Which UrgoK2 or UrgoK1 kit should be used in case of a patient with an ankle circumference > 32 cm? Can I use UrgoK2 or UrgoK1 for a patient with an ankle circumference > 32 cm?

For ankle circumference > 32 cm, the 25-32 cm kit may be used: the level of compression will approach the therapeutic pressure with the progressive oedema reduction. In the event of very stout legs, 2 kits may be used to cover the entire leg.

When to apply compression therapy?

In venous leg ulcer management, compression increases ulcer healing rates compared with no compression.
Strong compression therapy (minimum of 40mmHG) may be safely applied to a patient presenting with a wound on the lower leg with an ABPI (ankle Brachial Pulse Index) greater than 0.8. This type of wound is defined as a Venous Leg Ulcer. Another indication for compression therapy is when oedema is present in the lower limb. Compression is seen to be effective management for oedema.
Patients presenting with a wound in the lower leg with an ABPI of < 0.8 may need to be referred to a specialist for a vascular assessment. In some clinical areas, treatment of mild compression (maximum of 20mmHg) may be introduced when an ABPI between 0.6 and 0.8 is present. These lower limb wounds are usually classified as mixed aetiology ulcers.

References:
Franks , P., Barker,J., Collier, M. et al. Management of patients with venous leg ulcer: challengesand current best practice, J Wound Care, 25; 6, Suppl, 1–67

What is the difference between venous, mixed and arterial leg ulcer?

The three most common causes of leg ulceration are linked to disorders of the circulation. The vast majority (~70%) of lower-extremity ulcers are caused by chronic venous insufficiency (CVI), followed by arterial disease (~20%) or a combination of venous and arterial disease (15-21%).
To select the right treatment, it is essential to identify the wound aetiology during the initial assessment, by checking whether arterial blood flow of the limb is impaired.

References:
"HardingK, Dowsett C, Fias L, et al. Simplifying Venous Leg Ulcer Management.Recommendations from an Expert Working Group. https://tinyurl.com/y4h5k6gd(accessed 31 July 2020)
Neil K,Turnbull K. Use of specialist knowledge and experience to manage patients withmixed aetiology leg ulcers. J Wound Care. 2012; 21(4):168–74"

How can I measure the ABPI ? How can I measure it?

The ABPI (Ankle Brachial Pressure Index) is the systolic blood pressure at the ankle is divided by that at the arm. A low ABPI is considered to be indicative of blocked arteries du to peripheral arterial disease (PAD).
In patients presenting with leg ulceration, the APBI should be calculated using a Doppler device or other screening device before selecting a treatment option.

What can I do if there is no ABPI measurement?

"Where other methods of identifying vascular issues and ischaemia are not available, palpation of dorsal pedal pulses allows initial screening and requires no equipment. In this test, you can assess the pulse in the posterior and anterior tibial arteries by palpation.

How to do it?
The posterior tibial pulse is palpated just behind the medial malleolus. The anterior tibial pulse should be palpated at the ankle, at the midpoint between the two malleoli not more distally in the foot, where it lies deeper. The dorsal most prominence of the navicular bone is marked.
Pulse palpation is evaluated by using two fingers, the index and middle fingers of the dominant hand. The posterior tibial is felt posterior to the medial malleolus of the tibia. For the dorsalis pedis feel on the dorsum of the foot, lateral to the extensor tendon of the great toe.

Interpetation:
>> Absence of both pedal pulses on one foot strongly suggests the presence of pedal vascular disease
>> In case no pulse can be felt or if unable to perform pulse palpation, patient should be referred to a vascular specialist or relevant health professional for further assessment
NB: ABPI could be false in patients with arterial calcification.

What is a good compression system?

Compression therapy is recognized as the gold standard treatment of venous leg ulcers . Good compression therapy will restore proper venous dynamics to heal the wound.
Compression therapy should deliver continuous pressure (day & night, whatever the level of mobility of the patient), because ulcers do not take breaks!

