PROFORE^◊

PROFORE is a multi-layer compression bandaging system developed to apply sustained graduated compression for the management of venous leg ulcers and associated conditions. Multi-layer compression bandaging is the first choice in treatment for venous leg ulcers.¹

PROFORE is the gold standard 4 layer compression system which is backed up with extensive clinical evidence and support. A range of products is available to suit patient needs and expert support is provided through study days and education. 

PROFORE provides approximately 40mm Hg pressure at the ankle decreasing to 17mm Hg at the knee.²

What is a Leg Ulcer?

A leg ulcer may be defined as a loss of skin below the knee on the leg or foot. Leg ulcers can often be unsightly, painful and slow to heal. Whether they are venous, arterial or of mixed aetiology, nearly 80% of all leg ulcer patients are cared for in the community^{3, 4}

Leg ulcer treatment can be reduced to once a week with compression bandages as multi-layer bandages can be left in place for up to 7 days.

PROFORE Product Range

Key

PROFORE Components

All components of the PROFORE multi-layer bandage system are also available individually.

PROFORE #1	PROFORE #2
PROFORE #3	PROFORE #4

References

¹ Understanding Compression Therapy EWMA Position Document 2003

² Blair, SD, Wright, Dl, et al. Sustained compression and healing of chronic venous ulcers. BMJ (1998): 297: 1159-1161

³ Moffat C J, Oldroyd M I, Professional Nurse 1994; 9:486-497

⁴ Callum M J et al BMJ 1985; 290:1855-1856

⁵ The Charing Cross approach to venous ulcers Moffatt C, Stubbings N, Nursing Standard 1990; 5 12(10): 6-9

PROFORE Multi-Layer Compression System: The First Choice Treatment for Venous Leg Ulcers

A meta-analysis of 5 clinical trials with 797 individual patient data highlights a definitive improvement in healing rates of venous leg ulcers with four-layer compression bandage (4LB) as opposed to short-stretch bandage (SSB). ¹

The median days to healing were 90 days with 4LB compared with 99 days with SSB. There is significant evidence that 4LB heals patients faster than SSB. Patients are 36% more likely to heal with 4LB compared to SSB during a period of treatment.

PROFORE has been shown to achieve complete wound closure in 79% of venous ulcers by 12 weeks and 84% by 24 weeks. ²

First Line Therapy for Venous Leg Ulcers: A Recommended Management Pathway

The International Leg Ulcer Advisory Board (ILUAB) is an international expert panel comprising of some of the most eminent clinicians and researchers in the field of venous leg ulceration. Following an extensive review of the literature available on venous leg ulcers the Leg Ulcer Advisory Board met to design a recommended management pathway for the condition.

Download pdf of the recommended management pathway (Size 595KB)

Top 12 Clinical Papers:

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References

¹ O’Meara S, Tierney J, Cullum N, B Either display as MA abstract 2007.

² Moffat C J, et al (1999) Phlebology, 14, 139-142. Randomised Trial comparing Two Four Layer Bandage Systems in the Management of Chronic Leg Ulceration.

This information is intended for Healthcare Professionals only.

Only apply PROFORE following training in its application and with knowledge of the use of compression therapy in patients with compromised arterial circulation.

PROFORE is for single use only.

A Step by Step Application Demonstration for the 18-25cm Kit 

BEFORE APPLYING THE FIRST BANDAGE It is important to check the following:

1. Assess the patient thoroughly to ensure that sufficient arterial supply exists to apply compression therapy. The use of Doppler ultrasound is recommended. Ankle : Brachial pressure index (ABPI) should be greater than 0.8.
2. Measure the ankle circumference to confirm that it is greater than 18cm (padded).
3. Check if the patient's ankle circumference has changed due to a reduction in oedema. Always re-measure after the initial treatment period and check the bandage selection guide for the correct kit for the size of leg.
4. Assess the patient's limb for bony prominences or calf fibrosis. Ensure that these are well protected using the PROFORE #1 padding to distribute pressure evenly.

Apply PROFORE in the Following Sequence:

Step 1: 
PROFORE WCL Sterile Wound Contact Layer 
Do not use if pouch is opened or damaged. Remove from the pack with sterile forceps and apply to the wound. Hold in place until covered by PROFORE #1.

Step 2: 
PROFORE #1 Absorbent Padding Bandage 
Bandage the foot using an ankle lock. Apply from the ankle to the knee using a simple spiral technique and 50% overlap. Do not apply tension.

Step 3: 
PROFORE #2 Light Conformable Bandage 
Bandage the foot using an ankle lock. Apply from the ankle to the knee over PROFORE #1, using a simple spiral technique, apply at mid stretch and 50% overlap. Use tape to secure.

Step 4: 
PROFORE #3 Light Compression Bandage 
Bandage the foot using an ankle lock. Apply from the ankle to the knee, using a figure of eight technique at 50% extension. Use the central line as guidance. Use tape to secure.

