Understanding Compression Therapy: A Vital Approach for Wound Management for Venous Insufficiency and Lymphedema

Published in Wound Care on April 10, 2024

Compression, as defined by Merriam-Webster, is the action, process, or outcome of making something smaller or denser. It also refers to the condition of being reduced in size or density. This definition applies to compression as a treatment for lower extremity and lymphedema conditions.

There are various kinds of compression that can be used to treat wounds in the wound care field. The choice of compression depends largely on the patient's disease state. Let's begin with the basics and explain why compression is so crucial for venous insufficiency and lymphedema.

Venous Insufficiency and Lymphedema

Venous insufficiency is a condition where the veins in one’s lower legs have faulty valves. These valves are supposed to help the blood flow back to the heart, but when they are damaged, blood and fluid can accumulate in the lower extremities, leading to inflammation and swelling.

The lymphatic system is a network of vessels that carry protein-rich lymph fluid throughout the body. It's part of the immune system. Lymph nodes are organs that filter the lymph fluid and contain cells that fight infection and cancer. Lymphedema is the swelling of tissue caused by the accumulation of protein-rich fluid that is usually drained through the body’s lymph system. This means that there is some problem with the lymph drainage.

Some of the most common causes of venous insufficiency are:

Obesity
Previous varicose veins or blood clots
Family history of venous insufficiency
Pregnancy
Smoking
History of phlebitis or swelling/inflammation of the superficial veins
Sitting or standing for long periods of time

Lymphedema can be caused by:

Cancer: If cancer cells block lymph vessels, lymph fluid is then prevented from flowing, resulting in lymphedema. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.
Radiation treatment for cancer: Radiation can cause scarring and inflammation of lymph nodes or lymph vessels.
Surgery: In cancer surgery, lymph nodes are often removed to check if the disease has spread. However, this does not always result in lymphedema.
Genetics: The less common cause of lymphedema is an inherited condition.

Compression for Venous Insufficiency and Lymphedema

Compression is a useful treatment for venous insufficiency, as it supports the valves in the veins and helps them function properly. It also promotes the return of blood to the heart and reduces swelling in the lower extremities. Compression can improve blood circulation and relieve symptoms such as swelling and pain.

However, compression is not suitable for everyone and requires careful assessment. Some people may have other conditions or disease states that affect the blood vessels (such as peripheral artery disease, which means the arteries are narrowed), and compression may worsen their situation. The blood needs to reach all parts of the body.

To determine the appropriate level of compression, a measurement called an ankle brachial index (ABI) is used. It measures the blood pressure in the extremities and provides a guideline for nurses and compression specialists on how much pressure (in millimeters of mercury or mmHg) should be applied to the lower extremities to achieve a balance between benefit and harm.

Because compression involves many factors and complexities, it is essential for DME and HME providers to have a qualified and trained staff member who can fit compression correctly.

For lymphedema, compression helps to remove, manage, or prevent the accumulation of lymph fluid in the areas where lymph nodes are located, such as the arms, legs, or other parts of the body. There are various forms of compression, such as manual lymph drainage, compression bandages, compression garments, and sequential pneumatic compression.

Compression is a lifelong necessity for managing venous congestion and lymphedema.

Compression Guidance

The WOCN Society offers a VLU algorithm that can assist clinicians or podiatrists in deciding how to apply compression therapy for venous conditions. The algorithm helps to determine the appropriate level and type of compression for each individual. To access the algorithm, click here.

Compression therapy is an effective way to manage venous issues, but it should be done under professional supervision to ensure optimal outcomes.

For further questions on compression, contact Heather Trumm, Director of VGM Wound Care, at heather.trumm@vgm.com.

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