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Multilayer elastic compression for the treatment of a 30-year venous ulcer
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Their prevalence and complexity are expected to increase over the years.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The gold standard of treatment for VU, i.e., with a high level of evidence based on systematic reviews, is multilayer elastic compression (MEC).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although MEC bandages are increasingly used in practice, they remain neglected in many international consensus documents and guidelines related to compression. Added to this, this therapy is not available in the Brazilian Unified Health System, hampering access of the treatment to all patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A clinical case with use of MEC in a 73 years old female patient, with a history of post-thrombotic VU of the left lower limb (LLL) for more than 30 years, is reported. Throughout this period several forms of clinical treatments were followed: debridement, local dressings (activated charcoal, hydrofiber silver dressing, hydrogels) and compressive treatment with Unna’s boot and elastic band, without healing of the ulcer.</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the initial examination, an ulcer in the posterior and lateral regions of the LLL was observed with 15<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>cm, wound bed with a fibrotic and devitalized tissue, without signs of colonization, edge not adhered to the bed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The ulcer presented serous exudation and local pain with moderate intensity. Palpable distal pulses 4+/4+. MEC was initiated (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) with exchange of dressings twice a week for the first three weeks due to high exudation and saturation of the dressing and, thereafter, once a week. On the first 20 days, the VU became shallower, with partially vitalized bed and edges adhered to the wound bed, making possible the spacing of the dressing changes. In a three-month period, there was a significant improvement in the quality of the ulcer wound bed and a decrease in the ulcerated area until completes healing (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). High compression elastic stockings were prescribed to prevent relapse.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">According to a systematic review on compression therapy for VU, compression increases the healing rate. The multilayer system is more effective than the traditional ones, while high compression is more effective than low compression.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There are two basic forms of compressive treatment for VU of the limbs: inelastic (Unna's boot) and elastic (bands, elastic stockings and multilayer systems).</p><p id="par0040" class="elsevierStylePara elsevierViewall">MEC bandages usually have a protective orthopedic wool padding, and may also include a crepe retention layer, elastic compression bandage and cohesive elastic bandage to prevent slipping and keep the system in high compression during usage, becoming effective, because acts both in macro and microcirculation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The multilayer therapy is composed of 2–4 layers. The following brands are available in Brazil: UrgoK2®, Coban 2®, Jobst® (2 layers), Dyna-flex® (3 layers), Curatec K4® and Profore® by Smith & Nephew® (4 layers). The number of layers is not as essential as the ideal combination of different materials to maintain sustained compression.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A correct diagnosis and exclusion of peripheral arterial disease is important for the indication of MEC. The use of this therapy in patients with absence of distal pulses or ankle-arm index<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.9 is contraindicated.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">This system should remain on the limb for a maximum of seven days, having the advantage of the maintenance of sustained high compression around the ankle throughout this time. The compression should be from 35 to 40<span class="elsevierStyleHsp" style=""></span>mmHg and gradually lower in the region below the knee (17<span class="elsevierStyleHsp" style=""></span>mmHg). The patient must be stimulated to ambulate in order to achieve compression's benefits.</p><p id="par0060" class="elsevierStylePara elsevierViewall">MEC bandages should be applied by trained health professionals (physicians and nurses), because their effectiveness may be influenced by the application technique.