Compression therapy

Koebner Phenomenon in Kaposi's Sarcoma: A Large Single-Center Case Series and Review of Current Knowledge

BACKGROUND

occasional case reports have described the appearance of Kaposi's sarcoma (KS) on previously unaffected skin after incidental or accidental injury, but the association is probably under-reported.

OBJECTIVES

to present a large case series of patients suffering from Koebner phenomenon (KP) in KS and describe their main epidemiological, clinical, and therapeutic features.

METHODS

we have retrospectively analyzed our clinical and photographic records of 524 patients who had been diagnosed with KS between 2009 and 2021.

RESULTS

31 of 524 (6%) KS patients developed KP. Among these 31 patients, 24 (77%) had KS lesions after surgery, 4 (13%) after electrochemotherapy, laser therapy and cryotherapy, and 3 (10%) on areas affected by bullous diseases.

CONCLUSIONS

trauma, including surgery or other medical procedures, can trigger KS, underlying the importance of treatment options which cause the least injury to the skin.

Modified Robert Jones Bandage in reducing blood loss in total knee arthroplasty: A meta-analysis of randomized controlled trials

BACKGROUND

The purpose of this meta-analysis was to assess the effects of Modified Robert Jones Bandage (MRJB) in primary total knee arthroplasty (TKA).

METHODS

PubMed, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were systematically searched for randomized controlled trials (RCTs). All RCTs were compared to receive either MRJB (study group) or conventional wound dressing (control group) in TKA. Statistical analysis was assessed using RevMan 5.3 software.

RESULTS

A total of 5 RCTs involving 362 patients were included in the meta-analysis. No significant difference between the 2 groups was found in terms of total blood loss (Mean difference [MD], -25.41; 95% confidence interval [CI], -90.52 to 39.70; P = .44), intra-operative blood loss (MD, -13.77; 95% CI, -31.84 to 4.29; P = .14), drain blood loss (MD, 0.83; 95% CI, -30.07 to 31.72; P = .96), and transfusion rate (risk ratio, 0.95; 95% CI, 0.55-1.64; P = .86); There was also no significant difference in terms of range of motion (MD, -0.93; 95% CI, -3.64 to 1.79; P = .50), visual analog scale pain sores (MD, -0.02; 95% CI, -0.34 to 0.30; P = .90), and operative time (MD, -3.12; 95% CI, -13.42 to 7.18; P = .55), without increasing the risk of wound-related complications (risk ratio, 0.75; 95% CI, 0.27-2.08; P = .58) in both groups. No deep venous thrombosis occurred in all studies.

CONCLUSIONS

The current meta-analysis of the available evidence indicates patients with MRJB had not required the additional advantage compared to the conventional wound dressing for TKA. However, more high-quality studies are needed to confirm the above conclusions.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Should compression bandage be performed after total knee arthroplasty? A meta-analysis of randomized controlled trials

Background

Compression bandage often is used after total knee arthroplasty (TKA) to alleviate pain, ameliorate swelling, and reduce bleeding. However, there is controversy about its application due to conflicting clinical outcomes and potential compression-related complications. This meta-analysis aimed to answer the question of if compression bandage should be implemented routinely after TKA.

Methods

Relevant randomized controlled trials (RCTs) on compression bandage were comprehensively retrieved utilizing search engines such as PubMed, EMBASE, Web of Science, and the Cochrane Library, up to September 2019. Studies included in the meta-analysis were those that compared post-operative pain score, swelling, total blood loss, pre- and post-operative hematocrit levels differences, range of motion (ROM), and complications, using Review Manager 5.3.0.

Results

Included were seven RCTs, which reported on 511 knees. The pooled results showed the compression bandage group was associated with a greater post-operative pain score during ambulation at 48 h (WMD = 0.70, 95% CI 0.07 to 1.34, P = 0.03), compared with the non-compression bandage group. No statistically significant differences were found between the groups in post-operative pain scores at the other times, swelling, blood loss, ROM, or other complications (P > 0.05).

Conclusions

The current evidence is unable to conclude that compression bandage is necessary after primary TKA. Surgeons routinely undertaking compression bandage should deliberate whether there is enough clinical evidence.

