Compression therapy and collagen dressings

What is compression therapy?

Compression therapy is the primary model for the treatment of venous ulcers. UFAI surgeons select the optimal compression therapy for each patient to prevent complications, skin irritation, discomfort, pain, and soft tissue or nerve injuries.

Patients with chronic venous insufficiency have increased pressure in the veins when they are active. This pressure is almost double that of people with high-functioning veins and consistently exceeds 40 mmHg. This pressure variation occurs during walking because the foot and calf pump more. A diminished range of motion in the ankle and calf pump dysfunction both contribute to the development of venous ulcers.

By making regular appointments with a foot care professional, these problems can be caught before they escalate to venous ulcers.

Compression therapy serves several purposes in the treatment of venous insufficiency:

• Reduces the width of the vessels.
• Returns blood to the central circulation.
• Reduces edema (fluid buildup).
• Improves arterial circulation.
• Reduces levels of inflammation.

What are the types of compression therapy? 

Because one size does not fit all, the doctor will thoroughly examine your wound to determine the best compression treatment for you. We take a personalized approach to wound management.

Compression products are usually classified according to the level of compression at the ankle. For patients who do not have arterial disease, the pressure goal is about 40 mmHg at the ankle. These include:

Short Stretch Bandages

• Provide firm support so calf muscles can push when walking.
• Low pressure when at rest.
• Reduce edema; however, the bandages may need frequent changing because the limb shrinks in size.

Long Stretch Bandages

• Adaptable to the shape of the leg.
• High pressures are always sustained.
• Generally used for immobile patients with fixed ankles.
• Not used for patients with arterial insufficiency.
• Padding may be applied over bony prominences.

Multi-Layer Bandages

• Spiral or figure-eight wrapping allows maintenance of the compression gradient for long periods at rest and when moving.
• Require less frequent changing, but units are less cost-effective.
• Multi-layer bandages have shown improved healing compared to single-layer bandages.
• May alter gait and restrict ankle range of motion (increased risk of falls).

Compression Stockings

Compression stockings should be worn once the venous ulcer has healed to prevent reoccurrence.

Compression therapy may be initially uncomfortable, and many patients may try to opt out of treatment. But compression therapy is the key to healing this disease. The recommended dressing change interval is approximately every two days.

Collagen wound dressing and growth factor therapy

Sometimes venous ulcer wound healing fails to progress. This is typically due to an extended inflammatory phase, often caused by increased matrix metalloproteases (MMPs) in the wound. MMPs are necessary to break down damaged tissue. But too many can destroy the healthy extracellular matrix and impede wound healing. Bioburden, or the presence of biofilm in the wound, can also delay healing. When tardy wound healing occurs, collagen dressings can restart dermal regeneration and healing.

Both in vitro and in vivo studies on the use of oxidized regenerated cellulose/collagen dressing have demonstrated their efficacy in modulating the microenvironment of non-healing wounds by restoring the balance between matrix metalloproteinases (MMPs).

Applying collagen at the onset of a total-thickness skin tear will increase healing rates. That’s why this has become the standard of care.

Collagen is often chosen as an “ideal” biomaterial for wound-healing dressing because it can accelerate wound healing and granulation tissue formation and reduce bacterial infection in chronic wounds.

After four weeks of treatment with the collagen matrix dressing, 68% of patients experienced wound closure, progressing to 73% at the final visit or eight weeks after the initial application.

What is collagen? 

Collagen is the most abundant protein in the body and is the biological glue that supports cells. Collagen plays a significant role in all phases of wound healing such as new blood vessel formation, granulation tissue formation, wound debridement, and the wound's ability to re-grow tissue (epithelialization). The collagen in the wound dressing serves as a substitute for your body’s own collagen — thus speeding up the healing process.

A collagen matrix wound dressing contains collagen, alginate, carboxymethyl cellulose (CMC), antimicrobials, and ethylenediaminetetraacetic acid (EDTA), with or without silver.

Collagen used on hard-to-heal venous leg ulcers in conjunction with an absorbent secondary dressing under compression therapy has increased granulation tissue formation.

Collagen dressings for wound healing 

Collagen dressings support a moist wound environment, encourage new collagen fibers, and support new tissue growth and granulation tissue formation in the wound bed.

Excessive MMPs in the wound bed can interfere with the normal healing process. Collagen dressings bind and inactivate MMPs. MMPs attack and break down collagen, so collagen dressings give these enzymes an alternative collagen source. This allows the body’s natural collagen to be readily available for tissue growth during the wound-healing process.

Protease imbalance augments degradation of the ECM, impairs cell migration, and reduces fibroblast proliferation and collagen synthesis, all critical processes essential to healing.

Using a collagen dressing may stimulate healing in a stalled wound and reduce the wound size. Wound healing success depends on clinical assessment and treatment and choosing the proper dressing on the right wound at the right time. Acceleration of wound healing in chronic or stalled wounds may decrease healing time and reduce overall wound care costs.

Management strategies include silicone gels and sheeting, topical steroids, intralesional injections, radiation, laser therapy, and surgical scar correction.

Why trust your wound healing to UFAI?

It should not be a surprise that foot and ankle pain are widespread. The American Podiatric Medical Association reports that 77% of adults have experienced foot pain, which is constant for 80% of those. 

One of the great things about modern medicine is that our surgical team is well-versed in treating every part of the human body. An orthopedic foot and ankle specialist will keep you walking strong regarding the often-neglected feet. That’s where we come in.

With decades of combined experience and the highest success rates in the nation, UFAI providers have treated more than 200,000 patients. We are one of the country's most technologically advanced foot and ankle practices.

UFAI’s surgeons are at the forefront of research, education, product design, regenerative medicine, and foot and ankle care advancements. Our non-profit foundation educates surgical fellows in advanced foot, ankle treatment, and surgery, has performed dozens of clinical trials and has educated the community for 20 years.

Director Dr. Bob Baravarian — a Board-Certified Podiatric Foot and Ankle Specialist — is one of only a handful of foot and ankle clinicians to have both foot and reconstructive foot and ankle certifications as a Fellow of the American College of Foot and Ankle Surgeons.

Citations:

Cazzell S. A randomized controlled trial comparing a human acellular dermal matrix versus conventional care for the treatment of venous leg ulcers. Wounds. 2019 Mar;31(3):68-74. 

Driver VR, Fabbi M, Lavery LA, et al. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg 2010; 52(3 Suppl.): 17S–22S. PubMed

Derma Rite: https://dermarite.com/know-your-dressings-collagen-dressings-for-wound-healing/

Valle MF, Maruthur NM, Wilson LM et al.. Comparative effectiveness of advanced wound dressings for patients with chronic venous leg ulcers: a systematic review. Wound Repair Regen 2014;22(2):193-204. https://doi.org/http://doi.org/10.1111/wrr.12151