Questions And Answers On Compression For Lower Extremity Edema
- Volume 23 - Issue 9 - September 2010
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The pumps can help with Dr. Suzuki’s patients who cannot put on compression hose. “It is actually quite common to hear from my patients that their hands and arms are not strong enough to put on compression hose, even with various gadgets to help them put on the hose,” acknowledges Dr. Suzuki.
Dr. Lullove has a number of strategies for patients who cannot wear compression stockings. He has patients use a vasopneumatic compression pump system like Bio Compression (Bio Compression Systems) as part of their daily maintenance. He suggests patients have discussions with their primary care physician or cardiologist because sometimes the patients need help with diuresis and/or management of congestive heart failure or fluid balance issues.
Physical therapy, improving walking endurance and strengthening the calf are other helpful options, notes Dr. Lullove.
In addition to pumps, Dr. Suzuki suggests using Velcro-based compression wraps, such as Farrow Wrap and Circ-Aid™ (Circ-Aid Medical Products), which offer compression sleeves with multiple Velcro wraps. This makes them highly customizable even for unevenly swollen legs that need compression, notes Dr. Suzuki.
When do you consult other specialties, such as vascular surgery or a lymphedema therapist?
Dr. Lullove routinely refers patients for lymphedema therapy. For the most part, he says the cause of edema is related to chronic venous stasis congestion and failure of the calf-pump system. Dr. Lullove says such patients require more physical therapy/manual lymphatic massage and compression than those with pedal edema. Only infrequently do his patients have a true primary or secondary lymphedema, notes Dr. Lullove.
Dr. Satterfield “immediately” makes lymphedema consults in appropriate patients and emphasizes that managing the condition is a team effort. Given that lymphedema is a chronic condition, she notes that treatment is palliative and it is crucial to have a medical team on board.
As Dr. Suzuki notes, the conventional wisdom dictates that one should close the venous ulcer with wound care and/or skin grafts, and then send the patient to vascular specialists for vein ablation and closure. Dr. Suzuki says the prevailing thinking was this approach could prevent a recurrent leg ulceration.
However, after recent discussions with his local vascular specialists, Dr. Suzuki prefers to send his patients sooner for vein assessment. The reason for that is that current methods of vein ablation, such as VNUS Closure™ (Covidien) and sclerosing injections, are much less invasive and can occur in an office setting, according to Dr. Suzuki. In contrast, he says old methods like vein stripping and the Linton procedures were very invasive, painful and often created large surgical wounds afterwards.
As for the patients with lymphedema, once their leg wounds heal, Dr. Suzuki ensures patients receive follow-up in a lymphedema clinic and with lymphedema therapists. He says such patients need lifelong therapy consisting of manual lymphedema drainage massage, pumping, compression wrapping or garments in order to keep their limb size manageable.
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 the Director of Medical Education 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.