Section 7-1: Venous ulcers and the role of compression

It has been estimated that in the United Kingdom, the prevalence of venousulcers[Image-16K] is about 0.15% of the adult population. Much research has demonstrated that the majority of these ulcers will respond favourably to compression therapy provide that clinically effective levels of pressure are applied and maintained over an extended period. Compression implies the application of clinically effective levels of external pressure, applied to modify or assist a physiological process - generally blood flow. It is currently believed that compression values of around 40 mm Hg at the ankle reducing progressively up the leg are suitable for this purpose. The Crepe-type bandages that have been used for many years for the treatment of venous leg ulcers are totally incapable of maintaining the levels of pressure required. More recently a new generation of bandages and bandaging systems have been developed that are capable of producing these required levels. A recently introduced British Standard that describes a performance-based classification system for elastic bandages has designated these compression bandages as Type 3c. The bandages in the Drug Tariff that are suitable for the application of high levels of compression are described below. The inappropriate use of compression bandages can have very serious consequences, resulting in extreme cases in necrosis and amputation[Image-0K] It is vitally important, therefore, that no form of high compression bandaging system is applied to a patient unless the possibility of arterial disease has first been excluded by some appropriate method, and that all nursing staff involved in compression bandaging have been properly trained in the theory and practical application of this technique.