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Words on Wounds

A forum to discuss the latest news and ideas in skin and wound care.

Wednesday, June 19, 2019

Hitting your S.T.R.I.D.E. with lower extremity compression
Venous leg ulcers are associated with a prolonged healing trajectory and frequent recurrence (up to 70% within 3 months of healing). Chronic venous hypertension increases capillary permeability and ultrafiltration, promoting fluid buildup in the tissue, edema development, skin changes, and ulceration. The mainstay therapy for the management of venous disease involves consistent use of compression in combination with basic walking exercises.  

By applying external pressure mechanically, compression therapy in the form of bandages, wraps, or pumps is designed to reduce venous cross section, counteracting the effects of gravity to reduce pooling and to accelerate venous blood return from lower extremities to the heart, move fluid from the interstitial space back into the intravascular compartment, prevent venous reflux, and improve lymphatic drainage. Studies have shown that the stiffness at a given interface pressure is determined by extensibility with a single-layer bandage, but not with a multi-layer bandage.  

A recent publication, S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity, highlights six parameters that should be taken into consideration when selecting compression garments:

- S for the shape of the limb and selection. The compression system should be appropriately sized and conformable to the contour of the legs. 
- T for texture. Soft tissues can be described as watery, fatty, putty, or woody. According to this guideline, woody fibrotic tissue may benefit from stiff textiles with less extensibility and higher compression pressures.  
- R for refill or reestablishment of edema without compression. This problem can be minimized by using continuous day and night compression.
- I for issues that may affect adherence. These include mobility, dexterity, finance, and other systemic issues.
- D for dosage. This is compression pressure measured in mm Hg. 
- E for etiology. The type and strength of compression for the management of venous disease, venous leg ulcers, lymphedema, and lipidedema will vary.