Is it necessary to provide compression therapy to heal a venous stasis ulcer?

When treating any wound, you must alleviate or minimize the causative factor for the wound to heal. 

Venous stasis ulcers are secondary to the edema caused by venous insufficiency. Unless the edema is relieved, it will be very difficult to heal the ulcer. According to the Wound, Ostomy and Continence Nurses Society, compression therapy is the gold standard of venous therapy. Compression therapy heals more venous leg ulcers and decreases healing time, compared to no compression. 

Compression bandages must be applied correctly. Always follow manufacturer’s instructions. These bandages should be applied from the base of the toes to the notch of the knee, below the patella. Therapeutic compression is usually 30–42 mm Hg at the ankle. 

Antiembolism hose or stockings are not designed for therapeutic compression, as their rates are at 15–17 mm Hg. Therapeutic compression can be provided by rated bandages, stockings, boots and orthoses. Typically, if the resident currently has a wound or active edema, compression bandages are the easiest to apply. 

Compression selection should be based on careful assessment of the resident. If the resident is ambulatory, inelastic bandages or short stretch wraps, such as an Unna boot, can be utilized. Inelastic bandages or short stretch wraps require ambulation to force the calf pump to contract against the bandage. If the resident is non-ambulatory, then elastic bandages or long stretch wraps can be utilized, as they don’t rely on ambulation to achieve a therapeutic level of compression. 

Once the wound is healed and/or the edema is under control, the resident must continue to utilize compression therapy or the edema will return.