A prospective quasi-experimental controlled study evaluating the use of dynamic elastomeric fabric orthoses to manage common postpartum ailments during postnatal care

OBJECTIVE

To evaluate the effectiveness of a postnatal dynamic elastomeric fabric orthoses to manage postpartum pain, improve functional capacity and enhance the quality of life arising from postnatal ailments immediately to an 8-week postpartum, compared with patients who did not wear dynamic elastomeric fabric orthoses.

METHOD

A total of 51 postpartum women were recruited (day 0 to 10 days post-delivery) from hospitals and community-based health clinics to participate in a prospective quasi-experimental controlled study using parallel groups without random allocation. The subgroup of the compression shorts group wore SRC recovery shorts and received standard postnatal care. The comparison group received standard postnatal care alone. Wear compliance was monitored throughout the study. Primary outcome measure, Numeric Pain Rating Scale, and secondary outcome measures, Roland Morris Disability Questionnaire, Pelvic Floor Impact Questionnaire-7, and Short Form (SF-36) were assessed fortnightly over 8 weeks for both groups.

RESULTS

The compression shorts group reported a larger reduction in mean (SD) Numeric Pain Rating Scale score (-3.09 (2.20)) from baseline to 8 weeks, compared to the comparison group (-2.00 (1.41)). However, there was insufficient evidence of a statistical difference in Numeric Pain Rating Scale score at 8 weeks when comparing the compression shorts group and comparison group (-1.17; 95%CI: (-2.35, -0.01), R2 = .19, p = .050). The compression shorts group met the wear compliance of the dynamic elastomeric fabric orthoses and reported an average wear of the dynamic elastomeric fabric orthoses as 9 out of 14 days for 11 h per day (SD 4.8 h) between the fortnightly timepoints.

CONCLUSION

The use of dynamic elastomeric fabric orthoses may be considered during postnatal care as a non-pharmacological therapeutic intervention to manage pain resulting from common postpartum ailments. While the dynamic elastomeric fabric orthoses was clinically well accepted by participants with high wearing compliance, future research with larger population samples are needed to enable statistical conclusions on the effectiveness of a dynamic elastomeric fabric orthoses in postnatal care to be made.

REGISTRATION

Trial registration was not required as per the Australian Government Department of Health, Therapeutic Goods Administration.

Effectiveness, Feasibility, and Acceptability of Dynamic Elastomeric Fabric Orthoses (DEFO) for Managing Pain, Functional Capacity, and Quality of Life during Prenatal and Postnatal Care: A Systematic Review

Conservative interventions for addressing prenatal and postnatal ailments have been described in the research literature. Research results indicated that maternity support belts assist with reducing pain and other symptoms in these phases; however, compliance in wearing maternity support belts is poor. To combat poor compliance, commercial manufacturers designed dynamic elastomeric fabric orthoses (DEFO)/compression garments that target prenatal and postnatal ailments. This systematic review aimed to identify, critically appraise, and synthesize key findings on the effectiveness, the feasibility, and the acceptability of using DEFO to manage ailments during pre-natal and postnatal phases of care. Electronic databases were systematically searched to identify relevant studies, resulting in 17 studies that met the eligibility criteria. There were variations in DEFO descriptors, including hosiery, support belts, abdominal binders and more, making it difficult to compare findings from the research articles regarding value of DEFO during prenatal and/or postnatal phases. A meta-synthesis of empirical research findings suggests wearing DEFOs during pregnancy has a significant desirable effect for managing pain and improving functional capacity. Further research is required to investigate the use of DEFOs for managing pain in the postnatal period and improving quality life during prenatal and postnatal care.

Modified Robert Jones bandage can not reduce postoperative swelling in enhanced-recovery after primary total knee arthroplasty without intraoperative tourniquet: a randomized controlled trial

Background

Compression therapy is commonly used to reduce lower limb swelling and blood loss after knee surgery. This study was performed to investigate whether modified Robert Jones bandage (MRJB) as a postoperative compression therapy is necessary for enhanced-recovery primary total knee arthroplasty without the tourniquet application.