It should be consistently applied, at ~40mmHg at the ankle, to effectively restor venous dynamics. For this to be repeatable no matter which clinician is applying it, it needs to be easy to apply, with visual guidance to secure reliability and accuracy.

It should be comfortable & tolerable for patients. This will improve their treatment adherence. The first days are the hardest as the healing process begins.

References:
Greenstein, E., Tickner, A., Addressing Compression Continuity, Consistency, and Comfort Using a Dual Compression System, Pearls for Practice. 2020 June

There is slippage occurence. What should I do?

To prevent slippage and consistent compression, it would be important to do leg shaping before application.
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What can I do if my patient does not concord with the treatment?

Here are some tips to ensure concordance with compression therapy:
• Explain why compression therapy is so important
• Explain that compression, along with the right local treatment, will help the ulcer to heal sooner
• Explain how compression may feel. Use positive language like ‘support’ and ‘firm’, avoid words like ‘tight’
• Give clear, unambiguous information to the patient and their carers
• Ensure the correct size is selected by taking accurate limb measurements and fitting
• Apply compression first thing in the morning when oedema is minimal

Here are some examples of questions that can be used to encourage patients to participate in care planning:
• How do you feel about the (care) plan we have discussed?
• Is there anything that you feel will be difficult to do?
• What changes could be made to make this any easier for you?
• Do you have any other comments or questions?

When is compression contra-indicated?

Compression is contra-indicated in:
- For Full compression (~40mmHg): moderate or severe arterial conditions - notably with recent Ankle Brachial Pressure Index (ABPI) < 0.8
- For Lite compression (~20mmHg): severe arterial conditions, notably with recent Ankle Brachial Pressure Index (ABPI) <0.6
- Patients suffering from phlegmatia coerulea dolens, septic phlebitis
- Oedema from congestive cardiac failure
- Epifascial arterial bypass
- Known hypersensitivity to any of the components

How to prescribe compression bandages?

What tips can I give my patients to boost their healing?

What are the components of Urgo K2 Lite?

URGO K2 Lite/URGO KTwo Reduced is composed of KTech Lite/KTech Reduced (Layer 1) and KPress (Layer 2).
URGO K2 Lite/URGO KTwo Reduced Latex Free is composed of KTech Lite/KTech Reduced (Layer 1) and KPress Latex Free (Layer 2).
• Layer 1: KTech Lite/KTech Reduced: white, short-stretch bandage; provides compression, protection.
Composition: wadding: viscose, polyester; knitted layer: polyamide, elastane.
• Layer 2: KPress/KPress Latex Free: pink/beige, cohesive long-stretch bandage; provides the additional compression
necessary to achieve the therapeutic pressure and secures the bandages in place.
KPress composition: acrylic, polyamide, elastane; cohesive material containing natural latex.
KPress Latex Free composition: cotton, polyester, polyamide, elastane; synthetic latex free cohesive
material.

What are the components of Urgo K2?

URGO K2/URGO KTwo is composed of KTech (Layer 1) and KPress (Layer 2).
URGO K2/URGO KTwo Latex Free is composed of KTech (Layer 1) and KPress Latex Free (Layer 2).
• Layer 1: KTech: white, short-stretch bandage; provides compression, protection.
Composition: wadding: viscose, polyester; knitted layer: polyamide, elastane.
• Layer 2: KPress/KPress Latex Free: pink/beige, cohesive long-stretch bandage; provides the additional compression
necessary to achieve the therapeutic pressure and secures the bandages in place.
KPress composition: acrylic, polyamide, elastane; cohesive material containing natural latex.
KPress Latex Free composition: cotton, polyester, polyamide, elastane; synthetic latex free cohesive
material.

What are the components of Urgo K1?

URGO K1 is a multicomponent compression system in one bandage, composed of polyamide, elastane, and polyester yarns, combined together using three-dimensional knitting technology.