Chronic Oedema

Chronic oedema is an umbrella term for swelling that does not respond to elevation or diuretics and which has been present for three months or more. It can occur in the limbs and/or the trunk, head and neck or genitalia. There are a number of possible causes including;

• Dependency’ oedema: associated with immobility
• Venous oedema: e.g. resulting from venous disease such as post-thrombotic syndrome or severe varicose veins
• Oedema associated with obesity
• Lymphoedema: primary and secondary
• Oedema related to advanced cancer
• Oedema due to heart failure

Left untreated chronic oedema of the lower limbs can progress and cause skin changes such as discolouration, eczema, dry skin plaques and hardening of the tissues (refer to CHROSS checker picture cards below for examples). The risk of developing leg ulcers increases as the tissues become more vulnerable to injury and wounds fail to heal properly. The tissues become prone to infection and can require hospital admission. In the advanced stages the limbs change shape developing skin folds with hard cobblestone skin. They can begin to leak fluid profusely as the skin is unable to contain the fluid.

Chronic oedema can have a significant impact on a person’s quality of life. It is also costly to the health service in terms of time, resources and staffing. The key to managing chronic oedema is early intervention to prevent disease progression. The main interventions include compression therapy, skin care, exercise and elevation. Managing chronic oedema complicated with ulceration, lymphorrhoea (leaky legs) or infection can prove a challenge. However, with appropriate management strategies, these factors can be reduced.

Compression Therapy

Correctly applied compression therapy is recognised as the mainstay of treatment for both the preventative and therapeutic care of venous disease, with high compression bandaging now established as the treatment of choice for venous leg ulceration. Compression therapy is mainly delivered through the application of bandaging or compression hosiery.

Compression therapy aims to reverse the effects of venous hypertension by:

• Decreasing the capacity of and pressure within the superficial veins
• Assisting venous return by increasing the blood flow velocity in the deep veins
• Reducing oedema and subsequent wound exudate levels
• Minimising or reversing skin changes that impact on wound healing.

Reduced compression therapy can be applied in the absence of any red flags for compression (please refer to the Lower Limb Care pathway) as part of immediate and necessary care. High compression therapy should not be applied before the arterial status of the limb has been established (by completing a holistic vascular assessment including ABPI) and should be applied in line with local policy and guidelines.

Two-layer hosiery kits, may be considered a suitable first-line therapy for patients with minimal oedema and a regular limb shape. Our formulary product changed in 2024 from Actilymph to kits JOBST UlcerCare Compression Garments | JOBST UK. This decision was made as the liner component of the Ulcercare kit delivers mild (up to 20 mmHg) of compression and can be used to provide immediate, necessary care once red flags have been assessed and excluded. The outer stocking provides a further 20 mmHg and can be added following a holistic vascular assessment, where this confirms it is safe to initiate strong (up to 40 mmHg) therapeutic compression. Hosiery kits have also been shown to be a cost-effective alternative to bandaging in appropriate patients. However, they are not suitable for patients with moderate oedema, mishappen limbs or those with very large ulcers or heavily exuding (“wet”) wounds.

Multi-layer compression bandaging systems, such as K-Two kits, provide an alternative for patients with mild-moderate oedema, large or heavily exuding wounds. These systems typically consist of a combination of padding, short-stretch layers, and outer cohesive layers that together deliver sustained therapeutic compression while protecting the skin and accommodating wound dressings.

Patients with moderate oedema and/or a distorted limb shape are more likely to benefit from short-stretch compression bandaging, such as Clinistretch, which can better contain oedema and accommodate changes in limb contour. Short-stretch bandaging can also be particularly effective for more active patients, as it provides higher working pressure during movement while maintaining lower resting pressure. For video demonstration and application guides, please visit this link: Clinistretch® Compression Bandaging Guides on Vimeo.

Adjustable compression wrap systems may also be considered. However, there is currently insufficient evidence to confirm that they are as effective as established bandaging or hosiery systems for active wound healing. They may be more appropriately used following ulcer healing for ongoing oedema management, or may be considered in cases where traditional bandaging or hosiery kits are contraindicated, not tolerated, or impractical.

For compression garments (post-healing or preventative care), please refer to the following Hosiery Booklet and Hosiery Formulary for guidance on the selection and application of compression hosiery in Oxfordshire:

• • Oxfordshire Compression Hosiery booklet
  • Oxfordshire Compression Hosiery and Wrap Formulary
  • CHROSS checker tool- A4 form
  • CHROSS checker tool – picture cards
  • Hosiery prescription guidance V2