Venous ulcers are among the most frequent causes of chronic lesions in the European population. They usually occur in the medial area of the lower limb and in the malleolar area. The skin is hyperpigmented due to the accumulation of hemosiderin, with areas of white atrophy and lipodermatosclerosis. The bottom of the lesion may be fibrinous or granular, with small or flat edges, usually irregularly shaped. Usually, there is no particular painful symptomatology or, if it is present, it is relieved by the placement of the limb at discharge. Peripheral pulses are present.
Chronic venous insufficiency is the most important pathophysiological cause in patients with chronic ulceration of the lower extremities, which represent about 70% of all cases.
The cornerstone of the treatment of venous ulcers is represented by the elastocompressive bandage, a particular compression therapy, in fact, numerous randomized controlled studies have provided scientific data on its effectiveness, as it can improve:
The venous return, generating a reduction in the filtration of the fluid in the tissue;
Lymphatic drainage, the release of active anti-inflammatory mediator vessels by endothelial cells;
Peripheral decongestion; the benefits in preventing recurrences; The effects of the muscle pump.
To obtain these results, it is necessary to package the bandage through a correct choice of the material and with the correct methods, so that the experience of the professional in this field acquires a fundamental importance. A poorly packaged bandage can cause damage that slows the healing of wounds and worsens the patient’s quality of life.
During each dressing change, the leg should be carefully inspected for possible signs of pressure, skin lesions and atypical swelling that may be caused by local restrictions. In the decongestion phase, the reduction of edema should ALWAYS be quantitatively documented by regular measurements of the circumference around the ankle and calf. Pain is always a warning signal that should lead us to investigate the cause.
Possible bandages are as follows:
Inelastic or reduced stretch bandages (extendable up to 40% of the value) exert a compression of approximately 8-12 mm Hg.
Bandages with medium elasticity (extendable between 70-140% of the baseline value).
Tension compression is approximately 18 mm Hg and should be removed at night.
Bandages with long elasticity (extensible over 140%). They are used for maintenance after edema reduction, in the dystrophic extremities where the stockings are contraindicated. The pressure exerted is very high: 38-42 mmHg, therefore, the bandage packaged with this bandage is always mobile and must be removed at night.
The main contraindications for compression therapy are the following:
Non-self-sufficient patient in conjunction with serious diseases.
Dermatological diseases that contraindicate occlusive therapy.
Contraindications related to elastic compression.
Of fundamental importance is the first layer of the bandage, usually created with German cotton and similar, ideal for protecting the skin.
The second layer is created by the bandages mentioned above: it must be mobile when it is necessary to dress frequently (for example, in infected wounds), fixed when the characteristics of the lesion allow less frequent bandages. The bandage method used can be spiral or “8” (spike). The greater the overlapping of the bandages, the greater the compression, while the foot should be placed “hammer” (dorsal flexion) to avoid wrinkles in the ankle.
The elastic bandage of the limb should be applied with gradual and decreasing compression from the ankle to the knee. The tension of the band is thus maintained for Laplace’s law (the pressure is directly proportional to the tension of the band and inversely proportional to the radius of the leg). For this reason, the first layer is used to regularize the radius of the “cylindrical” limb or vice versa to “fiasco”.
It is always advisable to consult a professional expert in this area and consult the publications of authorized Scientific Societies.