Methods

In this prospective randomized controlled trial, 90 patients were grouped into 2 groups randomly. The experimental group received compression therapy with MRJB from toes to thigh for 24 h and the control group received no compression therapy. Knee swelling, blood loss, range of motion (ROM), pain, patient reported comfort level and complications were recorded.

Results

No significant differences were observed between the two groups when we compared knee swelling. Similarly, no significant difference on postoperative blood loss, pain, ROM, complications was found. However, patients in control group had significantly higher comfort ratings than compression group during the first 24 h.

Conclusions

MRJB is not routinely indicated in enhanced-recovery primary total knee arthroplasty without tourniquet application.

Trial registration

The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INR-16010177) dated 18th December 2016.

Stretchable Optomechanical Fiber Sensors for Pressure Determination in Compressive Medical Textiles

Medical textiles are widely used to exert pressure on human tissues during treatment of post-surgical hematoma, burn-related wounds, chronic venous ulceration, and other maladies. However, the inability to dynamically sense and adjust the applied pressure often leads to suboptimal pressure application, prolonging treatment or resulting in poor patient outcomes. Here, a simple strategy for measuring sub-bandage pressure by integrating stretchable optomechanical fibers into elastic bandages is demonstrated. Specifically, these fibers possess an elastomeric photonic multilayer cladding that surrounds an extruded stretchable core filament. They can sustain repetitive strains of over 100%, and respond to deformation with a predictable and reversible color variation. Integrated into elastic textiles, which apply pressure as a function of their strain, these fibers can provide instantaneous and localized pressure feedback. These colorimetric fiber sensors are well suited for medical textiles, athletic apparel, and other smart wearable technologies, especially when repetitive, large deformations are required.

Effect of compression therapy on knee swelling and pain after total knee arthroplasty

PURPOSE

Knee swelling after total knee arthroplasty may impair postoperative mobilisation and training, and as medical elastic compression stockings are well tolerated and effective to prevent oedema, haematoma and postoperative pain after venous surgery, we wanted to study whether this effect could be transferred to total knee arthroplasty surgery reducing postoperative swelling and pain and thereby facilitating mobilisation and improving patient-reported knee function.

METHODS

In a randomised controlled study, 88 patients were randomised to use either a medical elastic compression stocking or no stocking from the first postoperative day and the following 4 weeks after total knee arthroplasty. Outcome measures were knee, calf and ankle swelling, knee flexion, pain and patient-reported knee function.

RESULTS

Seventy per cent of the swelling had occurred before application of the stocking the day after surgery. Knee, calf and ankle swelling and knee flexion measured on days 2, 7, 14 and 30 showed no significant difference between the two groups. Maximum pain level at rest and at walking was similar for both groups during the observation period. Also, the Oxford knee score was similar between the two groups on days 14 and 30.

CONCLUSION

We did not find any clinical effect using a medical elastic compression stocking after total knee arthroplasty.

LEVEL OF EVIDENCE

I.

Compression stockings for the initial treatment of varicose veins in patients without venous ulceration

BACKGROUND

Compression hosiery or stockings are often the first line of treatment for varicose veins in people without either healed or active venous ulceration. Evidence is required to determine whether the use of compression stockings can effectively manage and treat varicose veins in the early stages.

OBJECTIVES

To assess the effectiveness of compression stockings for the initial treatment of varicose veins in patients without healed or active venous ulceration.

SEARCH METHODS

The Cochrane Peripheral Vascular Disease Group searched their Specialised Register (last searched 31 May 2011) and CENTRAL (2011, Issue 2). In addition, the reference lists of relevant articles were searched. Authors of ongoing and current trials were contacted. There were no language restrictions.

SELECTION CRITERIA

Randomised controlled trials (RCTs) were included if they involved participants diagnosed with primary trunk varicose veins without healed or active venous ulceration (Clinical, Etiology, Anatomy, Pathophysiology (CEAP) classification C2 to C4). Included trials assessed compression stockings versus no treatment, compression versus placebo stockings, or compression stockings + drug intervention versus drug intervention alone. Trials comparing different lengths and pressures of stockings were also included. Trials involving other types of treatment for varicose veins (either as a comparator to stockings or as an initial non-randomised treatment), including sclerotherapy and surgery, were excluded.

