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Vohra Wound Physicians: Healing Wounds, Saving Lives
In this demonstration, a wound care physician shows how to apply multi-layer compression wraps for the treatment of venous ulcers. Chris Leonard, DO discusses venous ulcers, their causes and treatment options. This demonstration is performed by a trained wound care physician for educational purposes only and should not be tried at home.
Video Text:
This video shows a brief demonstration of a three-layer compression wrap which is the mainstay of treatment for the underlying venous insufficiency.
Venous stasis ulcers are difficult to treat often because the underlying cause is not addressed. Various dressings can be used but it's very unlikely that they will heal unless the edema caused by the venous insufficiency itself is addressed.
The deep venous system becomes incompetent and shunts blood to the superficial venous system. That causes visible varicosities.
Because of the hydrostatic pressure, particularly when the lower extremities are in the dependent position, the interstitial fluid increases. That increases the distance from the capillary bed to the skin surface meaning that there's a greater diffusion distance for nutrients and important cells that are involved in the healing process to get to the skin. So, if a wound should form on the skin it's less likely that it will heal. This is one of the many reasons to treat the underlying edema associated with venous stasis.
Secondly, after blood pools because of the hydrostatic pressure, hemosiderin deposits occur and that's where you get your discoloration and ultimately your brawny edema.
The idea of a multi-compression wrap is that the initial layer is for protection of the skin and to some degree comfort. The second layer is generally a high stretch fiber that provides a constant but yet gradient of pressure which is high at the proximal end and continuously gets lower towards the knee. This creates a conduit and augmentation to venous return proximally. The third layer is generally a short stretch fiber which dynamically augments the pump action of the calf muscles for the blood back proximally towards the heart. It does not create a tourniquet effect and at rest it does not create undue pressures. But, during ambulation or during physiologic muscles movement it augments that pumping action to produce increased blood flow via the venous system back towards the heart.
It's been shown that single layer compression wraps are much less effective than single layer graded compression wraps. And, multi-layer compression wraps are more efficacious than single layer. So, they have to multi-layer and also graded.
What I mean by graded is that you want to have the highest pressure down here at the foot and ankle and the decreasing pressure as you come up so you don't create a tourniquet effect.
