Compression and peri-ulcer skin in outpatients' venous leg ulcers: results of a French survey.
OBJECTIVE
To evaluate concordance with compression therapy in ambulatory patients with venous leg ulcers.


METHODS
This was a prospective observational survey conducted in general practice. Consecutive patients with venous leg ulcers about to receive a non-adherent primary dressing and with no contraindication to compression bandaging were selected. At the inclusion visit, size, local aspect of the ulcer and the peri-ulcer skin were scored. Patients were asked about concordance with compression and were given a questionnaire to be completed at home. If patients were seen at a three-week follow-up visit, ulcer and peri-ulcer characteristics and concordance were reassessed.


RESULTS
A total of 2842 patients were included, of whom 2532 were re-evaluated at three weeks and 1397 (49%) returned their questionnaire. A compression bandage was already available for 62.9% of these patients, and 62.7% said they used it on a daily basis, 23.3% wore it one or two days per week and 13.7% wore it irregularly or never. There was a statistically significant correlation between concordance with compression and ulcer and peri-ulcer skin severity scores (p < 0.001 and p = 0.042 respectively). At the follow-up visit, concordance with compression therapy improved (80.1% were wearing it regularly). Ulcer, peri-ulcer skin severity scores and ulcer size were significantly lower (p < 0.001) when concordance with compression therapy was good. However, 65.6% of patients considered applying compression very difficult; 45% considered it very unaesthetic and 23% judge wearing it to be very painful, while 9% thought it may worsen their ulcer.


CONCLUSIONS
On a short-term basis, concordance with compression can be substantially improved by simple measures with a clear favourable consequence on both ulcer status and peri-ulcer skin aspect when a non-adherent primary dressing is used. However, the acceptability of compression to patients is poor, and continuous effort is required to convince them of its importance.
Dereure
O
O
Department of Dermatology, Hôpital Saint Eloi, Montpellier, France. o-dereure@chu-montpellier.fr
Vin
F
F
Lazareth
I
I
Bohbot
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001458:Bandages / Q000009:adverse effects / Q000592:standards; D003872:Dermatitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005194:Family Practice / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D009730:Nursing Assessment; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D017592:Skin Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000150:complications / Q000523:psychology / Q000628:therapy*; D014945:Wound Healing