A Guide To Compression Dressings For Venous Ulcers
Pertinent Insights On Compression Products
One can divide compression products into different categories: elastic versus inelastic; short versus long stretch; high compression versus mild versus low; single- versus multi-layer; and stockings versus bandages versus pumps. The products vary in their actions and pressures, but are generally classified based on the level of compression provided at the ankle.15 Several guidelines offer recommendations for the treatment of venous insufficiency.4 In theory, the goal compression for a patient without arterial disease should approach 40 mmHg at the ankle. With decreased ankle-brachial indices, less pressure is recommended.16
To achieve a graduated compression gradient, one needs to apply a bandage at a consistent tension and the bandage should be able to retain its shape over a long period of time. The pressure exerted on a limb is directly related to the number of layers one applies, the tension of application and is inversely related to the circumference of the limb and the width of the bandage.17 In other words, the more layers and the higher the tension, the higher the pressure. The smaller the limb and the narrower the bandage, the higher the pressure.
When clinicians apply a compression bandage to a normally shaped leg, the narrower ankle, when wrapped with the same bandage at the same tension with a consistent 50 percent overlap, will have a higher sub-bandage pressure than the wider thigh. Accordingly, this provides a graduated compression and improving venous return.
Practitioner technique can also affect the sub-bandage pressure.5 Skilled instruction is recommended prior to introducing these techniques into clinical practice.
What The Research Reveals About Inelastic (Short Stretch) Bandages
Inelastic bandages, also known as short stretch bandages, have minimal stretch and can only extend up to 30 to 70 percent of their length.18 Examples of inelastic bandages are included in the table “An Overview Of Compression Products For Venous Ulcers” at left. Patients can launder and reuse many of these bandages. Inelastic bandages provide compression not so much in the bandage itself but as a firm barrier against which the calf muscle presses during ambulation, thus supporting calf pump action.16
The inelasticity offers a high working pressure (30 to 40 mmHg) during ambulation and a low resting pressure when the leg is inactive or supine.19 This property may allow safer use when the patient has a venous ulcer in combination with decreased arterial circulation.16 One small study demonstrated safe and effective venous ulcer treatment with short stretch bandaging in 24 patients with a mean ankle-brachial index (ABI) of 0.62.20 These bandages may not be the best choices for patients with inadequate calf pumps such as those with limited ankle mobility, abnormal gait patterns, paralysis, immobility, and muscle wasting diseases that result in lower extremity muscle atrophy.5,21,22
The recommended application for inelastic bandages is a spiral wrap from the base of the toes to two fingerbreadths below the patella with a 50 percent overlap, consistent tension and avoidance of wrinkles and folds.
Clinicians may employ short stretch bandages to decrease edema. However, they are unable to sustain consistent compression for prolonged periods of time.23 The inelastic characteristics of these types of bandages do not allow for contouring of the bandage to the leg circumference once the edema has decreased. This can lead to slippage and creases in the bandage that can cause skin breakdown and discomfort.24 Therefore, one may need to change inelastic bandages more frequently until edema reduction has reached a steady state.16,25
The literature suggests that short stretch bandaging is as effective as any other compression bandage at reducing edema. However, short stretch bandaging may not be as effective at healing ulcerations.26