Compression therapy is a proven treatment that accelerates wound healing by applying controlled pressure to affected areas. This evidence-based approach is particularly effective for venous leg ulcers, lymphedema-related wounds, and other lower extremity injuries.

Compression Therapy for Wound Healing: A Comprehensive Guide

What is Compression Therapy?

Compression therapy is a treatment approach that applies controlled pressure to the extremities, most commonly the legs, using specialized bandages, garments, or pneumatic devices. It’s a cornerstone treatment for various vascular and lymphatic conditions, particularly for wounds associated with venous insufficiency, lymphedema, and other circulatory disorders.

Compression therapy products include:

• Compression bandages (short-stretch, long-stretch, multi-layer systems)
• Compression stockings/garments (in various pressure gradients)
• Pneumatic compression devices (intermittent pneumatic compression)
• Compression wraps with hook-and-loop fasteners

How Compression Therapy Works

The underlying mechanism of compression therapy involves several physiological processes:

1. Improving Venous Return

Compression applies external pressure to the limb, which:

• Reduces the diameter of distended veins
• Increases blood flow velocity
• Redirects blood from superficial to deep venous systems
• Prevents blood from flowing backward (reflux)

2. Reducing Edema

• Improves lymphatic drainage
• Increases interstitial pressure, helping to move excess fluid back into the vascular and lymphatic systems
• Prevents further fluid accumulation in tissues

3. Supporting Microcirculation

• Improves oxygen delivery to wound tissues
• Enhances removal of metabolic waste products
• Reduces inflammatory mediators in the wound area
• Promotes fibroblast proliferation and collagen synthesis

4. Mechanical Support

• Provides structural support to tissues
• Reduces distention of tissues
• Modifies the wound environment to promote healing

Goals of Compression Therapy

The primary goals of compression therapy in wound healing include:

1. Promoting Wound Healing
   • Creating an optimal healing environment
   • Reducing inflammation and edema
   • Enhancing tissue perfusion and oxygenation
   • Supporting cellular processes necessary for wound closure
2. Managing Underlying Conditions
   • Improving venous insufficiency
   • Controlling lymphedema
   • Preventing venous ulcer recurrence
3. Symptom Management
   • Reducing pain and discomfort
   • Decreasing limb heaviness and fatigue
   • Improving mobility and function
4. Prevention of Complications
   • Preventing wound deterioration
   • Reducing the risk of infection
   • Minimizing scarring and contractures

Types of Wounds Treated with Compression Therapy

Compression therapy is particularly beneficial for:

• Venous leg ulcers: The gold standard treatment, with healing rates of 40-80% at 24 weeks
• Lymphedema-related wounds: Helps manage fluid accumulation and supports healing
• Mixed arterial/venous ulcers: With modified/reduced compression levels
• Post-surgical wounds: Especially following vascular procedures
• Traumatic wounds: When accompanied by significant edema

Compression Protocols and Application

Pressure Levels:

Classification
Pressure Level
Clinical Application
Mild
15-20 mmHg
Prevention, mild venous insufficiency
Moderate
20-30 mmHg
Varicose veins, mild edema, prevention of venous ulcers
Strong
30-40 mmHg
Severe venous insufficiency, post-thrombotic syndrome, venous ulcers
Very Strong
40+ mmHg
Severe lymphedema, refractory cases

Application Techniques:

• Graduated compression (stronger at ankle, gradually decreasing upward)
• Spiral technique (for bandaging)
• Figure-of-eight technique (for additional support at the ankle)
• Multi-layer systems (combining padding, compression, cohesive layers)

Duration of Treatment

The duration of compression therapy varies based on the wound type, severity, and patient factors:

• Active Treatment Phase: Generally continues until the wound is completely healed
  • Venous leg ulcers: Average healing time 12-24 weeks with proper compression
  • May require bandage changes 1-3 times weekly initially, decreasing as healing progresses
• Maintenance Phase: After wound closure
  • Lifelong compression often recommended for venous insufficiency and lymphedema
  • Typically transitions to compression stockings or garments
  • Daily wear during waking hours or as prescribed
• Treatment Intensity:
  • Higher compression levels during active wound treatment
  • May transition to lower maintenance levels after healing

Contraindications and Precautions

Absolute Contraindications:

• Severe arterial insufficiency (ABPI < 0.5)
• Acute deep vein thrombosis (DVT)
• Acute cellulitis or infected wounds (until antimicrobial therapy initiated)
• Phlegmasia cerulea dolens (severe DVT with arterial compromise)

Relative Contraindications (requiring specialized assessment):

• Moderate arterial insufficiency (ABPI 0.5-0.8) – may use modified compression
• Peripheral neuropathy – requires careful monitoring
• Congestive heart failure – caution with fluid mobilization
• Skin sensitivity or fragility – may require special padding

Monitoring and Follow-up

Regular assessment is essential for effective compression therapy:

• Wound measurement and photography
• Assessment of wound bed and surrounding skin
• Evaluation of edema reduction
• Monitoring for compression-related complications
• Patient comfort and compliance assessment

Patient Education and Self-Care

Patient education is critical for successful outcomes:

• Proper application of compression garments
• Skin hygiene and moisturizing
• Signs of complications requiring medical attention
• Importance of compliance and long-term maintenance
• Lifestyle modifications to support treatment