Thrombosis after sclerotherapy and poorly applied bandaging for venous leg ulcers: case reports
Abstract
Side-effects occurring in patients treated by multilayer bandaging may be neurological, dermatological or arterial. We report on two cases of venous thrombosis involving outpatients treated for venous leg ulcers (VLU). In the first case, a lack of understanding of multilayer bandages and training on their use by the nursing staff was likely the cause of a superficial vein thrombosis (SVT) in a great saphenous vein tributary. The second case occurred in a patient suffering from an ulcer complicated by oedema. Insufficient education of the patient in alert symptoms for his condition and an inappropriate medical follow-up were the direct causes of a nonsevere distal vein thrombosis. We conclude that, as it has been suggested over a number of years, patients being treated with bandage therapy must be rigorously and carefully monitored.
Compression therapy, which improves muscle pump function, decreases venous hypertension and acts at the microcirculatory skin level is, at the present time, considered to be a gold standard in the short-and long-term treatment of venous leg ulcer (VLU) care.1 Compression therapy is mainly used in the form of bandages and less frequently with stockings, the latter being worn alone or with two stockings superimposed, one over the other. Compression bandages still remain the standard of care (SoC) for VLUs or mixed ulcers. Stockings are more adapted to small ulcers with little or no associated oedema.2,3 Among the types of bandage used, multilayer, multicomponent bandages remain the standard of care (SoC) in France, recommended by health authorities.4
Whatever the type of bandage used, it requires expertise of the medical staff to obtain the correct level of compression.5 Side-effects are more frequently observed and are more severe with bandages than stockings.6–8 Consequently, specialised training programmes for nurses are mandatory. These provide knowledge of how compression theory works, teach good bandaging techniques, accompanied by regular practice, and how to educate and monitor the patient and provide strict patient follow-through.
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