Introduction

Compression therapy is a well-established treatment modality for a number of conditions, including venous disorders, thrombosis, lymphedema, and lipedema. It is also very effective in treating various kinds of edema.¹ Based on patient diagnostic data, many patients with these conditions can benefit from targeted compression therapy.

Compression Therapy Principles

Compression therapy works by applying consistent, graduated levels of pressure to reduce the accumulation of interstitial fluid. When used to treat venous disorders, this pressure shifts fluid proximally, away from the lower leg.² The consistent pressure results in a decrease in vessel diameter. When a patient is lying down, even a small pressure value as low as 15 mm Hg is sufficient to constrict both superficial and deep veins, although during standing, higher pressure values of between 60 and 90 mm Hg are required.¹

Compression therapy devices provide stable support for the leg muscles, and this support increases the effects of the muscle pump and improves venous return. It also decreases fluid filtration into the tissue and increases lymphatic healing. For many patients, this process results in pain relief and edema reduction. Properly-applied compression therapy can help with peripheral decongestion in the short term and aid healing in the long term.¹ Healing is promoted by the release of vasoactive anti-inflammatory mediators by endothelial cells.³

Compression Therapy Methods

Compression therapy can be applied through a variety of garments or devices to provide patients with the optimal level of pressure. Common methods of applying compression include:

• Elastic bandages: Depending on the material used, compression bandages can have low to high elasticity. The application of compression bandages requires experience and training and should be done by a medical professional or a caregiver who has received proper training. In practice, many bandages are wrapped too loosely, thus impeding their ability to be effective.¹
• Non-elastic bandages: Zinc paste bandages and other non-elastic bandages can have limited efficacy in cases of early decongestion. These bandages are applied while wet and stiffen as they dry, developing a compression pressure.¹
• Multicomponent bandage systems: Multicomponent systems are ready-made bandage systems with multiple components for padding, compression, and fixation. These multilayer systems sometimes have visual indicators to assist in achieving optimal pressure.¹
• Compression stockings: Compression stockings offer mid-level compression between elastic and inelastic bandage systems. They are easy for many patients to put on, although arthritic patients may have trouble with them.⁴ Stockings are generally the first therapeutic option when ulcers are present.¹
• Intermittent pneumatic compression: Intermittent pneumatic compression therapy devices work by placing the extremity in a deflated cuff and then using an electronic control device to adjust the pressure gradient, duration, and interval.¹

The type of compression therapy most suited for a specific patient’s clinical needs can be determined based on many factors, including the patient’s mobility status, exercise needs, optimal pressure, and how much assistance they have to help with changing bandages or stockings, if necessary.

Clinical Considerations

There are multiple contraindications that should be considered before starting compression therapy, including advanced peripheral arterial disease, decompensated heart failure, septic phlebitis, and phlegmasia cerulea dolens. Compressive treatment may be possible for patients with polyneuropathy and chronic compensated heart failure, but it should be approached with caution.¹ Additionally, clinicians should assess for potential side effects when starting compression therapy, including assessing the patient’s pain level. Inspecting the leg for signs of pressure marks, skin lesions, and atypical swelling should occur during each bandage change.¹

Conclusion

Although compression therapy offers many benefits for patients with venous disorders and edema, among other conditions, it is not a one-size-fits-all treatment. There is a range of options to achieve the right pressure gradient and prevent complications in a way that fits the patient’s lifestyle.

References

1. Dissemond J, Assenheimer B, et al. Compression therapy in patients with venous leg ulcers. J Dtsch Dermatol Ges. 2016;14(11):1072-1087.
2. Webb E, Neeman T, et al. Compression therapy to prevent recurrent cellulitis of the leg. N Engl J Med. 2000;383(7): 630-639.
3. Renner R, Gebhardt C, Simon JC. Compliance to compression therapy in patients with existing venous leg ulcers: Results of a cross-sectional study. Med Klin. 2010;105:1-6.
4. Nair B. Compression therapy for venous leg ulcers. Indian Dermatol Online J. 2014;5:378-382.