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,4</span></a> The unit cost is still high, but the cost/benefit ratio is greater in relation to common dressings and other less effective therapies.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The advantages of MECs are related to the patient's comfort, tolerability and quality of life.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> There have been reports on improvement of pain, easiness in performing daily activities and lesser discomfort during the day and during sleep.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The MECs have demonstrated significant effectiveness in healing and comfort to the patient, where our clinical case study demonstrated effectiveness in its use, healing a VU with more than 30 years. This corroborates the systematic reviews regarding the indication of this method, favoring a faster healing with good cost–benefit ratio.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Bruna Cristina Velozo: Elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the literature.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Raquel Colenci: Effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Luciana Patrícia Fernandes Abbade: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:2 [ "identificador" => "xack458177" "titulo" => "Acknowledgment" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-09-17" "fechaAceptado" => "2019-08-26" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Velozo BC, Colenci R, Abbade LPF. Multilayer elastic compression for the treatment of a 30-year venous ulcer. An Bras Dermatol. 2020;95:263–4.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, São Paulo, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1285 "Ancho" => 855 "Tamanyo" => 102637 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Venous ulcer in the posterior and lateral region of the left lower limb without healing for over 30 years.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 564 "Ancho" => 855 "Tamanyo" => 77316 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multilayer elastic compression, performed with a 3 layer system for three months.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1283 "Ancho" => 855 "Tamanyo" => 124269 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Healed venous ulcer, featuring only some exulcerated and hyperkeratotic areas.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What is the existing evidence supporting the efficacy of compression bandage systems containing both elastic and inelastic components (mixed-component systems)? 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 17 | 10 | 27 |
| 2024 Outubro | 87 | 59 | 146 |
| 2024 Setembro | 118 | 76 | 194 |
| 2024 Agosto | 125 | 104 | 229 |
| 2024 Julho | 119 | 101 | 220 |
| 2024 Junho | 97 | 54 | 151 |
| 2024 Maio | 69 | 52 | 121 |
| 2024 Abril | 99 | 74 | 173 |
| 2024 Março | 107 | 65 | 172 |
| 2024 Fevereiro | 121 | 73 | 194 |
| 2024 Janeiro | 63 | 50 | 113 |
| 2023 Dezembro | 59 | 59 | 118 |
| 2023 Novembro | 66 | 70 | 136 |
| 2023 Outubro | 58 | 86 | 144 |
| 2023 Setembro | 71 | 74 | 145 |
| 2023 Agosto | 49 | 30 | 79 |
| 2023 Julho | 49 | 32 | 81 |
| 2023 Junho | 58 | 35 | 93 |
| 2023 Maio | 42 | 19 | 61 |
| 2023 Abril | 32 | 19 | 51 |
| 2023 Março | 61 | 38 | 99 |
| 2023 Fevereiro | 47 | 31 | 78 |
| 2023 Janeiro | 34 | 37 | 71 |
| 2022 Dezembro | 43 | 26 | 69 |
| 2022 Novembro | 46 | 53 | 99 |
| 2022 Outubro | 87 | 49 | 136 |
| 2022 Setembro | 38 | 54 | 92 |
| 2022 Agosto | 35 | 43 | 78 |
| 2022 Julho | 35 | 51 | 86 |
| 2022 Junho | 39 | 49 | 88 |
| 2022 Maio | 25 | 54 | 79 |
| 2022 Abril | 24 | 51 | 75 |
| 2022 Março | 38 | 63 | 101 |
| 2022 Fevereiro | 15 | 26 | 41 |
| 2022 Janeiro | 44 | 75 | 119 |
| 2021 Dezembro | 38 | 58 | 96 |
| 2021 Novembro | 29 | 47 | 76 |
| 2021 Outubro | 50 | 74 | 124 |
| 2021 Setembro | 32 | 51 | 83 |
| 2021 Agosto | 32 | 51 | 83 |
| 2021 Julho | 35 | 42 | 77 |
| 2021 Junho | 24 | 71 | 95 |
| 2021 Maio | 50 | 90 | 140 |
| 2021 Abril | 104 | 211 | 315 |
| 2021 Março | 43 | 45 | 88 |
| 2021 Fevereiro | 20 | 15 | 35 |
| 2021 Janeiro | 17 | 22 | 39 |
| 2020 Dezembro | 13 | 21 | 34 |
| 2020 Novembro | 16 | 21 | 37 |
| 2020 Outubro | 14 | 25 | 39 |
| 2020 Setembro | 10 | 8 | 18 |
| 2020 Agosto | 12 | 9 | 21 |
| 2020 Julho | 11 | 6 | 17 |
| 2020 Junho | 13 | 14 | 27 |
| 2020 Maio | 16 | 12 | 28 |
| 2020 Abril | 4 | 5 | 9 |
| 2020 Março | 0 | 3 | 3 |
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