Compression therapy options: A quick review

Presented here is a handy reference guide to the key features and important drawbacks of some of the top modalities in compression therapy.

Compression stockings (tubular compression)

· Can pull over leg like a sock, no special wrapping skills required

· Available in many sizes; ordered according to circumference of patient's leg at different anatomical points

· Patients with adequate manual dexterity and strength can apply and remove them without assistance, or home caregivers can assist them. No professional help is required.

· Washable, but shouldn't be placed in dryer

· Inexpensive

· Used as a preventive measure to reduce edema before a venous ulcer has developed or after it has healed

· Not for use when patient has an open venous ulcer

· Amount of compression not as high as with compression bandages

· May slip down the leg

· Patient compliance is essential

Other tubular compression:

Thera-Boot (manufactured by CircAid Medical Products, San Diego)

· Fastened with Velcro clasp

· Caregivers and patients with adequate manual dexterity can apply them

· Difficult for patients and caregivers to gauge amount of pressure being applied

· Reusable

· Adjustable as swelling decreases

· Expensive

Elastic bandages

· Inexpensive

· Should be applied by a health care professional

· Often reusable, and washable up to 15 times

· Should not be placed in a dryer

· Best results obtained by applying with 50% stretch and 50% overlap

· Some bandages have "stretch" markers woven into or printed on the fabric to guide those applying it to achieve 50% stretch

· Some bandages have a midline printed on them to help clinicians judge 50% overlap when spiraling up the leg

· Can be used as a preventive measure against swelling, or over an open, dressed venous ulcer

Multiple-layer bandage systems

· Prepackaged kits of three- and four-layer systems are commercially available

· Possible to construct your own multi-layered system based on existing models

· First layer usually some type of padding (e.g., cotton batting, cotton wool, or cast padding) applied in a continuous spiral

· Main purposes of first layer: absorb wound exudate, protect bony prominences at the ankles, normalize pressures achieved by overlying layers

· Second layer (in four-layer system) usually crepe, applied as a spiral

· Main purposes of second layer: smooth the inner layer and increase absorbency

· Third layer (second in three-layer systems) is elastic wrap applied in a spiral with 50% stretch and 50% overlap (purpose is to increase compression)

· Final layer is usually a self-adherent elastic layer applied in spiral with 50% stretch and 50% overlap

· Main purpose of last layer: Keeps other layers in place and increases compression to final goal

· Requires trained health care professional to apply

· Can leave in place for 7-10 days

· Disposable after dressing changes

· Should be applied when edema is at its lowest with leg in a horizontal position

· Potential drawback: Layers can slip down the leg, resulting in overly compressed areas that could create a tourniquet effect at the ankle

· Increase ankle circumference with padding for patients with very small ankles

Unna boots

· Time-proven modality, used successfully for a century

· Has become generic term for any gauze bandage impregnated with zinc oxide and used to achieve gradient compression in the legs.

· Application requires health care professional

· Several commercial preparations available

· Often becomes dirty and smelly

· Messy, not usually suitable for active people

· Usually remains in place for about a week

· Can be applied over wound dressings