Cath Lab Digest

Abstract: Chronic, recurring limb ulcers require a comprehensive approach that addresses the wound pathology, vascular status, and swelling. Although studies have shown that compression, especially high compression, is more effective than dressings alone, evidence to support one particular method of compression is limited. A sequential intermittent pneumatic compression (IPC) device was evaluated in four patients (two men, two women, age range 47 to 59 years) with nonhealing (history of 1 to 6 months) venous insufficiency (n = 2), postsurgical complication (n = 1), and radiation burn (n = 1) wounds and minimal to extensive clinically observable edema. All patients received standard wound care (debridement and/or appropriate dressings). Wounds were protected with an anti-shear wound dressing during pneumatic treatment. Each week, the various wounds and limb girths decreased until the site healed or limb volume normalized for that individual; 100% of the wounds healed. One patient, who had minimally observable edema, also responded positively when IPC was added to his standard wound care regimen. The pneumatic system was well tolerated in all patients. The results obtained suggest that combining appropriate standard wound care with this IPC treatment may facilitate closure of chronic, nonhealing wounds. Additional studies are needed to ascertain the effectiveness and cost-effectiveness of this treatment modality.

     Chronic recurring limb ulcers are associated with significant morbidity and require intensive and costly care.^1-4 They often result from venous insufficiency or from cancer therapies or surgeries that disrupt lymphatic function; they are challenging to heal.^5-8 The lymphedema commonly associated with ulcers contributes to the overall pathology of the disease, creating a need for a comprehensive therapeutic approach that addresses both the wound itself and regional swelling.^8,9

     The use of compression in the treatment of nonhealing lower extremity wounds not associated with arterial insufficiency is widely accepted.^2,3,5,9,10 The aims of compression treatment are to 1) enhance venous pump function and blood return to the heart, 2) reduce edema by elevating tissue hydrostatic pressure, and 3) encourage the flow of lymph fluid from the damaged tissues into functional drainage regions.^4,7,8,10 Compression treatments vary in overall configuration, materials used, and type and amount of pressure generated.¹ A variety of garments providing continuous compression to the limb are in clinical use, including Unna’s boot (Smith & Nephew, Quebec Canada), roller bandages, and hosiery.^1,5,11 The various compression methods used in ulcer healing have been compared in published and unpublished randomized controlled trials, the results of which have been analyzed in two systematic reviews.^1,11 Despite a variety of study limitations, the results of these reviews suggest that high compression is more effective than low compression and that multilayer compression is more effective than single-layer compression.¹

     In addition to compression wraps and garments, older generation, simple pneumatic devices delivering continuous or intermittent compression to the tissues have been used. Use of three such devices was recently reviewed by Berliner et al⁵ and Kalodiki.¹² Pooled data from three randomized studies^13–15 of venous ulcer healing analyzed by Nelson et al¹¹ found that intermittent pneumatic compression in combination with continuous compression yielded no better results than continuous compression alone.