Variability of pressure provided by sustained compression

Compression therapy is the cornerstone of treatment for patients with venous leg ulcers (VLUs). Although it is generally accepted that the therapeutic outcomes are directly related to the quality of compression therapy, delivering precise and sustained compression therapy is an ongoing challenge for health care professionals. Several factors influence quality of compression therapy: physical structure and elastomeric properties of the compression system, size and shape of the leg, skill and technique of the bandager and physical activity undertaken by the patient. Graduated compression is achieved by applying a bandage at the same tension from ankle to knee, providing the shape of the leg is normal. Many patients with VLUs have distorted legs, challenging the delivery of a desired pressure gradient. Poor bandaging technique can result in little or no benefit or may deliver too high a pressure causing a detrimental effect to the wearer. If the wearer is unable to tolerate the compression, patient concordance and effectiveness are affected. Training has been shown to reduce variability of sub-bandage pressure. Sub-bandage pressure increases during standing and walking. These pressure changes are related to the elastomeric properties of the compression systems. Health care professionals need to understand the properties of the available compression systems and how their application technique must be adjusted.