The treatment of venous leg ulcers is based on the correction of the venous hypertension. This can be achieved by conservative therapy such as compression, and stimulating the calf muscle pump. On the other hand invasive methods such as surgery, endovenous thermal ablation and duplex guided foam sclerotherapy treat the venous insufficiency and ulceration.

Compression therapy is the first option and still the cornerstone therapy with the most proven efficacy (grade 1A) in recent guidelines. [1] It improves the pump function of the calf, reduces the venous volume, oedema and the venous diameter, and it increases the venous flow, the arterial perfusion and the microcirculation.[2]

It is very important to choose the most efficient and the most patient-friendly compression modality. Evidently, inelastic compression material is superior to elastic material, but it requires very well skilled people to put the bandages correctly. On the other hand, elastic compression therapy has proven also to be efficient in the treatment of venous ulcers by reducing the capillary leakage and oedema.

But it is difficult to reach the correct pressure gradient during the walking and rest position with elastic material to attend the hemodynamic effect. This problem results in wide variation of elastic stockings with different sizes, pressure and stiffness.

Stockings for venous leg ulcers require at least 40 mmHg and a high stiffness. But to put such stockings in the older population with chronic venous disease is demanding and the compliance is poor.  So a compromise is born. A compression with air filled stockings

Despite several variations, elastic and non-elastic stockings, bandages, wrap around stockings, most have some fundamental problems:

• The pressure is not known. Due to variations in size, materials, shrinking of the leg, the person putting bandages on, sagging stockings or bandages, the actual pressure can be far from the prescribed pressure.
• Made to measure stockings are expensive but are required for higher pressures.
• Uneven pressure over the leg.
• Difficult to put on, in many cases the patient cannot do it him/herself. For a nurse it is hard work.
• Compliance might be low due to the difficulties.

The TPS is designed to remove all these issues.

By using air as the compression medium several of the above mentioned problems are solved. The pressure can be controlled exactly by the use of a digital pressure sensor. As the air chamber has only one compartment, the pressure will be exactly the same over the whole surface of the stocking. That also results in a very comfortable stocking. By inflating the stocking when it around the leg, it is very easy to put on. The adjustable fasteners allow for some variation in size, the amount of air needed will make up the remainder to have perfect fitting stocking without the need for made to measure. During the course of the day, the patient or nurse can easily control the pressure and adjust if necessary. It is even possible to deflate the stocking, for instance when lying down, only to inflate when standing up again.

The use of TPS vs the traditional stockings or bandages will substantially decrease the cost of compression therapy. The stocking itself is less costly by design, material in the limited number of sizes. In many cases the nurse is no longer required to put on the compression and where still needed, she can do her work faster and with much less effort.

The advantages

• Perfect pressure. The pressure can be set to an exact value in mmHg.
• The pressure is exactly equal on all locations on the skin, also in different regions such as the malleoli, the typical region where the ulcers are very chronic.
• Non-allergic material

Indications:

• Venous ulcers
• Chronic venous disease
• Compression after phlebectomy, endovenous thermal ablation, sclerotherapy and duplex guided foam sclerotherapy
• Dependency syndrome, impaired calf muscle function

Contra-indication:

1. ABI < 0.8 or > 1.3 ( Diabetes, polyneuropathy)
2. Immobility

It does not stop here. We have many ideas to further develop the TPS. Think of variable pressure. Automatic pressure increase when standing up. Constant pressure monitoring to get precise data for better studies.