Use of weekly compression and occlusive dressings in the treatment of lower limb ulcers: a 10-year experience

Objective: Lower limb ulcerations in older people pose a treatment challenge, given the underlying prevalence of comorbidities and frailty. Conservative management arises as a possible option. The aim of this study was to describe the results of treatment of lower limb ulcers with occlusive, compression dressings changed weekly in a single, private practice centre in Northern Spain. Method: This was a retrospective review of all consecutive cases of skin ulceration below the knee, no matter the aetiology, over a 10-year period. Vascular evaluation was performed on admission. Lesions were cleaned with sterile saline solution and neutral pH soap, covered with paraffin-impregnated gauze or hydrogel dressing, and a two-layer compression bandage (from metatarsal heads to popliteal fossa). Protective inelastic support was provided with adhesive tape on the heel and lateral aspects of the legs. Dressings were changed weekly. Main outcomes measured were: absence of pain (visual analogue scale); surface reduction of the ulceration; and complete healing. Bivariate analysis, Kaplan–Meier survival model and receiver operating characteristic (ROC) curves were used for predicting healing. Results: In this case review, 135 limbs of 93 patients were treated (mean age: 79.9±11.4 years; 71.1% were female). The majority of lesions were of venous origin (73.3%), and 14.1% (n=19) presented with a mean ankle–brachial pressure index of 0.70±0.08. Median surface lesion on admission was 4.2cm 2 , and 24.4% had been treated previously, with a median time from onset of two months. Full healing was achieved in 80.0% of patients after a median of six dressing changes. Treatment adherence was 91.2%. The only independent predictors of healing were a body mass index of <30kg/m 2 , lesion size (<5.5cm 2 ; area under the ROC: 0.713) and time from onset. Conclusion: The treatment of lower limb ulcers with occlusive, compression dressings with weekly changes can provide high healing rates, with high therapeutic adherence, effective pain management from the first dressing changes, enhanced patient autonomy and low recurrence of the index lesions.