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Figure 2
The diagram is organized in assessment, diagnosis, recommendations for treatment and outcomes.
Assessment must include ankle-brachial pressure index ABPI or toe pressure index, confirmation of the diagnosis
venous disease and investigations to exclude other disorders. Treatment is determined depending on the diagnosis.
Unfortunately these recommendations are not commonly used.
be used in routine clinical practice ( Kikuhime ) (8,9,10).
Hosiery provides the highest level of assurance for correct
sub-bandage pressure (8). This treatment does not
require further training except putting on and removing
the hosiery. This means that personnel already taking care
of the patient in his/her home can apply the compression
without risking the quality of the compression treatment
– including patients suffering from leg ulcers. Often the
patient will be able to take off the hosiery themselves before
bedtime and when showering.
HIGH PATIENT COMPLIANCE
Patient compliance is closely connected with the level of
knowledge and motivation of the patient with a leg ulcer
(9). Patient information, guidance in self care and participation
in the treatment are therefore important factors.
It is important to aim for optimal freedom of movement
during treatment. Movement of the foot and activation of
the ankle and calf muscle seems to be better when hosiery
is worn rather than when bandages are used. (10)
A further advantage of using hosiery is that the patient
is able to use his or her own footwear – which often can
be an issue when using some bandages.
Improved patient compliance, assurance of correct subbandage
pressure with faster healing and easier working
conditions for healthcare personnel are all good reasons
for changing to hosiery as soon as possible when treating
venous leg ulcers and mixed arterial and venous ulcers.
Science, Practice and Education
HIGHEST HEALING RATE
There is a connection between healing rates and type of
compression, but conclusions are difficult to draw. For
instance, a search in the Cochrane library has shown that
a healing rate of 84% in 12 weeks can be obtained using
hosiery compared to using inelastic bandages which
showed a rate of 53% in 12 weeks. (11)
A comparison of elastic and inelastic bandages showed
a healing rate of 35% for inelastic bandages compared
with 58% for elastic bandages. (12) Multi-layer bandages
have obtained a healing rate of 75% compared to usual
treatment (13). As stated in a status article in 2001 (14)
many studies have been carried out with few participants
and different conditions making a comparison difficult.
These studies cannot be directly compared due to different
conditions but they do indicate that multi-layer bandages
and hosiery, which are recommended in the EWMA document
(7), lead to the highest healing rates.
SUSTAINABLE SUB-BANDAGE PRESSURE
To be effective the bandage must sustain the pressure it is
applied with. In the Danish wound care magazine SÅR
(2003 no 2) and EWMA Journal (autumn 2004) an article
has been published “Watch the pressure – it drops!” (8)
This article is a study of the pressure conditions under
the bandages over time. Here are some results from the
study (figure 3);
EWMA Journal 2008 vol 8 no 3 27
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