Dogmas and controversies in compression therapy: report of an International Compression Club (ICC) meeting, Brussels, May 2011

Abstract

The International Compression Club (ICC) is a partnership between academics, clinicians and industry focused upon understanding the role of compression in the management of different clinical conditions. The ICC meet regularly and from these meetings have produced a series of eight consensus publications upon topics ranging from evidence-based compression to compression trials for arm lymphoedema. All of the current consensus documents can be accessed on the ICC website (http://www.icc-compressionclub.com/index.php). In May 2011, the ICC met in Brussels during the European Wound Management Association (EWMA) annual conference. With almost 50 members in attendance, the day-long ICC meeting challenged a series of dogmas and myths that exist when considering compression therapies. In preparation for a discussion on beliefs surrounding compression, a forum was established on the ICC website where presenters were able to display a summary of their thoughts upon each dogma to be discussed during the meeting. Members of the ICC could then provide comments on each topic thereby widening the discussion to the entire membership of the ICC rather than simply those who were attending the EWMA conference. This article presents an extended report of the issues that were discussed, with each dogma covered in a separate section. The ICC discussed 12 'dogmas' with areas 1 through 7 dedicated to materials and application techniques used to apply compression with the remaining topics (8 through 12) related to the indications for using compression.

Keywords: Compression bandages; Compression stockings; Intermittent pneumatic compression; Leg ulcers; Lipoedema; Lymphoedema.

Figure 1

3D reconstruction of the leg comparing the venous system in standing position before and after applying a compression stocking exerting a pressure of 22 mmHg. Under the stocking the cross‐section of the leg is reshaped into a more circular structure. V, varix; A, anterior tibial veins; P, posterior tibial veins; F, fibular veins; S, soleus veins.

Figure 2

Sub‐bandage pressure measurements on the distal medial leg in the sitting position with dorsiflexions and toe movements under inelastic (A) and elastic bandaging (B). The same curves are obtained by active and passive movement. Starting from a pressure of around 40 mmHg the pressure amplitudes during movement are much higher with inelastic than with elastic material (‘stronger massaging effect').

Figure 3

Pressure measurements under a compression stocking performed on the dorsal, ventral, medial and lateral aspect of the foot (X), the ankle (Y) and the lower leg (B–D) using a circular pressure probe of 45 mm diameter (Picopress^®) (HP). On the foot (segment X) the highest pressure is measured over the lateral and medial edge of the foot and the lowest over the flat parts (dorsum and foot sole) according to the law of Laplace.

Figure 4

Compression profile of a traditional gradient elastic stocking: compression level at the foot is less than either the ankle or B1 measuring points.

Figure 5

Cumulative healing rate of venous leg ulcers (VLUs) in three different compression systems with three different sub‐bandage pressure values (40). Group A: patients treated with Tubulcus stockings (36 mmHg); group B: patients treated with Tubulcus stockings + one elastic bandage (54 mmHg); group C: patients treated with Tubulcus stockings + two elastic bandages (74 mmHg).