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.
Department of Dermatology, Hôpital Saint Eloi, Montpellier, France. o-dereure@chu-montpellier.fr
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Dereure
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Vin
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Lazareth
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Bohbot
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