The fundamental objective of “therapeutic” compression in the legs is basically to counteract venous hypertension, and it is only achieved when the venous valves function again, and the blood is not retained in the veins.
As a concept, compression therapy is the pressure exerted on an extremity by materials of variable elasticity, to prevent and treat disease of the venolymphatic system. As a consequence, this pressure at the clinical level acts on the superficial and deep venous system.
What is the goal with therapeutic compression?
Any chronic venous disorder, part of the loss of capacity in the venous return to the heart, in such a way that the fluids do not circulate correctly throughout the body, stagnating in the affected area, usually in the lower limbs.
The effects of therapeutic compression are divided into:
- In the interstitial space, it reduces edema, reduces capillary filtration and ensures that the fluid moves towards non-compressed areas, improving lymphatic drainage.
- In the veins, it reduces the caliber, increases the flow and speed in the veins, reducing venous stagnation and improving the function of the venous pump. All these actions in combination have beneficial effects on microcirculation and cytokines by releasing anti-inflammatory mediators.
When compression is performed, what is sought is to improve that venous return and that circulation of body fluids in the affected area, avoiding fluid stagnation and fluid transfer to extravascular tissue.
In relation to this, the therapeutic effect can be achieved by various compression systems:
- Graduated Compression Stockings (MCM) and multi-layer stocking systems
- Phlebological Compression Bandage (VCF) and multi-component systems
- Medical Adaptive Compression Systems (ACS)
- Intermittent Pneumatic Compression
To apply this treatment, initially in the venolymphatic edema decongestion phase, the most widespread technique is bandages. This generates a pressure gradient through the different membranes that make up this part of the body, passing through the capillary walls and producing the accumulation of fluids in the extravascular tissue.
In this way, whether using compression bandages, or other techniques such as compression stockings, it is possible to regulate the pressure of the lower limbs. The application of one method or another will depend on the characteristics of the patient.
How to determine which therapeutic compression system to use?
Choosing the correct medical compression system requires a very thorough evaluation of the patient. In order to determine which system is the most suitable and the compression levels required by the patient. The most relevant factors to take into account are:
- Vascular compromise: Doppler ultrasound and ABI, these values will provide us with the necessary knowledge to rule out arterial pathology and know the mmHg that are required to normalize blood flow and lymphatic drainage.
- Comorbidity that accompanies vascular pathology and that can prevent the mmHg that would be required in an optimal situation from being applied. Comorbidity is the sum of a venous condition together with another unrelated one, such as diabetes or a heart problem. If this situation occurs, the therapeutic compression guidelines must be modified, either by applying lower than optimal pressures or by changing the types of tissues with which the compression is performed. Let us remember that less elastic fabrics perform higher work pressures and are more tolerated by patients, that is the reason why both stockings with flat fabric or bandages with low elasticity are more recommended in patients with multiple pathologies or with advanced age.
- Social situation: This aspect is relevant when selecting medical compression devices. If the patient does not have enough dexterity to put on just the stocking or bandages and lacks technical or family aids, Velcro-type compression systems or double stockings should be selected if high pressures are required. If not, it will always be more advisable to apply a compressive bandage or a compression stocking.
- Economic situation: no less relevant than the previous ones. Within the economic possibilities of the patient, we will look for the most efficient solutions, that is, to achieve the therapeutic objective at the least possible cost. In case of economic difficulties, non-reusable systems (adhesive or cohesive) that do not allow washing and subsequent use were discarded.
- State of the disease: Sometimes if the skin is very damaged or the area is very inflamed, it is recommended to use some type of bandage impregnated with zinc (to reduce inflammation and improve healing) or calamine (to alleviate the clinical manifestation of eczema). On the other hand, the more damaged the affected area, the more compression tolerance will be lower.
As has been seen, the level of pressure to be exerted will depend on the diagnosis, the clinical factors (assessing the severity of the symptoms), and especially the edema, lymphatic involvement, and detected comorbidities. For this reason, it is essential to have the diagnosis of a health professional and the correct follow-up of the professional throughout the treatment.
Elaborated by Carmen Alba Moratilla
With the collaboration of the Technical Department of Calvo Izquierdo S.L.
Bibliography:
- Partsch H (2003) Understanding the pathophysiological effects of compression. In: EWMA Position Statement; Understanding Compression Therapy 2003. Medical Education Partnership Ltd, London
- Partsch, H. and Mortimer, P. (2015), Compression for leg wounds. Br J Dermatol, 173: 359-369. Doi: 10.1111 / bjd.13851
- Diagnostic and therapeutic guidelines for diseases of the veins and lymphatics of the Italian College of Phlebology CIF, revisions 2003-2004
- Alba Moratilla C. Términos para comprender la compresión terapéutica. Rev. enferm. vasc. [Internet]. 15th of January 2022;4(Especial):4-32. Available on: https://www.revistaevascular.es/index.php/revistaenfermeriavascular/article/view/94
