Compressive Therapy in Wound Treatment: Which Aids to Choose and How to Use Them Correctly?
If a patient is dealing with a chronic wound, it is necessary to support its healing with proper compressive therapy. The main goal is to reduce swelling and improve venous flow in the body. By applying compression immediately in the morning, before any movement, we prevent blood from pooling in the lower limbs. But be careful! It must be done with the correct technique.
Compression Stockings or Elastic Bandages
The right pressure on the venous wall prevents blood from pooling, improves its return to the heart muscle, and reduces swelling in the lower limbs. Compression aids should always be applied in the morning − before the patient takes their first steps. We choose between compression stockings and elastic bandages.
Compression stockings are designed by the manufacturer to provide adequate support for venous circulation, so the compression is graduated. The strongest support is usually around the ankles and gradually decreases towards the knees. The compression mechanism utilizes the activity of calf muscles. There are many variants available − differing in material, elasticity, or stocking dimensions. This type of compensatory aid is prescribed by a doctor on a prescription for a therapeutic and orthopedic aid, which can be obtained from medical supply stores. It is necessary to measure the lower limbs correctly with a tailor's meter according to the attached scheme on the prescription, and this should be done in the morning before any movement. This ensures the correct size and subsequent compression. Usually, we choose compression stockings for patients without skin integrity damage. For less mobile individuals, it might be challenging to put on the aid, so the set includes a smooth sleeve that makes applying the stocking easier. It is advisable to remove them at night.
Elastic bandages are mainly used for patients with skin defects. The wound is not endangered by excessive pressure. Patients often cannot withstand continuous compression throughout the day due to the pain of the wound and the surrounding area. In this case, it is possible to manipulate the compression during the day and loosen the bandages as needed.
Long-Stretch and Short-Stretch Bandages
For the healing of chronic wounds, we use short-stretch bandages. They ensure the correct pressure on the venous system, thereby supporting the activity of the deep venous system. They provide an elasticity of 60−90%. Once applied, they exert low resting pressure and high pressure during patient movement, thereby promoting defect healing. They are non-elastic and are also ideal for immobile patients. They can be used repeatedly and washed up to 60°C.
Long-stretch bandages provide an elasticity of over 100%. They exert high resting pressure and low working pressure. Therefore, they are not suitable for treating skin defects or for immobile patients.
Technique and Principles of Bandage Application
- The bandage should be applied in the morning before the patient loads the circulatory system into the distal parts. If movement must be performed before applying the bandage, the patient should place their legs horizontally for 20 minutes before reapplying the bandage to reduce blood flow in the venous system.
- The bandage is applied starting from the toes.
- Applying from the ankles or insteps is completely unacceptable.
- We conclude as necessary under the knee or in the groin area.
- We select the appropriate number of bandages according to the patient's body constitution.
- We use the crisscross or spiral bandaging technique.
- The applied compression should not constrict the patient.
Local Wound Care Before Compression
Countless studies have confirmed that healing is easier and faster with compression therapy. Before applying it, we must treat the defect itself with therapy indicated by a doctor. The ideal method is moist healing, where a constant environment and temperature necessary for granulation and epithelialization are continuously maintained in the wound.
We perform wound debridement, treat the edges and surrounding area of the defect, apply the indicated primary dressing, which is fixed with a secondary dressing. Subsequently, we apply the compression therapy.
Among the advantages of moist healing are lower dressing frequency, better wound bed condition, shorter treatment duration, reduced pain during dressing changes, and reduced financial costs for medical materials.
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Sources:
1. What is compression therapy?. Available at: www.veinforum.org/patients/what-is-vein-disease/what-is-compression-therapy
2. Compression therapy. Available at: www.lecbarany.cz/kompresivni-terapie
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