Graduated compression stockings are stockings that exert pressure on the lower leg. The pressure is greatest at the ankle and gradually decreases as it goes up the leg. Graduated compression stockings are most commonly used to treat varicose veins, lymphoedema and chronic venous insufficiency. Compression stockings are also used postoperatively in patients who will be immobile for a long period of time to help prevent clot formation. Complications are due mainly to incorrect use. A comparative design study done by the Presbyterian Hospital of Dallas found that 29 per cent of patients were wearing their stockings incorrectly and 26 per cent had stockings of the wrong size.
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Skin necrosis is a serious complication occurring mostly in patients with diabetes or arterial disease. In patients with these conditions, graduated compression stockings can prevent oxygen from getting to the cells in the leg. This causes cell death, leading to necrosis. A survey published in the July 2009 issue of "Phlebolymphology" noted one-third of the Scottish general surgeons interviewed reported compression-induced skin necrosis. Necrosis is dangerous and requires immediate aggressive treatment, including arterial reconstructive surgery and limb amputation.
Compartment syndrome is a condition in which pressure in a muscle compartment increases to dangerous levels. Compartment syndrome as a result of wearing compression stockings is rare, but cases have been reported. Compartment syndrome often causes severe pain and numbness and tingling in the legs. It can lead to nerve damage and tissue death. Surgery is often needed to relieve pressure in the compartment.
Graduated compression stockings can prevent clots from forming. If, however, they are too large, they will not exert the correct amount of pressure on the leg. This can lead to clot formation. This is especially significant because most patients do not realise they are wearing their compression stockings incorrectly, so they often do not take other preventive measures.
Pain and Discomfort
Graduated compression stockings can cause extreme discomfort in the first few days of use. This may lead some patients to stop wearing them. Discomfort is especially prevalent in patients with swollen legs. Measures should be taken to reduce swelling before a patient is given compression stockings. Patients wearing the stockings for treatment of leg ulcers often experience severe pain as the stockings place pressure on the ulcer.
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- "The American Journal of Nursing"; Graduated Compression Stockings in Hospitalized Postoperative Patients; E.H. Winslow and D.L. Brosz; 2008
- "Postgraduate Medical Journal"; Ischaemic Complications of Graduated Compression Stockings in the Treatment of Deep Venous Thrombosis; N.D. Merrett and K.C. Hanel; 1993
- eMedicine Orthopedic Surgery: Compartment Syndrome; Stephen Wallace, M.D.
- "Phlebolymphology"; Skin Necrosis as a Complication of Compression in the Treatment of Venous Disease and in Prevention of Venous Thromboembolism; Michel Perrin; 2009
- The Harley Street Vein Clinic: Compression Stockings