DATA COLLECTION AND ANALYSIS

Two authors assessed the trials for inclusion and quality (SS and LR). SS extracted the data, which were checked by LR. Attempts were made to contact trial authors where missing or unclear data were present.

MAIN RESULTS

Seven studies involving 356 participants with varicose veins without healed or active venous ulceration were included. Different levels of pressure were exerted by the stockings in the studies, ranging from 10 to 50 mmHg. One study assessed compression hosiery versus no compression hosiery. The other six compared different types or pressures of stockings. The methodological quality of all included trials was unclear, mainly because of inadequate reporting.The symptoms subjectively improved with the wearing of stockings across trials that assessed this outcome, but these assessments were not made by comparing one randomised arm of a trial with a control arm and are therefore subject to bias.Meta-analyses were not undertaken due to inadequate reporting and actual or suspected high levels of heterogeneity.

AUTHORS' CONCLUSIONS

There is insufficient, high quality evidence to determine whether or not compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration, or whether any type of stocking is superior to any other type. Future research should consist of a large RCT of participants with trunk varices either wearing or not wearing compression stockings to assess the efficacy of this intervention. If compression stockings are found to be beneficial, further studies assessing which length and pressure is the most efficacious could then take place.

Effect of different pressure magnitudes on hypertrophic scar in a Chinese population

INTRODUCTION

This study aimed to investigate the effect of different pressure magnitudes on treatment outcomes of hypertrophic scars, and determine pressure loss over time.

METHODS

A randomized clinical trial was adopted. 53 hypertrophic scar samples from 17 Chinese participants were recruited and randomly assigned into a high pressure group (20-25 mmHg) and low pressure group (10-15 mmHg) for a five-month intervention program. The scars were assessed objectively before intervention and monthly after intervention for thickness, color (redness, yellowness and lightness) and scar pliability. Pressure magnitude at each assessment was also measured. Two-way repeated ANOVA was used to compare for differences between groups.

RESULTS

The results showed that both levels of pressure produced reduction in scar thickness and redness, but the improvement in the high pressure group was statistically better than that of the counterpart (both p<0.05). Monthly pressure measurement revealed that pressure loss in the high pressure group was more severe. However, no major changes in other color parameters and pliability were observed for both the groups.

CONCLUSION

High pressure was demonstrated to be more effective for scar management, but it was also more prone to higher pressure loss. Pressure therapy integrated with regular monitoring of the interface pressure is suggested to improve its therapeutic efficacy.

Comparison of compression stocking with elastic bandage in reducing postoperative edema in coronary artery bypass graft patient

The removal of the saphenous veins in coronary artery bypass graft (CABG) surgery may cause leg edema. Compression therapy is often used to prevent postoperative edema. The objective of this study was to compare the efficacy of medical compression stocking (TED) and elastic bandage-type on donor limbs after CABG. The peripheries of lower limbs were measured at four regions (A: end of tarsal bones, H: heel , B: immediately above the ankle, C: largest circumference of the calf) at admission in 295 patients how CABG candidates and differences in these measurement points at discharge compared to measurements at admission time were calculated. The difference was considered as a measure of the effectiveness of two types of compression to prevent postoperative edema in donor limbs after CABG. The alterations of 396 donor limbs of 295 patients were examined after CABG at admission and discharge time. In 101 patients veins for graft were taken from both lower limbs. After analysis, if subjects had worn TED stockings, the peripheries of donor limbs at discharge were less than at admission time in the A and H regions compared to elastic bandage group (P(A) = 0/009), (P(H) = 0/012). The conclusion reached was that using the kind of knee length compression stocking (TED stocking , Kendall Co.) is more effective edema at foot and heel regions in donor limbs after CABG than elastic bandages.

