(CS-090) Use of adjustable Velcro compression garments in patients with chronic venous insufficiency and diabetic neuropathy: An alternative compression solution to manage edema and edema related ulcers in this high-risk population.

Introduction: Chronic Venous Insufficiency (CVI) is a global problem with a prevalence of 19% and an annual incidence of up to 2.3%. It represents 2% of the annual healthcare budget in Western Society. The gold standard for the treatment of CVI is compression therapy. Front line compression therapy is typically the use of a multilayer compression dressing to reduce edema and heal ulcers. Multilayer compression dressings are not an appropriate choice for every patient, especially those with diabetic neuropathy as their lack of protective sensation can result in serious secondary injuries.

Methods: The following 3 case studies look at a serious complication / injury associated with multilayer compression dressings in patients with diabetic neuropathy and how a solution was achieved with the use of adjustable velcro compression garments. These case studies can be generalized in this population and used as an alternative compression treatment.

Case 1: 38 year old female with diabetic neuropathy and venous ulcer lost to follow up for 4 weeks. She returned with multilayer compression dressing still in place , healed venous ulcer, but with an eschar covered diabetic ulcer to the anterior ankle. This became a limb salvage case with multiple hospitalizations, surgeries and ended in a rehab admission. Her need for compression therapy was managed with the use of an adjustable velcro compression garment to prevent further injury and allowed the wound to heal.

Case 2: 30 year old male with lymphedema, diabetic neuropathy, Klippel-Trenaunay-Weber syndrome and venous related ulcers. He developed a diabetic ulcer to the anterior ankle from a multilayer compression dressing. He healed with advanced wound care and compression via an adjustable lower leg velcro compression garment and a custom capri compression legging to manage upper leg and abdominal lymphedema.

Results: Case 3: 77 year old male with limited mobility, lymphedema, diabetic neuropathy and venous ulcers. He developed bilateral diabetic ulcers to the anterior ankles secondary to his inability to feel the multilayer compression dressing slip and bunch at the ankles creating full thickness injuries. He was treated with the use of an adjustable velcro compression garment to control his venous hypertension while mitigating the pressure at the anterior ankle.

Discussion: