Compression therapy for ulcers: The science and the art

Abstract

Introduction: Chronic ulcers are characterized by being resistant to all forms of treatment. Recent improvement in compression techniques, notably use of multilayer bandaging has created a need for a re-look into it's use.

Materials and methods: The authors present two case reports of successful management of chronic ulcers using compression through bandaging where all other forms of treatment had failed. This is followed by a review of literature based on previous articles as well as more recent ones found through Pubmed.

Conclusion: It is suggested that, at least in India, compression through proper multilayer bandaging, should be a choice far higher in the treatment ladder than so previously. However, if the technique is improper, it may be harmful so the option is to be exercised with care and only by those who have received adequate training. The need of a team approach, and alongside, wider introduction of more and better training facilities for therapists and nurses is underlined.

Keywords: Chronic ulcers; compression therapy; lymphoedema; multilayer bandaging.

Figure 1

Case 1 - Ulcer in the year 2001

Figure 2

Case 1 the ulcer was its smallest size a few weeks after SSG in 2006. However, the size increased again and he also developed secondary ulcers in two more places

Box 1

Our technique of compression bandaging (MLLB)

Figure 3

Same patient seen 3 months after initiating multilayer bandaging

Figure 4

Case 2 - Multilayer bandaging in progress, This was done by the patient himself to enable photographs after the ulcers had largely healed

Figure 5

Case 2 Leg views datewise at various stages of healing. Bandaging was initiated on 17/05/2012. When he came for follow-up after 10 days of home care (3 weeks from day 1), a small superfical ulcer (photo no 5) was found on the shin which was attributed to a minor injury by the patient. However, one contribution could be using knots instead of tapes during self bandaging. Healing has been accompanied by a fall in the leg circumference.

Figure 6

Case 2 At follow-up visit at 7 weeks

Figure 7

Protocol followed before introduction of MLLB[8]. Legends: Vpl – Compression therapy on an ambulatory basis VPL - Compression therapy on 24/7 basis after admission LVA -Lympho-nodo venous shunt surgery In between compression sessions, we would be using SLB. Introduction of MLLB has made the protocol similar to VPL, but on an ambulatory basis.