An overview of technologies related to care for venous leg ulcers

Venous leg ulcers remain a major problem in the United States, with spending reaching more than $1 billion annually. Current treatment options for this condition center around the use of compression therapy delivered by bandages, medical-grade stockings, or pneumatic compression devices. While these forms of therapy can produce dramatic improvements, cost and patient compliance remain an issue. In parallel with this need, wearable, wireless health monitoring systems have recently emerged as a low-cost solution for management of chronic health conditions. To this end, researchers at the Center for Robotics and Intelligent Machines (North Carolina State University) and the Carolon Company (Rural Hall, NC) have proposed an integrated sensing and therapeutic compression module. This article will review technologies related to the design of such a device, as well as provide direction for future research.

Skin pressure profiles and variations with body postural changes beneath medical elastic compression stockings

BACKGROUND

Medical elastic compression stockings (GCSs) are one of the most widely used mechanical compression approaches to relieve venous disorders of the lower limb. The skin pressure profiles applied by compression stockings may be altered with body postural changes, thus exerting influences on their therapeutic efficiency.

OBJECTIVES

To examine and quantify objectively the skin pressure distribution and magnitude beneath GCSs with body postural changes, and to analyze the possible reasons for skin pressure variations.

METHODS

The pressure levels of four different kinds of commonly used GCS were measured using piezoelectric sensors and a multichannel measuring system in six female healthy volunteers in 10 different body positions.

RESULTS

Body postural changes significantly influenced the skin pressure profiles (P < 0.001). Skin pressures at the ankle and on the anterior side of the leg were always highest when tested in all positions. Extension and flexion of the knee joint significantly influenced the skin pressure at the anterior and posterior aspects of the leg, especially when tested in the sitting position with the knee flexed at 90 degrees and in the supine position with the knee flexed at more than 90 degrees (P < 0.001). Plantar flexion of the ankle joint, such as up-heel standing and heel-off walking, significantly increased the skin pressure in the ankle region. Contraction, extension, and relaxation of the calf muscle did not produce large fluctuations in skin pressure when tested in positions with full knee extension.

CONCLUSIONS

Body postures may be one of the most important factors influencing the skin pressure profiles applied by compression stockings. The anatomic structure of individual legs, the special design of compression stockings, and the physical properties of stocking materials also influence skin pressure variations at different tested locations in different body positions. Appropriate leg postural changes and exercise may improve the therapeutic effectiveness of GCSs.

Treatment of classic Kaposi's sarcoma-associated lymphedema with elastic stockings

Lymphedema of the lower extremities is a frequent complication of Kaposi's sarcoma (KS). Compressive therapy is the basis of treatment for lymphatic disorders, but to the authors' knowledge, there are no controlled trials to evaluate its effectiveness in KS-related lymphedema. Sixty-five patients with classic KS-associated lymphedema limited to below the knee were studied. Fifty patients received below-knee elastic stockings, whereas the remaining 15 did not use any compressive device. Among treated patients, 60% (30/50) experienced a limb volume reduction, while 40% (20/50) had an increase of limb volume. In contrast, all patients (15/15) of the untreated group had an increase of limb volume. No correlation between lymphedema reduction and systemic or local chemotherapy was observed, supporting compressive therapy as the major strategy for the treatment of this condition. Our results suggest that elastic stockings may be important tools for the management of lymphedema associated to classic KS.

Lower Extremity Arterial and Venous Ulcers

The prevalence of peripheral arterial disease in the general population is high, but the awareness of primary care providers of the disease process is low. The disease is not recognized by primary care providers. Early recognition and treatment of venous diseases that progress to postphlebotic syndrome, such as after a deep vein thrombosis, will prevent venous ulcers that add considerable expense to the health care system. Vascular assessment, including routine ABI measurement of patients who are in risk categories for vascular disease will identify those patients so that prevention programs can be put into place early. Major contributions to the understanding and management of leg ulcers and wound healing have been made in the last decade. However, there is still confusion as to the exact mechanism behind ulcer development and the best method to manage, cure,and prevent these ulcers has yet to be found.

Sclerotherapy basics

Sclerotherapy involves the injection of a fluid into blood vessels to eradicate them. A thorough understanding of the basics of sclerotherapy are important when beginning sclerotherapy procedures in practice. This article reviews the essential information of sclerosants, treatment of small vessel disease, and patient management.