WCJC #11, IPC for VLUs
Faster Healing and a Lower Rate of Recurrence of Venous Ulcers Treated With Intermittent Pneumatic Compression: Results of a Randomized Controlled Trial
Oscar M. Alvarez, PhD, Lee Markowitz, DPM, Rachelle Parker, MD, and Martin E.
Wendelken, DPM, RN
ePlasty, June 5, 2020; http://eplasty.com/review-articles/4068-faster-healing-and-a-lower-rate-of-recurrence-of-venous-ulcers-treatedwith-intermittent-pneumatic-compression-results-of-a-randomized-controlled-trial
I picked this article to review because it discusses the treatment of hard to heal venous leg ulcerations that have been present for more than one year and are greater than 20 cm² in surface area. Given the chronicity and severity of disease in these patients, comparing different treatment regimens to identify a better approach is helpful.
This study compared the use of intermittent pneumatic compression (IPC) with standard of care static compression versus standard of care static compression alone for the treatment of chronic venous leg ulceration (VLU). It was a prospective, randomized-controlled, parallel-group, comparative trial. Patients were randomly assigned to either multilayer compression therapy (MLC) alone or IPC plus MLC.
The MLC used in all patients was a Profore four-layer bandage system. MLC was changed twice per week for most patients. The IPC used was a 4-chamber intermittent gradient, sequential, pneumatic compression device (Sequential Circulator Model 2004). IPC therapy sessions were performed for one hour twice daily at 40 to 50 mmHg. All study subjects were followed for 96 weeks. There were 25 patients in the control group and 27 patients in the IPC group.
The median time to healing by nine months was 141 days for the IPC-treatment group and 211 days for the control group, P = .031.
IPC group reported less pain than the control group up to the first six weeks of the study but was statistically significant with a P < .05 for only the first three weeks.
IPC group had a greater reduction in leg edema than the control group but the difference was not statistically significant.
This is an interesting study because it only enrolled patients who had VLU for greater than one year and greater than 20 cm² in size. These are difficult to treat patients that typically are seen in a wound care center. MLC is the gold standard for treatment but many patients still do not respond in a timely manner to MLC. Adding IPC appears to be an effective means of increasing the rate of healing. In my own practice, patients treated with IPC generally find the treatment to be comfortable. It is rare that patients complain of pain with the treatment.
This study confirmed what I already believe to be the case that adding IPC would be helpful. I would recommend adding this treatment regimen to any patient with difficulty in healing a VLU. Sometimes this is not possible because IPC may not be covered by the patient’s insurance.