Evaluation of two different intermittent pneumatic compression cycle settings in the healing of venous ulcers: A randomized trial. Nikoloscoka Suzana; ARSOVSKI Andrej; DAMEVSKA Katerina; GOCEV Gorgi; and PAVLOVA Ljubica. Abstract: Background: Intermittent pneumatic compression (IPC) has been successfully used in the treatment of venous ulcers, although the optimal setting of pressure, inflation and deflation times has not yet been established. The aim of this study was to compare the effect of two different combinations of IPC pump settings (rapid versus slow) in the healing of venous ulcers. Material/Methods: 104 patients with pure venous ulcers were randomized to receive either rapid IPC or slow IPC for one hour daily. The primary and secondary end points were the complete healing of the reference ulcer and the change in the area of the ulcer over the six months observational period, respectively. Results: Complete healing of the reference ulcer occurred in 45 of the 52 patients treated with rapid IPC, and in 32 of the 52 patients treated with slow IPC. Life table analysis showed that the proportion of ulcers healed at six months was 86% in the group treated with the fast IPC regimen, compared with 61% in the group treated with slow IPC (p=0.003, log-rank test). The mean rate of healing per day in the rapid IPC group was found to be significantly faster compared to the slow IPC group (0.09 cm2 versus 0.04 cm2, p=0.0002). Conclusions: Treatment with rapid IPC healed venous ulcers more rapidly and in more patients than slow IPC. Both IPC treatments were well tolerated and accepted by the patients. The data suggests that the rapid IPC used in this study is more effective than slow IPC in venous ulcer healing.

Importance and Advantages of Intermittent External Pneumatic Compression Therapy in Venous Stasis Ulceration by Ufuk Alpagut, MD and Enver Dayioglu, MD, Department of Cardiovascular Surgery, Istanbul Medical Faculty of Istanbul University, Turkey. Abstract: Venous ulcers are seen following post-thrombotic syndrome with venous insufficiency and can begin as a result of minor trauma. In this retrospective study the authors examined the value of external intermittent pneumatic compression therapy in chronic venous ulcers. Results in 1,250 patients with post-thrombotic syndrome, 235 of these patients with leg ulcers, revealed that this modality of therapy shortens the therapy duration, lowers the total therapy cost, and hastens the return to active life in comparison to the classical therapy with compression stockings and compression bandages. In the light of their findings they propose the wider use of this adjuvant therapy.

Intermittent, Gradient, Pneumatic Compression plus Standard Compression for Hard to Heal Venous Ulcers in Subjects with Secondary Lymphedema and CVI: Analysis of a Prospective Randomized Clinical Trial by Oscar M. Alvarez, PhD, Linda Waltrous, RN, BSN, Martin Wendelken, DPM, RN, Lee Markowitz, DPM, Rachelle Parker, MD, and Emannuel Pappous, MD Center for Curative and Palliative Wound Care Calvary Hospital, Bronx, NY New York Medical College, Valhala, NY. Abstract: Thirty-four subjects with secondary lymphedema, chronic venous insufficiency, and hard to heal lower leg ulceration (>1year old & >20cm2 surface area) were treated with either intermittent, gradient, pneumatic compression (IPC* n=17) plus standard care or standard care alone (control). Standard care consisted of a non-adherent primary wound dressing plus a 4 layer compression bandage (4-LB** n=17). The mean age and size of the ulcers were 1.8 years and 34cm2 respectively and did not differ significantly between groups. IPC was performed using a 4-chamber pneumatic leg sleeve and gradient, sequential pump. All pumps were calibrated to a pressure setting of 40-50 mmHg on each subject and treatments were for 1-hour twice daily. Evaluations were performed weekly to measure edema, local pain, degree of wound granulation, and wound healing (incidence of complete closure and rate of healing from wound surface area measurements). The median time to wound closure by 8 months was 135 days for the IPC-treated group and 198 days for the control group (P= 0.039). The rate of healing was 1.1+0.4 mm/day for the control group and 2.3+0.7 mm/day for the group treated with IPC (P=0.026). When compared to subjects treated with standard care, the group treated with IPC reported less pain at each evaluation point for the first 6 weeks of the trial. At weeks 1, 2 and 3 the visual analog pain scores were significantly lower for the IPC-treated group (P<0.05). During the first 8 weeks, the IPC-treated group had an 8.9% mean decrease in leg edema compared to 4.5% for the group treated with compression bandages alone. These results suggest that IPC is a valuable adjunct to standard care in the management of chronic, difficult to heal, large, or painful venous ulcers.

