Compression treatment of chronic venous ulceration: A review

Objective: To review the recent medical literature with regard to the use o f compressive therapy in healing and preventing the recurrence of venous ul ceration. Methods: Searches of Medline and Embase medical literature databases. Appro priate non-indexed journals and textbooks were also reviewed. Synthesis: Elastic compression therapy is regarded as the 'gold standard' t reatment for venous ulceration. The benefits of elastic compression therapy in the treatment of venous ulceration may be mediated through favourable a lterations in venous haemodynamics, microcirculatory haemodynamics and/or i mprovement in subcutaneous Starling forces. Available data indicate compres sive therapy is highly effective in healing of the large majority of venous ulcers. Elastic compression stockings, Unna boots, as well as multi-layer elastic wraps, have all been noted to achieve excellent healing rates for v enous ulcers. In compliant patients it appears that approximately 75% of ve nous ulcers can be healed by 6 months, and up to 90% by 1 year. Non-healing of venous ulcers is associated with lack of patient compliance with treatm ent, large and long-standing venous ulceration and the coexistence of arter ial insufficiency. Recurrence of venous ulceration is, however, a significa nt problem after healing with compressive therapy, even in compliant patien ts; approximately 20-30% of venous ulcers will recur by 2 years. Conclusions: Compressive therapy is capable of achieving high rates of heal ing of venous ulceration in compliant patients. Various forms of compressio n, including elastic, rigid and multi-layer dressings, are available depend ing on physician preference, the clinical situation and the needs of the in dividual patient. Compressive therapy, while effective, remains far from id eal. The future goals are to achieve faster healing of venous ulceration, l ess painful healing and freedom from ulcer recurrence.