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The Role of Adjuvant Compression Therapy in Preventing Ulcer Recurrences

Compression therapy has been recognised for many years to be a means of both healing and preventing a recurrence of venous ulcers. A number of trials which are covered by Dr Moneta on page 151 have shown that compression treatment speeds the healing of venous ulceration. My brief today is however not to talk about compression in ulcer healing but instead the role of compression in chronic venous disease. A number of years ago we demonstrated that a combination of elastic stockings and stanosolol (a fibrolytic enhancing agent) was more efficient than stockings alone in healing lipodermatosclerosis. The placebo group treated by stockings however also improved with the area of lipodermatosclerosis diminishing. More recent studies have shown that compression stockings reduce the risks of developing post-thrombotic skin changes and ulcers in patients who have had a deep vein thrombosis. We have previously shown that elastic compression stockings do not appear to effect calf pump function, indicating that compression probably works by raising the local interstitial pressure. The development of graduated compression stockings has enhanced efficacy. We have recently conducted a study to compare inexpensive graduated compression stockings against more expensive garments in patients with healed venous ulcers. While there was no significant difference in the ulcer breakdown rate between the two groups of those