(CS-073) Unwrapping the Truth: Did Your Compression Dressing Make Things Worse

Dr. Daniel Hallman, DPM, MS, CWS – Director of Clinical Projects, The Wound Pros; Hugh Richardson, DPM – The Wound Pros; Ashley Meusa, DPM – The Wound Pros; Amena Babers, NP – The Wound Pros

Introduction: Venous leg ulcers (VLUs) pose a significant challenge in patients with peripheral arterial disease (PAD), often requiring individualized treatment plans. The standard of care involves compression therapy, but its safety and efficacy depend on accurate vascular assessment. This study aims to compare the effectiveness of pre and post volume plethysmography* with ABI/TBI and PVR in guiding compression therapy for PAD with VLUs.

Methods: A cohort of diabetic patients with VLUs underwent mobile comprehensive vascular assessments, including pre volume plethysmography*, ABI/TBI, and PVR. Pre-compression arterial blood flow studies were conducted with patients in a supine or elevated leg position. Standardized care dressings were applied, followed by the application of 3-layer compression wraps. Post-compression arterial volume plethysmography* and TBI measurements were taken, and the results were compared with the pre compression ABI/TBI and PVR findings. (Arterial Duplex Ultrasound was used to validate results)

Results: Early findings challenged the assumption that ABI/TBI and PVR alone are sufficient indicators for safe compression therapy. The introduction of pre and post volume plethysmography revealed alterations in arterial perfusion in diabetic patients with varying classifications of peripheral arterial disease (PAD). In some cases, compression therapy worsened arterial perfusion, highlighting the need for a more nuanced approach.

Discussion: This study underscores the importance of precise vascular assessment in diabetic patients with VLUs. While ABI/TBI and PVR remain standard, the inclusion of pre and post volume plethysmography* provides a more comprehensive understanding of arterial perfusion dynamics. This nuanced approach allows clinicians to identify patients at risk of worsening arterial perfusion under compression therapy. Further research is underway to refine guidelines for post-compression evaluation, ensuring safe and effective compression therapy in this challenging patient population.