Physics of Using Compression to Treat Venous Leg Ulcers and Other Conditions of the Lower Extremities

Compression is the mainstay of management of ambulatory venous hypertension, the most common sequel of which is venous leg ulceration. The logic for selecting compression is based on physical principles governing tension, pressure, volume as elegantly enshrined in the works of French mathematician philosophers Laplace and prior to him, Pascal. The application of Laplace’s law for using compression bandages to manage limb swelling consequent to unrelieved venous pressures and sequelae are described and used with Pascal’s law to comprehend the limitations of compression systems. While robust data from several reports endorse the concept of using compression, evidence also indicates the limitations of and difficulties encountered in practice of offering compression which involve, to a large part, changing position: from lying still to standing upright and being ambulant. The concept of measuring static stiffness index (SSI), described by Partsch, helps to explain these changes. SSI should be measured with the patient upstanding and at a specific point on the calf. This and guidance for offering compression for other clinical conditions are described in this chapter.