Intermittent pneumatic compression as an adjuvant therapy in venous ulcer disease. A prospective randomised trial of four-layer versus short stretch compression bandages for the treatment of venous leg ulcers. Intermittent pneumatic compression improves venous ulcer healing. [The impact of the sonotherapy and compression therapy on enhancement of healing venous leg ulcers after surgical treatment].
Despite improvements in healing rates venous ulcer disease still carries significant morbidity and cost. Any therapy that further improves healing rates is worthy of consideration. The recognised effects of intermittent pneumatic compression (IPC) on both arterial and venous circulation suggest that its use may confer significant benefits to venous ulcer healing. This study investigates the potential additive effects of adjuvant IPC on the healing and subsequent prevention of venous ulcers. Some improvement in the rate of healing in venous ulcers is noted. These findings are set against a background of very high healing rates in both treatment and control groups. No benefit is seen to accrue if IPC is used as an adjuvant therapy to help prevent recurrence of ulcers although the study period is very short. This trial was undertaken to examine the safety and efficacy of four-layer compared with short stretch compression bandages for the treatment of venous leg ulcers within the confines of a prospective, randomised, ethically approved trial. Fifty-three patients were recruited from a dedicated venous ulcer assessment clinic and their individual ulcerated limbs were randomised to receive either a four-layer bandage (FLB)(n = 32) or a short stretch bandage (SSB)(n = 32). The endpoint was a completely healed ulcer. However, if after 12 weeks of compression therapy no healing had been achieved, that limb was withdrawn from the study and deemed to have failed to heal with the prescribed bandage. Leg volume was measured using the multiple disc model at the first bandaging visit, 4 weeks later, and on ulcer healing. Complications arising during the study were recorded. Data from all limbs were analysed on an intention to treat basis; thus the three limbs not completing the protocol were included in the analysis. Of the 53 patients, 50 completed the protocol. At 1 year the healing rate was FLB 55% and SSB 57% (chi 2 = 0.0, df = 1, P = 1.0). Limbs in the FLB arm of the study sustained one minor complication, whereas SSB limbs sustained four significant complications. Leg volumes reduced significantly after 4 weeks of compression, but subsequent volume changes were insignificant. Ulcer healing rates were not influenced by the presence of deep venous reflux, post-thrombotic deep vein changes nor by ulcer duration. Although larger ulcers took longer to heal, the overall healing rates for large (> 10 cm2) and small (10 cm2 or less) ulcers were comparable. Four-layer and short stretch bandages were equally efficacious in healing venous ulcers independent of pattern of venous reflux, ulcer area or duration. FLB limbs sustained fewer complications than SSB. The effects of intermittent pneumatic compression on the healing rates of ulcers in patients with chronic venous insufficiency were examined in a prospective, controlled study of 22 patients. Patients were randomly assigned to the experimental or the control group. Both groups received local wound care followed by application of an Unna boot. In addition, subjects in the experimental group received intermittent pneumatic compression (IPC) twice weekly for one hour each session. Healing rates were reported in square centimeters per day. Data analysis revealed a mean healing rate of 0.08 cm2 per day for control subjects and 0.15 cm2 per day for experimental subjects. Statistical analysis, demonstrated the healing rates of the two groups to be statistically different. The results appear to indicate that intermittent pneumatic compression is beneficial in the management of venous insufficiency ulcers. The aim of this paper was to describe the impact of the sonotherapy and compression therapy on enhancement of healing venous leg ulcers after surgical treatment.
                Three comparative groups of patients--A, B and C were made at random from patients with venous leg ulcers, which had been earlier operated by modified Babcock' method. The 24 patients were included (in use of software Monte Carlo) to the group A, 25 patients to the group B and 24 patients to the group C (control group). The patients in all comparative groups were treated pharmacologically. Ulcerations at patients in group A were additionally treated in use of ultrasound. And ulcerations at patients in group B were additionally treated in use of compression therapy. The evaluated factors were to estimate the sonotherapy and compression therapy causes any changes of the surface, longest and widest dimensions, and volume of tissue defect. For all comparative groups calculated the Gilman parameter. The weekly speed of changes of surface and volume were estimated too.
                After therapy there was statistically significant decrease of whole surface and pus-covered and granulation area, longest and widest dimensions, and volume of ulcers in all groups while there was no statistically significant difference--except pus-covered areas--between the groups observed. Comparison in terms of pus-covered area indicated a significant difference between all groups, in favor groups A and B than C.
                There are no special reasons for application of ultrasound and compression therapy in enhancement of healing process--however the following results must be verified on bigger population and longer patient observation. The sonotherapy and compression therapy promote only decontamination process compared with control group.
IPC may increase healing compared with no compression, but it is not clear whether it increases healing when added to treatment with bandages, or if it can be used instead of compression bandages. Rapid IPC was better than slow IPC in one trial. Further trials are required to determine whether IPC increases the healing of venous leg ulcers when used in modern practice where compression therapy is widely used.