Chronic venous insufficiency affects 25–40% of women and 10–20% of men in the U.S., and venous leg ulcers (VLUs) — the most advanced manifestation — represent a $14.9 billion annual healthcare burden with a 50–72% recurrence rate within 3 months of healing without ongoing compression. Lymphedema, affecting 10 million Americans (primarily post-cancer lymph node dissection), requires lifelong compression management to prevent progression to irreversible fibrotic tissue changes. Evidence-based compression therapy — applied by clinicians and continued by patients — is the most effective intervention for both conditions. Our wound care and orthopedic catalog includes a complete range of compression products from Mölnlycke, Smith+Nephew, 3M, BSN Medical, and Jobst.
Mechanism: Why Compression Works
Sustained external compression on the lower extremity increases tissue pressure above the capillary filtration pressure, reducing transcapillary fluid filtration and promoting venous and lymphatic return. In VLU, compression reduces venous hypertension (the primary pathophysiological driver), promotes granulation tissue formation, and reduces edema that impairs oxygen delivery to healing tissue. Multi-layer compression bandaging systems maintaining 40 mmHg at the ankle with graduated reduction toward the knee produce the highest healing rates in randomized trials — healing 60–70% of VLUs within 12 weeks vs 20–35% without compression.
Multi-Layer Compression Systems
Four-layer bandaging systems (Profore from Smith+Nephew; Coban 2 from 3M) are the gold-standard compression modality for VLU healing. Each layer provides distinct function: orthopedic wool (padding/protection), crepe bandage (conformability), compression bandage, and cohesive outer wrap (fixation and moisture management). Two-layer systems (DYNA-FLEX, Coban 2 Lite) provide equivalent compression in a simplified application — important in community nursing where bandaging skill varies. Weekly bandage changes are standard during active ulcer healing; more frequent changes may be needed for high-exudate wounds requiring dressing changes underneath. Dressing selection under compression follows standard VLU wound bed principles — non-adherent primary dressings or foam primary dressings are appropriate under compression systems.
Compression Hosiery for Prevention and Maintenance
Once a VLU has healed, lifelong graduated compression hosiery (20–30 mmHg for mild-moderate CVI, 30–40 mmHg for severe CVI or post-thrombotic syndrome) reduces recurrence by 75% compared to no compression. Patient adherence is the primary barrier — fitting by a trained compression fitter and selection of the most comfortable appropriate garment dramatically improve adherence. For lymphedema, flat-knit garments (lower elongation, higher working pressure) are preferred over circular knit (higher resting pressure) for moderate-to-severe lymphedema, particularly with fibrotic changes. Our orthopedic and rehab catalog includes Jobst, Juzo, Medi, and Sigvaris compression hosiery across standard and custom sizing.
