52
WOUND CARE TODAY
2015,Vol 2, No 1
FOCUS ON COMPRESSION HOSIERY
›
›
Prevention of deep vein
thrombosis (DVT) in patients who
have mobility difficulties
›
Prevention of complications
following DVT
›
Maintenance and reduction of
chronic oedema/lymphoedema.
In one 40-patient study, Stephen-
Haynes and Sykes (2013) identified
the following reasons for hosiery
prescription:
›
83% (n=35) of respondents used
hosiery for prevention of ulcer
recurrence
›
72% (n=30) used hosiery for the
management of chronic oedema
›
56% (n=24) used hosiery for
prevention of venous
leg ulceration
›
50% (n=21) used hosiery to
actively treat leg ulceration
›
31% (n=13) used hosiery for the
management of varicose veins.
COMPRESSION HOSIERY
OPTIONS
It is important to select the
appropriate hosiery as it will lead
to improved clinical and financial
outcomes. In the UK, hosiery is
classified by the yarn used and by the
amount of compression the garment
exerts. Hosiery is either flat-knit or
circular-knit.
Flat-knit hosiery
These garments are thicker and are
sewn together. The fabric is stiffer so
they are more suitable for distorted
limbs and controlling oedema. Made-
to-measure garments are usually
flat-knit.
Circular-knit
These garments are thinner and finer
and are knitted on a cylinder with no
seam. They are suitable for low-risk
patients with mild or little oedema.
Being lighter, they are often more
cosmetically acceptable to patients.
Hosiery is also classified according
to the level of compression it
provides. The World Union of Wound
Healing Societies (WUWHS) (2008)
offers the following classification:
›
Mild: less than 20mmHg
›
Moderate: 20–40mmHg
›
Strong: 40–60mmHg
›
Very strong: greater than
60mmHg.
Clinicians can choose between
British and European standard
hosiery and the choice is usually
dependent on the levels of oedema or
lymphoedema present.
British Standard classification
British Standard has three classes and
these can be used variously for varicose
veins, DVT prevention, treatment and
prevention of venous leg ulcers, post-
thrombotic venous insufficiency, and
lymphoedema (
Table 1
).
Hosiery treatment kits are also
available within the British Standard
category that combine a 10mmHg
liner and class 3 (25–35mmHg)
garments; thus providing 40mmHg
of therapeutic compression to aid
ulcer healing. This is an alternative
option to compression bandaging. It
is suitable for those with a small ulcer
and exudate that can be managed
with a primary wound dressing. It
offers a clinically viable alternative as
well as positive financial outcomes
(Ashby et al, 2014).
European Standard
European Standard classification
garments, particularly those with a
higher stiffness index, are commonly
accepted as the most suitable hosiery
choice for oedema management
(Lawrence, 2006; Lymphoedema
Framework Project, 2006). They are
available in four classes (
Table 2
).
Style and fit
Compression hosiery is available as:
›
Standard fit
›
Made-to-measure hosiery
›
Leg ulcer treatment kits.
It is available in different styles
such as thigh length and below-knee
stockings, socks, and tights. Factors
to consider when prescribing hosiery
include:
›
Size
›
Colour
›
Open/closed toe
›
Style.
PREVENTING THE RECURRENCE
OF LEG ULCERATION
Dowsett (2011) identified a reduction
in recurrence of leg ulceration from
18–20% to 5.8% following a structured
plan for the introduction of RAL hosiery
(a German quality standard) within one
UK primary care trust, demonstrating
that hosiery has the potential to reduce
leg ulceration recurrence.
HOSIERY IN THE TREATMENT OF
VENOUS LEG ULCERATION
Where it is clinically appropriate,
the use of compression hosiery
in the care of patients with active
venous leg ulceration achieves
similar healing rates to those
achieved with compression
bandages (Burgess and Robinson,
1993; Samson and Showalter, 1996;
Ashby et al, 2014). The venous leg
ulcer study performed by Ashby
et al (2014) was a randomised
control trial (RCT) that investigated
compression hosiery versus four-
layer compression bandaging in the
treatment of venous leg ulcers in
457 patients.
Table 1:
British Standard drug tariff classification for compression hosiery
Class
Pressure
Support
Indications for use
Class1
14–17mmHg
Light
›
Early varicose veins
›
Mild ankle oedema
Class 2
18–24mmHg
Medium
›
Medium severity varicose veins
›
Post-thrombotic limb
›
Mild oedema
›
To prevent recurrence of venous ulcers
Class 3
25–35mmHg
Strong
›
Severe varicose veins
›
Gross oedema
›
Chronic insufficiency
›
To prevent recurrence of venous ulcers
