Compression Stockings and Bandages: What the Evidence Shows

The SOX Trial’s Flawed Placebo

Fedor Lurie explained that the influential SOX trial’s placebo stockings, intended as five millimeters of mercury, actually required 7 to 8 millimeters at the calf to stay up, and that low and high pressure stockings reduce post DVT swelling similarly, undermining guidelines that recommend against stockings.

Inconsistent Bandage Pressure in Practice

A study of experienced wound care nurses found only about a third of applied bandages fell within the target pressure range, and pressure decreases over time at different rates for different bandages, while patients using adjustable Velcro devices applied pressure more consistently than nurses.

High Pressure Compression in Mixed Ulcers

Lurie described studies showing correctly measured high pressure compression in patients with mixed arterial and venous ulcers improves tissue oxygen saturation rather than causing ischemia, provided pressure is measured and does not exceed perfusion pressure.

Surface Versus Intramuscular Pressure

Lurie cited research showing pressure measured inside the leg’s muscular compartment runs higher than pressure on the skin surface, for example 70 millimeters of mercury inside when only 40 is measured at the surface, reinforcing the need for direct pressure measurement devices.