Management of chronic lower extremity venous disease with leg ulcers and dermatological skin conditions such as chronic eczema and dermatitis. This is only appropriate where compression, occlusive wrap is indicated. Classified as inelastic-rigid compression therapy.
Documentation confirming lower extremity venous disease
Compression wrap applied by skilled, trained clinician per order by physician, provider, or prescribing authority
Unna boot is indicated only for ambulatory patients who must be encouraged to walk daily
The most significant feature of the Unna boot is rigidity
Upon ambulation, the rigid compression wrap restricts outward movement of calf muscle directing the contraction force inward to improve calf muscle pump
Prior to application, the patient should be assessed to rule out lower extremity arterial disease. Compression wrap can be used if the patient's Ankle Brachial Index (ABI) is equal or greater to 0.80 mmHg
Compression wrap can remain in place for up to 7 days.
The patient must be ambulatory for use of compression wrap impregnated with paste
Inelastic wrap does not stretch
Compression approximately 20 mmHg when ambulating
Do not apply tightly; allow for possible swelling of leg
Assessment to rule out arterial disease is vital. Failure to detect significantly reduced arterial blood flow can result in pressure necrosis, amputation of limb or even death
Do not apply if ABI is less than 0.80 mmHg; or if patient has diabetic advanced small vessel disease
Promptly remove if patient develops pain, swelling, itching, excessive drainage, foul odor; pale, cool or numbness of extremity distal to wrap; becomes wet, soiled, or slippage occurs
Does not accommodate moderate to high exudative wounds and fluctuating edema
Do not get compression wrap wet. Cover with plastic protector for bathing
If very thin ankle or prominent tibial crest, apply extra padding to prevent pressure necrosis
The skin of leg ulcer patients is easily sensitized to topical medicaments, including preservatives. Sensitization should be suspected in patients, particularly where there is deterioration of the surrounding skin
Common ingredients include calamine, zinc oxide, glycerin, or gelatin
Review contraindications for compression wrap (manufacturer instructions for use).