It is generally agreed upon that the fundamental treatment for chronic venous insufficiency and venous leg ulcers is compression. Compression increases the interstitial fluid pressure assisting the transport of fluid back into circulation, thereby reducing venous hypertension. Most clinicians assume that venous ulcers heal easily with standard compression (20-30mm Hg) consisting of inelastic, short-stretch and elastic bandages. But data from randomized clinical trials have shown that less than 50% of patients with this type of compression healed within a 24-week period.
Greater incidence of wound closure has been demonstrated when compression is greater (30-40mm Hg). The ideal degree of compression for venous ulcer healing depends on the size of the leg, size and duration of the wound, location of the ulcer, degree of ambulation, severity of CVI, and availability of arterial blood supply (perfusion). In addition, local interface pressures provided by short stretch bandages can vary significantly depending on the anatomical location of the wound.
We studied the effect of localized compression by increasing the interface pressure directly over the ulcer area with a novel bolster wound dressing (P-FAB). P-FAB wound dressing is an air-filled polyethylene pillow with a medical foam wound contact layer that comes in a variety of shapes and sizes. Localized compression is especially helpful when treating lower leg or foot wounds that are in concave or non-cylindrical areas, such as the dorsum of the foot or around the ankle.
We investigated the healing rates, local interfacial pressures and the wound pain index of 10 consecutive venous ulcer patients treated with P-FAB and either 2- or 4-layer compression bandages. All patients had one or more painful wounds over a concave or non-cylindrical area of the leg. Healing rates and wound pain in wounds treated with P-FAB were compared to retrospectively to historical control patients with wounds in similar locations and compressed without a bolster dressing. All patients were followed for 12 weeks or until healing.
Results for P-FAB
All (100%) of the P-FAB treated patients reported pain relief and the mean decrease in VAS score was 3. The incidence of wound closure after 12 weeks was 78% for the P-FAB group and 63% in historical control group. Mean increase in interfacial pressures before and after bolstering with P-FAB was 12.12mmHg.
Although, it has not been formally studied, most experienced wound care clinicians believe that bolstering venous ulcers is helpful. P-FAB is a uniform wound dressing bolster that provides consistent and reproducible local compression. Results of this preliminary study show that P-FAB may be a valuable adjunct to compression therapy in the treatment of venous ulcers.
Oscar M. Alvarez PhD1,2, Vikram Ravikumar3, and Martin Wendelken DPM, RN1, 1Center for Curative and Palliative Wound Care, Calvary Hospital Bronx, NY, 2New York Medical College, Valhala, NY, 3Sun Scientific , Inc. Dobbs Ferry, NY
*This study was supported in part by a grant from the New York State Department of Health and the RTS foundation.