Current Insights On Managing Lower Extremity Wounds With Edema

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CPT Code Update For Compression Dressings

Wound care practitioners have been using multi-layer compression bandages for decades. Dr. Suzuki notes the introduction of a new Category I CPT code for the application of multi-layer compression bandages that are commercially available.

   The CPT code 29581 is for “Application of multi-layer venous wound compression system, below the knee” and became effective on January 1, 2010. If one is applying one of these multi-layer compression bandages on both legs, Dr. Suzuki suggests modifying the CPT 29581 with -50 to indicate bilateral placement.

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   In contrast, Dr. Lullove is moving away from MLD. He says it is more important to “wrap and walk” patients with chronic venous insufficiency edema in comparison to those with traditional lymphedema.

   Dr. Satterfield says she will not use silver sulfadiazine (Silvadene, Monarch Pharmaceuticals) under dressings on venous stasis ulcers because Silvadene increases exudates.

    “Exudative wounds under a compressive dressing can be a death knell,” emphasizes Dr. Satterfield.

   She says significant advances in treatment have given clinicians a variety of different treatment options for lower extremity wounds with edema.

    “What a difference 10 years have made in being able to answer this question,” comments Dr. Satterfield. “A decade ago, the answer would have been an Unna Boot and not much else but now there are so many great modalities.”

Q:

What is your compression bandage of choice to treat leg edema?

A:

Both Drs. Satterfield and Suzuki use Profore. Dr. Satterfield calls Profore her first choice due to its air permeability. She says Co-Flex, which does not have air permeability, is her backup choice. Dr. Satterfield cites an advantage of Co-Flex in that its printed guide provides an indicator of how much pressure to apply with the bandage, although she notes clinicians will have a pretty good feel of that themselves.

   In addition, Dr. Suzuki will also use Dyna-Flex (Systagenix Wound Management) and Coban 2 layer. He cites the ability of these bandages to accommodate wound dressings and various leg shapes while providing reliable graduated compression in the form of higher compression at the ankle. Patients can wear the bandages for up to one week and Dr. Suzuki notes that he sees most of his patients once a week.

   As for the primary dressing, Dr. Suzuki frequently uses the foam dressing Mepilex (Molnlycke Healthcare) as well as the antimicrobial dressing Mepilex Ag (Molnlycke Healthcare), which he places underneath the compression bandages. When the situation calls for a maximally absorbent dressing, Dr. Suzuki uses Xtrasorb™ dressing (Derma Sciences). While this dressing is thin, Dr. Suzuki says it offers an extremely absorbent primary dressing that absorbs a lot more exudates than regular ABD pads.

   Dr. Lullove’s preferred compression bandage for leg edema is Juzo (Juzo USA). He notes the high quality bandages do not have the same short lifespan of other compression stockings. He adds that Juzo also has silicone beading at the top of the stocking to prevent slippage.

   Dr. Lullove is in private practice in Boca Raton and Delray Beach, Fla. He is a Staff Physician at West Boca Medical Center in Boca Raton. Dr. Lullove is a Fellow of the American College of Certified Wound Specialists.

   Dr. Satterfield is an Adjunct Associate Professor at the Western University College of Podiatric Medicine in Pomona, Calif. She is a Fellow and President-Elect of the American College of Foot and Ankle Orthopedics and Medicine.

   Dr. Suzuki is the Medical Director of Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo, Japan.

   For further reading, see “How To Manage Venous Stasis Ulcers” in the May 2007 issue of Podiatry Today or “Vascular Intervention In Difficult Wounds” in the July 2002 issue.

   To access the archives, visit www.podiatrytoday.com.

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