Not Yo’ Grandma’s Stockings

By Christopher Miles, OT, CLT, CWCA, medi USA

Compression garments aren’t what they used to be – and those of us in wound care couldn’t be happier.                                      Not Yo' Grandma's Stockings

Unfortunately, when patients think of compression garments they think of socks that are too tight and difficult to get on, or tend to roll and pinch. What they might not be thinking is that compression therapy is practically the only medical treatment likely to reduce the rate of recurrence of their nasty, painful and smelly venous leg ulcers.

And even better? Over the years, compression garments have advanced and come full-circle, which is a good thing because they are being used now more than ever. In fact, it’s hard to turn on the TV without seeing a professional athlete wearing some form of compression garments.  Even healthcare clinicians working long shifts have found that compression can greatly enhance their overall vascular function and reduce weariness and fatigue in their legs.

The myth of compression therapy

Some believe that compression therapy is not needed once a vascular leg ulcer has healed. This is a myth. The recurrence rates of venous leg ulcers have been documented as high as 80% within the first five years. This can likely be related to marginal compliance with compression therapy by our patients. Even once a vascular wound has healed, the underlying problem that caused the wound to open – the high pressure in the venous system – is still present. On-going compression therapy to reduce venous pressure is required to prevent the recurrence of vascular leg ulcers.

So why does compression need to be soooo stinkin’ tight?

It is important to think of compression as a medical treatment that is prescribed at a certain “dosage” level.  Different diagnoses indicate different dosages, just like other types of medicine or treatment:

  • Dosage of compression is measured in mmHg.
  • A patient with moderate peripheral artery disease and an Ankle Brachial Index (ABI) of 0.7 can likely only tolerate light compression (around 10-20mmHg)
  • However, a patient with chronic lymphedema may likely benefit from compression 40mmHg or higher.
  • When treating your patients with venous leg ulcers who have an ABI over 0.8, compression of 30-40mmHg is indicated.

This therapeutic dosage of external compression is what the venous system requires to keep venous pressures lower, in attempt to limit the recurrences of these ulcers.

No, they’re not as easy as tube socks

Patient compliance with compression garments is a constant challenge.  In case you didn’t know, the most common complaint about compression is that they are just too difficult to get on.  As reviewed above, the “tightness,” or compression dosage level, can make a garment more difficult to put on. It is important that, as clinicians, we properly educate our patients on the reasoning behind – or justification of – a compression level.  It is ill-advised to allow a patient to select a lower compression level for comfort or convenience, because it is likely to be a sub-therapeutic dose and put them at a higher risk for ulcer recurrence.

Fortunately, there have been significant advancements in compression garment styles that make them easier to manage.  Garments do not have to be just one tight layer that’s difficult to get on. Rather, they can consist of two lighter levels that add up to the appropriate therapeutic dose.  Adjustable Velcro compression devices are also a fantastic garment alternative that are much easier for patients to independently manage.   Sharing various compression tips and tricks with patients can also help ensure their success.

Using compression garments, along with knowing more about them and educating patients, can be the key to compression therapy success. Because, as they say, “Every leg needs a hug!”

Are you on board with compression?

Compressions garments have come a long way over the years, both in terms of structure and functionality. Have you noticed the increase in their popularity, and have your patients grown more comfortable with using them? What about you – have you used them when at work or home? We’re all about compression garment stories! Please leave your comments, thoughts or stories right here.

Christopher Miles

Christopher Miles, Christopher Miles, OT, CLT, CWCA, medi USA

Christopher Miles, OT, CLT, CWCA is a Senior Wound Care Product and Clinical Specialist at medi USA.  He will present the session “Because Every Leg Needs A Hug: Medical Compression is a Dose Dependent Medical Treatment” at the 2016 Wild On Wounds National Conference in Las Vegas.  In the session, which will include didactic and hands-on activities, participants will increase their understanding of compression types, options and dosage, and how each can ultimately impact success and outcomes.

Wild on Wounds 2016

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