Step 5: 
PROFORE #4 Flexible Cohesive Bandage 
Bandage the foot using an ankle lock. Apply from ankle to knee using a spiral technique with 50% extension and 50% overlap. Press lightly on the bandage to ensure that the bandage adheres to itself.

Frequently Asked Questions about PROFORE

Q: What is PROFORE?

A: PROFORE is a multi-layer compression bandaging system consisting of 5 components: a sterile wound contact layer; a padding bandage; a light conformable bandage; a light compression bandage and a flexible cohesive bandage.

Q: How much compression does PROFORE deliver?

A: Current understanding is that optimum compression therapy is achieved with a sub-bandage pressure of 40mm Hg at the ankle. This has become the benchmark pressure for compression bandages).

PROFORE is designed to apply sustained graduated pressure of 40mmHg to the ankle area decreasing to 17mm Hg at the knee. It is supplied in 4 compression strengths to cover all sizes of ankle.

Q: How does compression heal a leg ulcer?

A: Compression helps to reverse the venous insufficiency in the leg, healing any damage and helping to direct the flow of blood back towards the heart.

Q: What wound contact layers can be used under PROFORE?

A:PROFORE has been developed to work with PROFORE WCL (TRICOTEX*) a low adherent wound contact layer consisting of a single layer of knitted, bright viscose.

Q: Can PROFORE be used on patients with a history of DVT?

A: It is unlikely that compression would exert any effects on the deep veins and so compression is not contra-indicated. Elastic Compression is considered to be an indispensable complement to anti-coagulant treatment for DVT. Venous insufficiency is a risk factor for DVT, compression therapy improves this condition

Q: Does PROFORE contain latex?

A: Yes, the standard kit contains latex, however there are latex free formulation kits available for all ankle circumferences and compression variants which are specially formulated with no latex containing ingredients.

Q: Does PROFORE Latex Free contain ingredients that may cause allergic reactions?

A: No, PROFORE Latex Free formulation is free from potential known allergens such as colophony, thiuram and carbamate. However, to be 100% sure, patch testing is recommended prior to use.

Q: What is the shelf life for PROFORE?

A: The shelf life of PROFORE is 3 years.

Q: How is PROFORE WCL sterilised?

A: PROFORE WCL (TRICOTEX) is sterilised using gamma radiation.

Q: What is the wear time of PROFORE?

A: PROFORE can be worn for up to 7 days, depending on the level of exudate. At the start of treatment it may be necessary to change the bandage twice a week as the oedema reduces.

PROFORE Lite delivers 23mm Hg pressure and can be worn on the leg for up to 7 days.

Q: When should I use PROFORE?

A: PROFORE should be used on venous leg ulcers and associated conditions.

Q: Why is PROFORE available in 4 kit sizes?

A: PROFORE has been designed to provide the correct level of compression for all ankle circumferences. Most conventional bandages are only available in one size. On larger ankle circumferences the pressure delivered by these bandages will be less than the optimum 40mm Hg.

PROFORE is available in 4 sizes to ensure that every ankle circumference receives the correct level of compression.

Q: How do I write a PROFORE prescription and what are the components of each kit?

Kit <18cm ankle circumference="PROFORE" #1(x2), #2, #3, #4 and wcl>
Kit 18 - 25cm ankle circumference = PROFORE #1, #2, #3, #4 and WCL
Kit 25 - 30cm ankle circumference = PROFORE #1, #4, + and WCL
Kit > 30cm ankle circumference = PROFORE #1, #3, #4, + and WCL
PROFORE Lite = PROFORE#1, #2, #4 and WCL

Kits can now also be prescribed as above.

Q: Why is the third layer applied in a figure of 8 technique?

A: This technique ensures the sub-layers are held in place and ensures the correct pressure level is applied to the limb.

Q: Why aren't all bandages applied in a figure of 8 technique?

A: By crossing the bandages on the tibia, localised pressure on the bone is increased which may cause pressure damage.

Q: Should you measure the ankle before or after padding with PROFORE #1?

A: If the leg is very thin, you should measure before and after padding to ensure that the correct kit is selected. For example, if an ankle measures 15cm before padding, but 18cm after padding, then the 18-25cm kit should be applied. The narrower the leg the higher the level of pressure is delivered.

Q: Why is the bandage slipping between applications?

A: Check the consistency of bandaging to ensure it isn't under stretched at the top of the limb. Ensure the padding layer is used to achieve a graduated leg shape as a basis for bandage application.

Q: How do patients tolerate PROFORE?

A: The rapid improvement of the venous return delivered by sustained graduated pressure relieves the internal tension in the leg and gives a lightening feeling. As a result patient tolerance is very high.

References

¹Blair, SD, Wright DI et al. Sustained compression and healing of chronic venous ulcers. BMJ (1988): 297:1159-1161