Compression Therapy to Prevent Recurrent Cellulitis of the Leg
Compression therapy is a treatment involved in wearing compression garment daily. Guidelines suggest that this therapy can prevent the recurrence of cellulitis in patients with chronic oedema of the leg. Although this therapy is widely used by clinicians, there are limited trials to support the practice. Webb and colleagues conducted a randomized, controlled, single-centre trial titled “Compression Therapy to Prevent Recurrent Cellulitis of the Leg” published in The New England Journal of Medicine. A summary of the findings is given below:
Objectives:
To investigate the effectiveness of compression therapy in preventing recurrence of cellulitis of the leg in patients with chronic oedema of the leg.
Method:
Participants with chronic oedema of leg and recurrent cellulitis are divided into two groups; compression group (receiving leg compression therapy along with education on cellulitis prevention) and control group (only education). Patients were followed up every 6 months until 3 years or until 45 episodes of cellulitis occur within the trial period.
Findings:
A study showed that patients with compression therapy experienced less incidence of recurrent cellulitis as compare to conservative treatment. Side effects are observed with the use of prophylactic antibiotics in the prevention of cellulitis. Hence, compression therapy was recommended for long-term use. Additionally, this therapy has shown to manage other common conditions with chronic oedema such as venous ulcers, chronic venous insufficiency, and skin conditions (e.g., hyperkeratosis). It is also reported that the potency of the therapy is not related to the causative bacterial species. Although; the mechanism for the preventive actions of compression therapy is not known yet. Studies suggest that improved immune response and skin integrity due to compression therapy could be responsible for reducing the risk of cellulitis along with lessening oedema. Therapy also helps in providing physical protection of skin.
Limitations:
With the support of specialist lymphedema physiotherapists, the common barrier of applying and removing compression garments is reduced in this trial. Hence, the findings might not be generalizable to other patients who have no access to specialists. Authors acknowledge that follow up within a short duration and misdiagnosis by a medical practitioner can be one of the limitations. Other limitations can be small size and early termination of the trial.
The larger and longer trial needs to be encouraged especially without access to specialized lymphedema services, authors add.
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