Compression bandaging is the main form of treatment for venous leg ulcers. Venous leg ulcers occur when the veins and muscles in the lower legs are weak and can't efficiently pump the blood back to the heart. Gravity causes the blood to pool in the lower legs. The pooling blood eventually leaks out of the veins and into surrounding tissue. This causes the tissue to swell, which leads to wounds and ulcers. Increasing external pressure on the legs with a compression bandage forces the blood back into the veins, creating an improved blood flow and allowing the ulcers to heal. A compression bandage applies pressure to the leg, with greater pressure near the ankle and reduced pressure higher up. This forces the blood to keep circulating away from the lower leg. When the blood stops pooling in the lower legs, the swelling goes down.
There are several types of compression bandages, including rigid or non-elastic compression, multi-layered compression, short-stretch, and single-layer compression. Of these, multi-layered compression (either two-layer or four-layer) and short-stretch bandages seem to be the most effective, although there is a somewhat higher risk of complication with short-stretch bandages.
When applying a multi-layered compression bandage, usually the physician will first dress the wound and then apply padding to narrower areas of the leg. (The padding is used to smooth out the unevenness of the leg's circumference. Without this padding, areas surrounding the ankle bones and other spots would receive less pressure, allowing blood to pool there, so the treatment would be less effective.) The physician will wrap the leg with one or two layers of absorbent and cushioning material, followed by one or two layers of elastic and adhesive bandages which provide compression and keep the wrapping in place.
The leg will then be completely wrapped from the toes to the calf. The bandage may be left on or reapplied for several weeks, until the swelling has gone down. Because they are elastic, as the swelling goes down, the bandages are able to maintain the proper amount of pressure.
When the swelling in the legs has gone down and the ulcer has healed, the doctor may recommend compression stockings. These provide a lesser amount of pressure and help to maintain proper blood circulation.
You should not attempt to treat leg ulcers yourself. Your doctor's expertise is important. Venous leg ulcers account for about 70 percent of all leg ulcers; however, applying a compression bandage to other wounds or ulcers, including arterial ulcers, can make the problem worse. In addition, although Ace bandages or other over-the-counter wraps may seem similar to compression bandages, these are not appropriate bandages to use. They do not provide the correct amount of pressure to the legs and may not be applied with the correct technique. If you believe compression bandaging could help you, first have your doctor diagnose your wounds as venous ulcers, then he or she can provide the appropriate treatment.
