Compression therapy Resources

Chronic oedema of the lower limb arises when the balance between capillary filtration, venous return, and lymphatic drainage is disrupted. Venous hypertension, most often resulting from venous reflux or obstruction, increases capillary pressure and fluid extravasation into the interstitial space (Eberhardt and Raffetto, 2014). Sustained oedema impairs oxygen and nutrient diffusion, promotes inflammation, and contributes to skin changes such as lipodermatosclerosis, hyperpigmentation, and ultimately ulceration (Moffatt et al, 2017). The development of venous leg ulcers is therefore closely linked to the chronic cycle of venous hypertension, oedema, and tissue breakdown, with healing often delayed by persistent swelling and recurrent episodes of cellulitis (Guest et al, 2020).

Lymphoedema is a chronic, progressive condition caused by impaired lymphatic drainage, leading to swelling, skin changes and increased risk of infection. Although specialist services provide targeted treatment, many patients are first seen in community settings where generalist practitioners may have limited knowledge or training in lymphatic care. This article offers a practical overview to support non-specialist healthcare professionals in recognising and managing lymphoedema. It outlines prevalence, risk factors and common presentations, highlights key assessment and differential diagnosis points, and reviews core management principles, including compression therapy, skin care, exercise and patient education. The psychosocial impact of lymphoedema and the importance of timely referral to specialist services are also discussed. Early recognition, consistent advice and person-centred support can improve outcomes and quality of life, while collaborative working ensures safe longterm care.

This case report explores the community management of a patient with a medical history of heart failure (HF) and oedema. Gold standard guidelines recommend targeting clinical congestion and oedema with increased loop diuretics alongside multilayer compression bandages for effective limb decongestion, reduction of swelling and limb shape restoration. Without early identification and intervention, oedema can worsen, leading to skin changes such as lymphorrhoea (wet or leaky legs), and having a detrimental physical, functional, and psycho-emotional impact on patients. Yet, HF and oedema continue to be mismanaged because healthcare workers have reservations about the use of compression therapy and concerns about overloading the circulatory system in patients with HF. This case report demonstrates appropriate treatment and management of oedema in patients with HF within a community district team setting, highlighting best guidance on diuretics, compression therapy, exercise, and skin care.

Despite advances in wound care, treatment of lower limb ulceration remains suboptimal, with poor outcomes often attributed to inadequate diagnosis, failure to follow evidence-based practice, and variations in care delivery. These shortcomings result in delayed healing, reduced quality of life (QoL), and a significant economic burden on healthcare systems. Compression therapy is the recommended treatment for venous ulcers and ulcers with mixed aetiology, however there are some individuals who may not respond to compression alone or who are unsuitable due to arterial status. Recent advances in adjunctive therapies, such as the geko^® device, offer promising results for these patients. This muscle pump activation (MPA) device activates the calf and foot muscle pumps,
increasing venous, arterial and microvascular blood flow. This article examines the impact of leg ulceration on healthcare services and patient outcomes, while exploring the potential of the geko^® device to improve healing rates and reduce associated costs.

Suboptimal management of leg ulcers is a growing burden on NHS nursing and financial resources (Guest et al, 2015; 2017; 2020). Compression therapy plays a crucial role in leg ulcer management by improving outcomes and reducing the burden of disease, however it is not routinely applied in practice and knowledge and confidence between bandage types and application styles often varies greatly (Guest et al, 2017; Hopkins, 2023). This article focuses on the importance of compression therapy in the management of leg ulceration and how to select the appropriate compression therapy based on the patient’s presenting symptoms. It identifies possible barriers to application and offers potential strategies and suggestions to support the use of compression options in the community.

The vast majority of wound care is undertaken by community nurses (Dhoonmoon, 2023), with £941 million attributed to venous leg ulcer care and a further £836 million spent on unspecified leg ulcer management (Guest et al, 2017). If signs and symptoms can be 
recognised and a diagnosis made, a plan of care can be drawn up and treatment implemented quickly and efficiently to reduce costs escalating further. More important though, the patient’s condition will improve quickly and deterioration in quality of life can be avoided. Nursing staff are currently encouraging patients to take a more active role in their own care, guiding them in how to look after their own long-term conditions, which can promote long lasting healing and independence.

This case series evaluation assessed the efficacy of WoundExpress™ (Huntleigh Healthcare), a novel IPC device, which applies compression to the thigh of the afflicted leg for the management of hard-to-heal leg ulcers. Eleven wound treatment centres or wound care specialists undertook WoundExpress evaluations. Eligible and willing patients (n=61), with a ‘hard-to heal’ leg ulcer used the WoundExpress device for two hours a day, in addition to continuing to receive their standard wound care for a 16-week period. Fifty-three participants completed the evaluations. Thirty-three percent (n=19) of all ulcers healed within the 16-week study period; the mean time to healing was 10 weeks. A further 60% of ulcers (n=35) progressed towards healing within the 16-week period, with a mean surface area reduction of 56% (23cm2). The evaluation concluded that thigh-administered IPC is an effective adjunctive treatment, that aids healing and reduces pain, for patients with hard to heal leg ulcers.

Increasing pressures experienced within community nursing are having detrimental effects on the care and treatment provided to patients. Among these is the management of venous leg ulcers, where a culture of passivity has possibly developed, resulting in significant delays in measuring patients’ ankle brachial pressure index (ABPI) and reduction in the use of full, therapeutic compression therapy. As pressures increase, so does the financial burden on the NHS and associated psychosocial impact often experienced by patients living with lower limb ulcers. Urgent reform of leg ulcer services is required to better manage these conditions and improve the quality of care received by patients. This article provides evidence from examples of successful service transformation, and puts forward recommendations for future practice.

It is estimated that 1.5% of the adult population in the UK is currently living with a leg ulcer (Guest et al, 2015). There is substantial evidence to suggest that venous leg ulcers are being poorly managed with delays in assessment, poor primary dressing choice and suboptimal levels of compression contributing to the delay in wound healing (Gray et al, 2018). The bulk of leg ulcer care takes place within primary care (Guest, 2015). Despite there being considerable evidence to support the use of compression therapy and undertaking accurate leg ulcer assessment, this does not appear to always happen in practice. This paper looks at how one clinic improved healing outcomes and patient quality of life through holistic assessment, patient education, supported self-care and introducing compression wraps into the treatment regimen.

Chronic oedema is a major clinical problem worldwide (Moffatt et al, 2019a). The condition has many important secondary consequences for health, activity and participation (Moffatt et al, 2017). Its prevalence also has a significant association with the presence of a wound (Moffatt et al, 2019b). There are many challenges to managing patients in this group, which can lead to ineffective and inappropriate care and have a significant impact on patient quality of life (Green and Meskell, 2016). This article discusses some of these challenges and the impact which they may have on patients and healthcare professionals caring for them.