Acceleration of the blood flow velocity also has Diabetic patients with media sclerosis are at particular
antithrombotic effects and, in combination with the risk in this respect, since sonographic pressure measure-
resulting decongestion, has anti-inflammatory efficacy. ments are of little diagnostic value in these cases. If neu-
ropathy is also present, the patient feels no pain and this
Moreover, the low resting pressure especially of bandages “warning signal” is also missing.
with a high working pressure allow the small vessels to
be aerated during muscle relaxation and thus to be In patients with latent heart failure, the sudden increase
refilled with arterial blood; during muscle contraction in venous return induced by the compression can cause
they are squeezed out again by the high working pres- right heart decompensation.
sure. This interplay of forces increases the blood circula-
tion in the nutritive vascular segments of the terminal Finally, a compression bandage is almost ineffective if
vessels, thereby substantially improving the metabolic ulcers that have been present on the ankle for decades
performance. and frequent relapses have resulted in stiffening due to
dermatofibrosis.
Compression therapy is therefore indicated in disease
states characterized by a tendency to edema, in throm- The bandaging materials
bophlebitis, deep thrombosis, postthrombotic syndrome, In compression bandage treatment, different clinical situ-
primary varicosis without and with perforator incompe- ations require the use of bandage material with differing
tence and in venous leg ulcer of any etiology. force-stretch behaviour which may be described as the
ratio between working pressure and resting pressure.
The effectiveness of a compression bandage essentially
depends on the physical properties of the compression The working pressure results from the resistance present-
material used in terms of its force-stretch behaviour, and ed by the bandage to the expansion of the muscles dur-
on the application technique employed. However, it ing muscle contraction. This pressure is always measured
should always be remembered: A compression bandage on the extremity while it is moving and is higher the less
can only be fully effective combination with active move- the bandage material can be stretched.
ment!
The resting pressure essentially corresponds to the appli-
Certain constellations also place limitations on the use of cation pressure, i.e. the force used to stretch the bandage
compression therapy: Although pAOD is not considered when it is applied, but is also influenced by the individual
an absolute contraindication, in these patients compres- restoring force of a bandage. Restoring force is the ten-
sion therapy may only be used with a thorough knowl- dency of elastic material to slowly contract when relieved
edge of the arterial pressure conditions (caution: arterial of loading. The resting pressure is therefore measured on
ankle pressure below 70 mmHg). the unmoved extremity. It is lower, the less stretchable
the bandage material.
Compression therapy [64.65]
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