Carlos Sánchez Fernández de la Vega*

Fingoi Centre/Primary Care-Galego Health Service, Lugo, Spain

*Corresponding Author: Carlos Sánchez Fernández de la Vega, Fingoi Centre/Primary Care-Galego Health Service, Lugo, Spain.

Received: February 11, 2025; Published: March 18, 2025

Abstract

This article examines the macroscopic changes in both lower extremities of a patient with chronic venous insufficiency and severe comorbidities, including chronic renal failure and heart failure. Over a period of 25 months, from December 2022 until the patient became bedridden and was subsequently hospitalized due to progressive clinical deterioration and a poor prognosis—ultimately leading to death—the ulcers were treated exclusively with the double focal compression technique, while treatment for underlying conditions was maintained.

The primary objective of this study was to analyse the clinical course of the ulcers through a photographic sequence documenting their progression across various anatomical regions. Based on a retrospective analysis of previously treated cases, a dual hypothesis-physiological and physical-is proposed to interpret the observed outcomes. It is postulated that focal compression may activate physiological mechanisms such as angiogenesis and arteriogenesis, thereby promoting vascular regeneration. This effect may, in turn, be mediated by physical principles, particularly Pascal’s principle and the continuity equation for fluids, which could explain the redistribution of pressure and its impact on local perfusion. From this perspective, focal compression emerges as a therapeutic strategy with the potential to promote tissue regeneration and facilitate ulcer closure.

Method: For more than two decades, I have treated venous ulcers in over 200 patients using a compression bandage with gauze padding applied directly over the ulcer. This retrospective review documents consistent healing achieved solely through the pressure exerted by the bandage, without the need for adjunct therapies.

The cases included ulcers of varying sizes and complexities. Initially, elastic bandages were used, but they were later replaced with inelastic ones. Additional materials included gauze, adhesive tape, saline solution, and basic diagnostic tools such as a portable Doppler and monofilament.

Results: Findings presented at international conferences and published in peer-reviewed journals highlight the following key aspects:

• The use of antibiotics was not required, as no infections occurred.
• Debridement agents were unnecessary, as the technique itself promotes two types of debridement: autolytic and mechanical.
• Effectiveness was observed in patients with severe peripheral arterial disease (Ankle-Brachial Index ≥ 0.6).
• In patients who started treatment in the early stages of the disease, ulcer closure occurred within an average of 6 to 8 weeks.
• Ulcer recurrence depended on the degree of vascular deterioration, emphasizing the importance of strong compression stockings after ulcer closure.
• Favourable outcomes were noted in patients with mild-to-moderate heart failure, with no episodes of decompensation and improved mobility and quality of life.
• Enhanced skin integrity and aesthetic appearance were observed, particularly in patients treated with compression over surgical sutures, where a reduction in perilesional inflammation and more homogeneous healing was noted.

It is hypothesized that these outcomes may be linked to the stimulation of angiogenesis and arteriogenesis due to the redistribution of pressure induced by focal compression. This effect is supported by physical principles such as Pascal’s principle and the continuity equation for fluids, which may explain improved tissue perfusion and the activation of regenerative processes. However, while these mechanisms are physiologically plausible, it is essential to validate these findings through large-scale controlled studies, including comparative clinical trials with standard therapies such as multilayer compression bandaging or negative pressure therapy. A precise characterization of the effects of focal compression would help establish its potential as a first-line treatment for various clinical conditions.

Keywords: Vascular Leg Ulcers; Double Focal Compression Bandaging; Angiogenesis; Arteriogenesis; Chronic Venous Insufficiency

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Citation

Citation: Carlos Sánchez Fernández de la Vega. “Double Focal Compression Bandaging Technique: Enhancing Vascular Regeneration in the Lower Limbs". Acta Scientific Clinical Case Reports 6.4 (2025): 10-26.

Copyright

Copyright: © 2025 Carlos Sánchez Fernández de la Vega. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.