Intermittent pneumatic compression for treating venous leg ulcers.

Nelson EA, Mani R, Thomas K, Vowden K

Published Online:

February 16, 2011

Venous leg ulcers (open sores) can be caused by a blockage or breakdown in the veins of the leg. Compression, using bandages or hosiery (stockings), can help heal ulcers. However, they do not always work, and some people are not willing or able to wear them. Intermittent pneumatic compression (IPC) uses an air pump to inflate and deflate an airtight bag wrapped around the leg. This technique is also used to stop blood clots developing during surgery. However, the review of trials found conflicting evidence about whether or not IPC is better than compression bandages and hosiery. Intermittent pneumatic compression (IPC) is better for healing leg ulcers than no compression but it is uncertain if it improves healing when bandages or hosiery are already used. Delivering the IPC therapy in a rapid manner by inflating and deflating the IPC device more quickly resulted in more ulcers being healed than with a slower deflation regime.

Abstract (click to read)

Background:

Intermittent pneumatic compression (IPC) is a mechanical method of delivering compression to swollen limbs that can be used to treat venous leg ulcers and limb swelling due to lymphoedema.

Objectives:

To determine whether IPC increases the healing of venous leg ulcers. To determine the effects of IPC on health related quality of life of venous leg ulcer patients.

Search strategy:

For this update we searched the Cochrane Wounds Group Specialised Register (searched 10 December 2010); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4); Ovid MEDLINE (2007 to November Week 3 2010); Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 09, 2010); Ovid EMBASE (2007 to 2010 Week 48); and EBSCO CINAHL (2007 to 3 December 2010).

Selection criteria:

We included randomised controlled trials (RCTs) that compared the effects of IPC with control (sham IPC or no IPC) or made comparisons between IPC treatment regimens, in venous ulcer management.

Data collection and analysis:

Both review authors reviewed titles and abstracts and agreed on full studies to be retrieved. One review author extracted data and assessed studies for risk of bias and this was checked by a second review author.

Main results:

We identified seven randomised controlled trials (including 367 people in total). Only one trial was at low risk of bias having reported adequate randomisation, allocation concealment and blinded outcome assessment.

In one trial (80 people) more ulcers healed with IPC than with dressings (62% vs 28%; p=0.002). Four trials compared IPC plus compression with compression alone. The first of these trials (45 people) found increased ulcer healing with IPC plus compression than with compression alone (risk ratio for healing 11.4, 95% Confidence Interval 1.6 to 82). The remaining three trials (122 people) found no evidence of a benefit for IPC plus compression compared with compression alone.

One small trial (16 people) found no difference between IPC (without additional compression) and compression bandages alone. One trial (104 people) compared different ways of delivering IPC and found that rapid IPC healed more ulcers than slow IPC (86% vs 61%).

Authors' conclusions:

IPC may increase healing compared with no compression, but it is not clear whether it increases healing when added to treatment with bandages, or if it can be used instead of compression bandages. Rapid IPC was better than slow IPC in one trial. Further trials are required to determine whether IPC increases the healing of venous leg ulcers when used in modern practice where compression therapy is widely used.

This record should be cited as:

Nelson EA, Mani R, Thomas K, Vowden K. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD001899. DOI: 10.1002/14651858.CD001899.pub3

Assessed as up to date:

January 4, 2011

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Wounds Group

Health topics:

Heart & circulation > Ulcers: venous > Compression

Wounds > Ulcers: venous > Compression

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Intermittent pneumatic compression for treating venous leg ulcers.

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