Abstract: Four Layer VLU Compression Dressing Appears Safe for Arterial Ischemia: Moving Water from Subcutaneous Fat is Salutary for Skin Perfusion (45th Annual Conference (June 22-26, 2013 ))

Martin J. Winkler Sr., MD, FACS, Martin J Winkler, Sr., MD, FACS, Vascular Surgeon, Omaha, NE, Alan Neil, BSc, ASN Associates, Wound Specialist, Omaha, NE and Sara Monica Winkler, Engineering, Student, Department of Bio Engineering Stanford University, Research Assistant, Omaha, NE

Purpose

Moffatt, at Charring Cross London, introduced four layer dressings for venous leg ulcers that have been widely embraced around the world.(1, 2, 3) After extensive use, initial concerns about arterial necrosis due to excessive concentric compression layers have not been realized. Initial Doppler pressure, ABI, guidelines, set up to protect from ischemic complication, stated ‘… compression is not usually recommended with an APBI of lower than 0.8,’ are not well supported by clinical data.(4,5)

Kozeny introduced focused fuzzy wale elastic compression (FWC) stockinet in 2007 that limits compression to 20% of the skin surface and rapidly moves water out of subcutaneous fat.(6) No Doppler blood pressure guidelines were advocated. This case series, and extensive clinical use suggests that FWC is not only safe, but may be therapeutic for at risk ischemic skin

Methods

FWC was used as the elastic engine of a four layer dressing to treat four chronic VLUs with co-morbid profound arterial ischemia.

Results

Photos document technical details of therapy and the healing of all wounds.

Conclusion

FWC appears safe for the elastic compression of VLUs with co-morbid arterial occlusive disease. The observation of rapid VLU healing in spite of low ABI values raises the possibility that focusing fuzzy wale compression on 20% of the skin surface improves arterial perfusion.

1427 Four Layer VLU Compression Dressing Appears Safe for Arterial Ischemia: Moving Water from Subcutaneous Fat is Salutary for Skin Perfusion