Compression Therapy

Edema, or swelling caused by excess fluid that has become trapped in body tissues, is the result of a hydrostatic pressure-based imbalance in normal fluid exchange caused by an increase in filtration and/or a decrease in absorption of fluids at the capillary level. The application of compression from an external compression wrap/bandage or pneumatic compression device/pump works in conjunction with muscle contraction to stimulate the venous and lymphatic capillaries to absorb excess fluid, reducing the edema, improving vascular nutrition, and even help in wound healing. Compression garments are primarily used to maintain the achieved reduction in edema and enhance daily functionality.

Indications for Use of Compression Therapy

Indication for Use	Rationale for Use	Type of Compression
Venous ulcers	Compression bandages can be applied over the dressings covering wounds to help promote healing	Bandages/wraps Pneumatic device/pump Compression garments
Venous Insufficiency	Compression decreases venous edema helping to prevent the development of venous ulcers	Bandages/wraps Pneumatic device/pump Compression garments
Local edema resulting from extremity trauma and the inflammatory response	Compression supports the skin and assists with the muscle venous pump mechanism to decrease edema	Bandages/wraps Pneumatic device/pump
Post-operative edema	Compression decreases post- surgical leg graft edema (cardiac surgery)	Bandages/wraps Pneumatic device/pump
Patients with amputations	Helps improve wound healing and the long-stretch bandages and stump shrinkers help shape the limb in preparation for a prothesis	Bandages/wraps Pneumatic device/pump Compression garments
Prevention of thrombophlebitis	Used post-surgery to help prevent against deep vein thrombosis (DVT) as well as edema during air travel	Pneumatic device/pump Compression garments
Lymphedema	Used a part of a comprehensive program designed decongestive therapy. Reduces fibrosis and promotes absorption of fluid from the interstitial space in lymphatic and venous capillaries	Bandages/wraps Pneumatic device/pump Compression garments

Note: In addition to tissue fluid retention, which is present in acute edema, chronic edema is characterized by deposits of proteins and fibrinogen in the interstitial space. This deposition produces a more fibrotic and firm mass, as compared to “pitting” that is present in acute edema. Compression of tissues that have experienced these fibrotic changes, including scars, promotes the reabsorption of proteins into the lymphatic circulation.

Contraindications and Precautions for Use of Compression

• Ankle/Brachial Index (ABI) ≤0.8: Compression at this level of ABI may further increase peripheral resistance and compound the problem
• Arterial wounds: Because arterial wounds have decreased circulation, compression may further compromise circulation
• Renal edema: In the condition of renal edema, kidneys are unable to filter fluid rendering treatment ineffective
• Acute infections: May potentially spread the infection
• Deep Vein Thrombosis: May potentially cause movement or dislodgement of the clot
• Diabetes: The combination of sensory deficits and arteriole insufficiency increases the risk for skin breakdown
• Malignancy: Compression may increase the risk of metastasis
• Genitalia edema: Compression of lower extremities with lymphedema may move fluids being removed from the lower extremity into the genital area.