A service evaluation to examine the use of compression strapping for the management of patients with retromalleolar leg ulcers in a specialist community setting

Leg ulcers are costly to the NHS, and they have a significant impact on patients' physical, social, and psychological well-being. Compression therapy is traditionally the "gold-standard" treatment for the management of venous leg ulcers and can be beneficial for those individuals with mixed ulcer aetiology. Evidence suggests that the application of standard, strong, graduated compression bandaging does not apply therapeutic compression to the retromalleolar fossa. The addition of compression strapping has been found to increase sub-bandage pressure, promote healing, reduce pain and increase quality of life in patients with retromalleolar leg ulcers. This service evaluation aimed at evaluating the use of compression strapping with patients with retromalleolar leg ulcers. The service evaluation included 24 patients with 41 ulcers treated with compression strapping by a specialist team. Patients treated with CS had multiple comorbidities and shared common characteristics including foot and ankle oedema, previous ulceration, reduced mobility, and failure to heal despite the application of "gold-standard" compression therapy. Following application of compression strapping, 17 patients (n = 27/41 ulcers) healed, mean pain scores decreased, and mean quality of life scores increased. The compression strapping was tolerated well, and patients reported a positive experience. This service evaluation has contributed towards a growing evidence base that supports the use of CS for the management of patients with retromalleolar leg ulcers.

Interface pressures with compression systems: relevance to clinical practice

Interface pressures with compression depend on many factors relating to the science of measurement and intrinsic, patient-related factors, including limb size and tissue texture. While it is important for manufacturers of compression devices to measure pressures, it may not always be relevant to clinical practice where application methods and oedematous limbs may affect final pressures. Accurate performance of any compression system relies on the use of the right technology for the right condition and patient lifestyle. Correct application following training and in accordance with instructions for use may be adapted according to individual patient comfort and needs, including mobility, tissue texture and the stage of management. In order to provide treatment regimens that are safe, effective and well tolerated by patients, as well as being easy to apply and demonstrate sound economic practice, science needs to meet clinical practice. Patient reporting is an important for successful treatment, matching clinical effectiveness with patient acceptance during reassessment and monitoring.

Challenging present concepts in compression therapy: static stiffness index is not consistent and not clinically relevant

Once a circumferential force is delivered to a limb by a compression device, assuming the tension within the device remains constant, any change in the total force is dependent upon a change in circumference of the limb, with the rate of change (excluding fabric creep) being dependent on the stress strain curve of the device. This article addresses the pre-conceived and well-accepted principle that interface compression delivered by a compression device substantially increases with the position of the limb, based on the positions of sitting (non-weight bearing) to standing and/or during muscle activity (ankle dorsiflexion). Using engineering parameters and clinical measurements, the authors demonstrate that changes in interface pressure are minimal if any, and that the current concept should be modified accordingly. Declaration of interest: This study was sponsored by Carolon. L. Reid, and S. Kravitz are employees of Carolon. M. Hegarty-Craver has received monetary compensation as a researcher for Carolon.

Simulated pressure changes in multilayer, multicomponent wrap systems when transitioning from rest to standing

OBJECTIVE

The objective of this paper was to investigate the pressure applied to the lower leg by multilayer, multicomponent wrap systems, in different positions Method: The stretch profiles of five multilayer, multicomponent wrap systems were tested, three 2-layer and two 4-layer systems. These were quantified in the laboratory using a tensile testing device. The circumference of the lower leg was measured on healthy participants in three locations (ankle, B1 level, and calf) in three different postures (rest, dorsiflexion, and standing).

RESULTS

The largest changes in circumference were used to simulate the pressure changes under the multilayer, multicomponent products using Laplace's Law. While the pressure differences were large for the zinc plaster product, pressure changes ranged from 5-10mmHg for the other, more elastic products. Additionally, it was noted that the leg decreased in circumference at the B1 level and calf for the majority of participants when transitioning from sitting to standing. This decrease in size results in a decrease in bandage tension and applied pressure.

CONCLUSION

These results show that the sub-bandage pressure is not significantly affected by changes in posture when used as intended, within the therapeutic range.

DECLARATION OF INTEREST

This study was sponsored by Carolon. L. Reid, and S. Kravitz are employees of Carolon and E. Grant is a Member of the Board. M. Hegarty-Craver and C. Kwon have received monetary compensation as researchers for Carolon.