Effectiveness of Compression Therapy in Patients with Leg Ulcers

Methodology and Study Course, Observed Population

A total of 32 patients (56% men; 37.5% diabetics; average age 80 years) with mixed (arteriovenous) etiology leg ulcers were included in the prospective study, which took place from September 2018 to May 2019 at the vascular surgery department of the university hospital in Caen.

The inclusion criteria for the study were as follows:

• age ≥ 18 years
• leg ulcer persisting for at least 4–6 weeks
• ankle-brachial index (ABI) < 0.9 or toe-brachial index (TBI) < 0.7
• signs of chronic venous insufficiency according to Doppler examination

Compression therapy was set according to hemodynamic parameters as follows:

• ABI ≥ 0.9, TBI < 0.7 and toe pressure ≥ 50 mmHg: inelastic compression
• ABI between 0.9 and 0.8: elastic compression 40 mmHg
• ABI between 0.8 and 0.6 and TBI ≥ 0.7: elastic compression 30 mmHg
• ABI between 0.8 and 0.6 and TBI between 0.7 and 0.6: elastic compression 20 mmHg
• ABI between 0.8 and 0.6 and TBI between 0.6 and 0.5: inelastic compression
• ABI between 0.8 and 0.6 and TBI < 0.5: exclusion from the study

The primary observed parameter was transcutaneous oxygen tension (TcpO₂; a marker of skin perfusion) after 1 month of compression therapy measured by a probe on the dorsum of the foot between the first and second interdigit space. Quality of life (according to the Short-Form 36-Item questionnaire), compliance with therapy, and the size of the leg ulcer were also assessed.

Results

The average values of hemodynamic parameters were as follows: ABI 0.86 ± 0.18 mmHg; TBI 0.25 ± 0.12 mmHg. The leg ulcer was diagnosed in patients an average of 48 months before entering the study. Compression therapy of 20 mmHg was indicated for 7 of them, 1 at 30 mmHg, and the rest (n = 24) were indicated for inelastic compression.

There was a significant increase in TcpO₂ after 1 month of compression therapy (51.2 ± 15.05 mmHg) compared to the start of the study (49.3 ± 13.01 mmHg; p = 0.025). The average size of the leg ulcer before compression therapy was 49 ± 102 cm² and after 1 month of therapy 37 ± 94 cm², corresponding to a reduction in area of 12 ± 8 cm² (p < 0.001). Patients additionally reported pain relief. A total of 75% of them adhered to the prescribed therapy 6–7 days a week.

Conclusion

Compression therapy tailored to hemodynamic parameters (ABI and TBI) led to an increase in transcutaneous oxygen tension (as a marker of skin perfusion), a reduction in the area of the ulcers, and pain relief in patients with mixed etiology leg ulcers.

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Source: Elhomsy S., Chrusciel J., Sanchez S. et al. Clinical efficacy and safety of long-term compression in patients with mixed arterial and venous etiology ulcers in the leg. Int J Angiol 2022; 32 (1): 34–39, doi: 10.1055/s-0041-1735204.