Compression bandaging effects on lower extremity peripheral and sub-bandage skin blood perfusion

Laser-Doppler blood perfusion was simultaneously measured on both great toes and the lateral upper-calf before and during fore-foot-to-knee compression bandaging of one test-leg in ten vascularly healthy female volunteers. Two bandaging methods were sequentially used separated by a 30 minute interval. Bandage A consisted of a layer of zinc impregnated gauze and an elastic wrap; bandage B had the elastic wrap only. Sub-bandage pressures of the test-leg were measured at distal and proximal lateral below-knee standardized sites. The study purpose was to determine the effects of moderate compression pressure levels on skin microcirculation under and distal to bandaged regions. Initial (mean ± sem) sub-bandage pressures achieved for bandages A and B were similar, being respectively 32.9 ± 2.8 and 28.4 ± 3.9 mm Hg. Both bandage types were associated with significant reductions in test-leg toe blood perfusion amounting to 44.2 ± 13.1 percent and 27.5 ± 10.5 percent for bandages A and B respectively. Contrastingly, test-leg sub-bandage blood perfusion did not differ from its pre-bandage baseline mean level for either bandage type. These findings show that a widely used bandaging method and a slight variant each significantly reduces distal (toe) blood perfusion without reducing sub-bandage skin perfusion. Absence of sub-bandage perfusion decreases may be related to a partially compensating reflex vasodilatory response, but such effects if present are inadequate to prevent reductions in distal perfusion. These results reinforce the need for due care and risk-benefit considerations with respect to therapeutic compression levels.