The clinical management and outcome of venous ulcers in legs with deep-venous obstruction.
OBJECTIVE
as a result of a serious complication from compression bandaging in a patient with venous ulceration and deep-vein obstruction, a policy of incremental compression in such limbs has been developed. The purpose of this retrospective study is to review the outcome of this policy.


METHODS
limbs with deep-venous obstruction (stenosis or occlusion) were treated initially with 3-layer compression bandaging and reviewed 24 h later. If 3-layer bandaging was tolerated, it was re-applied for a further 48 h. If there were no problems, then 4-layer bandaging was applied and the patient reviewed at 24 and 72 h. If 4-layer bandaging could not be tolerated, the limb was returned to 3-layer bandaging.


RESULTS
of 325 limbs seen in a venous-ulcer clinic, 22 (7%) had deep-vein obstruction. Fifteen (68%) limbs were able to tolerate 4-layer bandaging, five (23%) could tolerate 3-layer bandaging and two limbs (9%) could only tolerate class 2 compression hosiery. The overall 1-year healing rate was 55%. There were no serious complications from bandaging.


CONCLUSIONS
a protocol of incremental compression bandaging is safe in ulcerated legs with deep-vein obstruction and produces healing in up to 55% of cases.
Bello
M
M
Leicester University Department of Surgery, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
Naik
J
J
Scriven
M J
MJ
Hartshorne
T
T
London
N J
NJ
D000368:Aged; D001458:Bandages; D005260:Female; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000209:etiology / Q000628:therapy*; D014689:Venous Insufficiency / Q000150:complications; D014945:Wound Healing