Best Practices for the Prevention and Treatment of Venous Leg Ulcers by Brian Kunimoto, MD, FRCPC; Maureen Cooling, RN, ET; Wayne Gulliver, MD, BMS, FRCPC; Pamela Houghton, BS, PT, PhD; Heather Orsted, RN, BN, ET; and R. Gary Sibbald, MD, FRCPC; ABSTRACT: Chronic venous insufficiency is the most common cause of leg ulcers. Its incidence increases as the population ages. Managing venous leg ulcers involves treating the cause, optimizing local wound care, and addressing patient-centered concerns. The cornerstone of the diagnosis to chronic venous insufficiency includes demonstrating venous disease. The clinician must rule out significant coexisting arterial disease by performing a thorough clinical assessment and obtaining an ankle brachial pressure index. The most important aspect of treatment is resolving edema through compression therapy for those individuals with an ankle brachial pressure index greater than or equal to 0.8. Intermittent pneumatic compression therapy device offers a viable option for treating and managing chronic venous insufficiency with venous stasis ulcers. Medical management includes increasing mobility. Selected patients may respond to surgery, adjunctive therapies, and lifestyle enhancements. Twelve recommendations are made incorporating current best clinical practices and expert opinion with available research. The approach to venous disease is best accomplished through a multidisciplinary team that revolves around the active participation of patients and their families. The authors' intent is to provide a practical, easy-to-follow guide to allow healthcare professionals to provide best clinical practices.

EVALUATION OF INTERMITTENT PNEUMATIC COMPRESSION AS ADJUNCTIVE MAINTENANCE THERAPY IN POSTMASTECTORMY LYMPHEDEMAA. Szuba, R. Achalu, S.G. Rockson, Stanford Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Stanford, CA USA. We studied the safety and efficacy of intermittent pneumatic compression therapy as an adjunct to standard decongestive lymphatic therapy in patients with stable post-mastectomy arm lymphedema. Study design: Randomized, cross-over, 2 month study with 6 month follow-up. Patients and methods: 29 patients with post-mastectomy arm lymphedema and without evidence of active cancer were enrolled. Patients were randomized into two groups: Group I were asked to continue their routine maintenance therapy with use of a Class II compression garment and self-applied manual lymphatic drainage (MLD); patients assigned to Group II were asked to use the intermittent pneumatic compression (IPC) pump for 1 hour daily (40-50mmHg) in addition to conventional therapy (garments + MLD). All patients crossed over to the alternate therapy after one month. Patients who elected to continue chronic use of the pump were evaluated after 6 months. Clinical evaluation was performed at the beginning of the study, after the first and the second month and after six month follow-up. The evaluation included tank volumetry, skin tonometry, and measurement of range of motion. Results: 27 patients completed the study. Two patients voluntarily withdrew. There was a mean volume reduction of 89.5 ml during the month with IPC and volume increase of 32.7 ml during the month of routine maintenance therapy. The difference was statistically significant (p<0.05). There was no difference in tonometry results. Of the 21 patients who completed chronic use of IPC, 19 were available for analysis. After 6 months, there was a further average volume reduction of 29.1 ml (not statistically significant). No adverse effects of IPC were observed. Conclusion: Intermittent pneumatic compression is safe and well tolerated and may offer additional benefit for patients with post-mastectomy lymphedema.