Some Effects of Sustained Compression On Ulcerated Tissues

Abstract

Sustained leg compression is the first line of treatment for patients with chronic venous ulcers. The success rates of this treatment vary, and the mode(s) of action are not well understood. In this study, tissue oxygen tension (TcPO₂), surface pH, and reactive hyperemia measure ments were made to observe changes associated with sustained compression in patients with chronic venous ulcers. Patients with chronic venous ulcers (n = 20, 13 F, 7 M, median age 65.5 years, median ulcer size 13.9 cm²) were assigned to the same treatment, wound dressings, and 4-layer bandaging during a 24-week period. Duplex ultrasound, venous refilling time, skin tissue oxygen, and ulcer surface pH were measured at defined time points. Ulcer areas were calcu lated from contour traces done at regular dressing changes. The difference between ulcer surface pH and control values measured proximally on the same leg diminished with healing (p = 0.02), which occurred despite the evidence of deep venous reflux. Ulcers with smaller initial areas healed quicker (p=0.003). A greater likelihood of healing was observed in women (p = 0.017). Sustained compression may potentiate healing by acting on the microcirculation in ulcerated tissues.

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References

Bello M. , Scriven M. , Hartshorne T. , et al: Role of superficial venous surgery in the treatment of venous ulceration. Br J Surg 86:755-759, 1999.

Guest M. , Smith JJ , Sira MS , et al: Venous ulcer healing by four-layer compression bandaging is not influenced by the pattern of venous incompetence. Br J Surg 86:1437-1440, 1999.

Burnand K. , Clemenson G. , Whimster I. , et al: The effect of sustained venous hypertension on the skin capillaries of the canine hind limb. Br J Surg 68:41-44, 1982.

Coleridge Smith P. , Thomas P. , Scurr J. , et al: Causes of venous ulceration: A new hypothesis. Br Med J 296:1726-1727, 1988 .

Falanga V. , Eaglestien WH : The trap hypothesis of venous ulceration. The Lancet 17:1006-1008, 1993.

Fagrell B. : Microcirculatory disturbances—the final cause for venous leg ulcers ? VASA 11:101-103, 1982.

Barnes M. , Mani R. , Barrett DF , et al: How to measure changes in edema in patients with chronic venous ulcers ? Phlebology 7:31-35, 1992.

Kolari P. , Pekenmaki K. , Pohjola R. , et al: Transcutaneous oxygen tension in patients with post thrombotic leg ulcers: Treatment with pneumatic compression. Cardiovasc Res 22:138-141, 1988.

Prasad A. , Ali-Khan AA , Mortimer PS : Leg ulcers and edema: A study exploring the prevalence, etiology and possible significance of edema in venous ulcers. Phlebology 5:181-187, 1990.

10.

Mani R. : Transcutaneous measurements of oxygen tension in venous ulcer disease . Vasc Med Rev 6 :121-131, 1995.

11.

Mani R. , Hammad L. , Roberts G. : The microenvironment around leg ulcers. In: Evidence-Based Wound Care, ed. by Suggett A et al. London: RSM Press, 1998, pp 5-13.

12.

Baker SR , Burnand KG , Sommerville KM , et al: Comparison of venous reflux assessed by duplex scanning and descending venography in chronic venous disease. Lancet 341:400-403, 1993.

13.

Rayman G. , Williams SA , Spence P. , et al: Improved hyperemic response to minor trauma in Type I diabetes . Br Med J 292:1295-1298, 1986 .

14.

Roberts G. , Hammad L. , Shearman C. , et al: Physical changes in dermal tissues around ulcers. Proc 7th European Conference of Advances in Wound Management. ISBN (1902 499 034), 1997, pp 104-105.