017;377(16):1559–67.CrossRefGoogle Scholar
  44. 44.
    Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–24.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Alvarez OM, Wendelken ME, Markowitz L, Comfort C. Effect of high-pressure, intermittent pneumatic compression for the treatment of peripheral arterial disease and critical limb ischemia in patients without a surgical option. Wounds. 2015;27(11):293–301.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Kavros SJ, Delis KT, Turner NS, Voll AE, Liedl DA, Gloviczki P, et al. Improving limb salvage in critical ischemia with intermittent pneumatic compression: a controlled study with 18-month follow-up. J Vasc Surg. 2008;47(3):543–9.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    de Araujo T, Valencia I, Federman DG, Kirsner RS. Managing the patient with venous ulcers. Ann Intern Med. 2003;138(4):326–34.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Fracchia E, Elkababri M, Cantello C, Gori A, Partsch H, Forni GL. Venous-like leg ulcers without venous insufficiency in congenital anemia: successful treatment using compression bandages. Dermatol Surg. 2010;36(8):1336–40.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Chia HY, Tang MB. Chronic leg ulcers in adult patients with rheumatological diseases - a 7-year retrospective review. Int Wound J. 2014;11(6):601–4.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Stebbins WG, Hanke CW, Petersen J. Enhanced healing of surgical wounds of the lower leg using weekly zinc oxide compression dressings. Dermatol Surg. 2011;37(2):158–65.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Thompson CB, Wiemken TL, Brown TS. Effect of postoperative dressing on excisions performed on the leg: a comparison between zinc oxide compression dressings versus standard wound care. Dermatol Surg. 2017;43(11):1379–84.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Armstrong DG, Nguyen HC. Improvement in healing with aggressive edema reduction after debridement of foot infection in persons with diabetes. Arch Surg. 2000;135(12):1405–9.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Mars M, Desai Y, Gregory MA. Compressed air massage hastens healing of the diabetic foot. Diabetes Technol Ther. 2008;10(1):39–45.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F, Coordinators V. Epidemiology of chronic venous disorders in geographically diverse populations: results from the vein consult program. Int Angiol. 2012;31(2):105–15.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Oduncu H, Clark M, Williams RJ. Effect of compression on blood flow in lower limb wounds. Int Wound J. 2004;1(2):107–13.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Grada AA, Phillips TJ. Lymphedema: diagnostic workup and management. J Am Acad Dermatol. 2017;77(6):995–1006.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Committee E. The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology. 2016;49(4):170–84.Google Scholar
  59. 59.
    Lay-Flurrie K. Use of compression hosiery in chronic oedema and lymphoedema. Br J Nurs. 2011;20(7):418. 20, 22Google Scholar
  60. 60.
    Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93(2):96–111.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015;350:h2039.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Scott G, Mahdi AJ, Alikhan R. Superficial vein thrombosis: a current approach to management. Br J Haematol. 2015;168(5):639–45.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Di Nisio M, Peinemann F, Porreca E, Rutjes AW. Treatment for superficial infusion thrombophlebitis of the upper extremity. Cochrane Database Syst Rev. 2015;11:CD011015.Google Scholar
  64. 64.
    Moustafa A, Alim HM, Chowdhury MA, Eltahawy EA. Postthrombotic syndrome: Long-term sequela of deep venous thrombosis. Am J Med Sci. 2018.Google Scholar
  65. 65.
    Appelen D, van Loo E, Prins MH, Neumann MH, Kolbach DN. Compression therapy for prevention of post-thrombotic syndrome. Cochrane Database Syst Rev. 2017;9:CD004174.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Nilsson L, Austrell C, Norgren L. Venous function during late pregnancy, the effect of elastic compression hosiery. Vasa. 1992;21(2):203–5.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Thaler E, Huch R, Huch A, Zimmermann R. Compression stockings prophylaxis of emergent varicose veins in pregnancy: a prospective randomised controlled study. Swiss Med Wkly. 2001;131(45–46):659–62.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Allegra C, Antignani PL, Will K, Allaert F. Acceptance, compliance and effects of compression stockings on venous functional symptoms and quality of life of Italian pregnant women. Int Angiol. 2014;33(4):357–64.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Smyth RM, Aflaifel N, Bamigboye AA. Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database Syst Rev. 2015;10:CD001066.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Dr. Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiUSA

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