Questions And Answers On Compression For Lower Extremity Edema
Lower extremity compression can be very effective for reducing edema. These expert panelists discuss the use of compression hose and how compression pumps can be an alternative for patients who cannot wear the hosiery. They also discuss appropriate consults to lymphedema and vascular therapists.
Do you prescribe compression hose for patients with edema?
Kazu Suzuki, DPM, CWS, frequently prescribes compression hose after ensuring that the patient does not have leg ischemia. Given that most of his patients are elderly women, he says “pretty much all of them” have some type of leg edema that will benefit from some type of compression hose, which will reduce fatigue and discomfort in their legs. He also emphasizes that vascular exam and skin perfusion testing before applying compression are imperative because the patients over 70 years of age and patients with diabetes over 50 years of age are at high risk for leg ischemia.
Eric Lullove, DPM, also prescribes compression hose but says one should first establish if patients can put on the hose. Kathleen Satterfield, DPM, tends not to prescribe compression hose because of this issue. Since her lymphedema patients are obese, Dr. Satterfield says they cannot negotiate putting on the hosiery and the expensive hose ends up unused in a drawer. In addition, some of her patients have opened up their wounds or sustained friction wounds by putting on compression hose.
If Dr. Lullove’s patients cannot wear 30 to 40 mmHg stockings, he will try 20 to 30 mmHg or 15 to 25 mmHg. Dr. Lullove says some compression is better than none. For mild edema, Dr. Suzuki may recommend non-prescription strength (8 to 12 mmHg) hose. For patients with wounds, he prescribes prescription strength (20 to 30 or 30 to 40 mmHg) compression hose or uses multi-layer compression bandages. He adds that “most patients will do fine with 20 to 30 mmHg, while large and active young adults, for example, a young construction worker or plumber, will require 30 to 40 mmHg, as the hydrostatic pressure in his leg veins can be tremendous.”
Dr. Suzuki asks patients to seek out brand names such as Sigvaris, Medi, Jobst and Juzo. While Dr. Suzuki notes that these brands are relatively expensive, he says they are durable. He also notes that commonly available T.E.D. hose (Kendall Healthcare Products) are good for prevention of deep vein thrombosis (DVT). However, Dr. Suzuki concedes the hose does not apply graduated compression and may not be effective at reducing edema and healing ulcers.
Dr. Lullove says some patients do better with Farrow Wraps (Farrow Medical Innovation) as opposed to compression stockings.
What do you do if your patients cannot comply with using compression hose?
Dr. Satterfield recommends pneumatic compression devices for home use on a daily basis for patients with edema. “A patient can sit at home, watch a little TV while using these and be adherent,” notes Dr. Satterfield. “There is no struggle getting them on and off so it is not wasted money.”
While the older compression pumps had some potential problems creating genital lymphedema and potential clotting, Dr. Satterfield notes the newer models, with the addition of more compression chambers, seem to have overcome any problems. She emphasizes the importance of combining the therapy with ongoing manual lymphatic drainage.
Likewise, if a leg ulcer has been non-healing for more than six months, Dr. Suzuki may prescribe lymphedema pumps that patients can use at home in addition to compression hose or compression bandages. As he notes, the pumps come with large leg air bladders that “milk” the leg(s) from the distal to proximal direction, which effectively reduces leg edema. He recommends that patients use the pump for one hour, two to three times per day, at home.
NormaTec USA is one company that dispenses lymphedema pumps while dozens of other companies make similar leg pumps, according to Dr. Suzuki.