TREATMENT OF CHRONIC VENOUS ULCERS USING SEQUENTIAL GRADIENT INTERMITTENT PNEUMATIC COMPRESSION

Objective: To determine if a limited regimen of sequential gradient in termittent pneumatic compression ('HomeRx': HRx) is as effective in pr omoting the healing of chronic venous stasis ulcers as is the Unna's b oot (UB), considered the 'gold standard' in compression therapy. Desig n: Fifty-three patients aged 31-85 years, with ulcers ranging up to 31 .8 cm(2) (mean 9.9, SE 1.1) were prospectively randomized to treatment s with UB or HRx and followed weekly for 180 days or until healing was complete, whichever came first. The HRx group wore graduated compress ion stockings, which were removed only while intermittent pneumatic co mpression was applied bilaterally at home for 1 h each morning and 2 h each evening. The UB was re-applied at least weekly. The two groups w ere equivalent in their use of hydrocolloid dressings and periods of l eg elevation. Setting: Therapy performed at home, with weekly visits t o an outpatient clinic. Main outcome measures: Complete ulcer healing and the rate of healing, based on area and perimeter changes; amounts of wound exudate and pain. Results: Complete healing was achieved in 2 0 of 28 patients (71%) in the HRx group, compared with 15 of 25 (60%) treated with UB. Three patients had an adverse reaction to UB, one had cellulitis and five were non-compliant. Correcting for these withdraw n patients by life table analysis, healing rates were 76% and 64%, res pectively. Healing rates did not correlate with haemodynamic measureme nts made prior to treatment. Conclusions: Using HRx for just a few hou rs daily to supplement graduated elastic compression heals venous ulce rs at least as well as does the UB, without its disadvantages (e.g. th e need for frequent re-application by qualified personnel, difficulty bathing), affording patients greater convenience during treatment.