1
|
Dissemond J, Protz K, Stücker M. Compression therapy in dermatology. J Dtsch Dermatol Ges 2023; 21:1003-1019. [PMID: 37565365 DOI: 10.1111/ddg.15161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/28/2023] [Indexed: 08/12/2023]
Abstract
Compression therapy is a conservative therapy that can be used in many patients with dermatological conditions, especially those associated with edema. In addition to its well-established use in venous and lymphatic disorders, there is increasing evidence that compression therapy supports the healing of inflammatory dermatoses. The presence of edema, regardless of its etiology, is an indication for the use of compression therapy. Nowadays, a variety of materials and treatment options are available for compression therapy, each with their own advantages and disadvantages. Often, compression therapy with low resting pressures is sufficient for effective therapy and is better tolerated by patients. The main contraindications to compression therapy are advanced peripheral arterial disease and decompensated heart failure. Individual factors and economic considerations should be taken into account when deciding on compression therapy with the patient. Patient self-management should be encouraged whenever possible. This requires education and support tools.
Collapse
Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
| | - Kerstin Protz
- Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Markus Stücker
- Department for Dermatology, Venerology and Allergology, Ruhr-University Bochum, Vein Center of Dermatology and Vascular Surgery, Bochum, Germany
| |
Collapse
|
2
|
Dissemond J, Protz K, Stücker M. Kompressionstherapie in der Dermatologie. J Dtsch Dermatol Ges 2023; 21:1003-1020. [PMID: 37700410 DOI: 10.1111/ddg.15161_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/28/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie Kompressionstherapie ist eine konservative Therapie, die bei vielen Patienten mit dermatologischen Krankheiten durchgeführt werden kann, insbesondere wenn diese mit Ödemen assoziiert sind. Neben den wissenschaftlich sehr gut belegten Indikationen bei venösen und lymphatischen Erkrankungen, gibt es auch zunehmend wissenschaftliche Hinweise, dass durch die Kompressionstherapie die Abheilung entzündlicher Dermatosen unterstützt wird. Wenn Ödeme vorliegen, handelt es sich, unabhängig von deren Genese, um einen Einsatz im Rahmen der Zulassung der Kompressionstherapie.Für die Kompressionstherapie stehen heute verschiedene Materialien und Versorgungsoptionen mit systemspezifischen Vor‐ und Nachteilen zur Verfügung. Oft ist eine Kompressionstherapie mit niedrigen Ruhedruckwerten für einen Therapieerfolg ausreichend und wird von den Patienten besser toleriert. Als wichtigste Kontraindikationen der Kompressionstherapie sind die fortgeschrittene periphere arterielle Verschlusskrankheit und die dekompensierte Herzinsuffizienz zu beachten.Bei der gemeinsam mit dem Patienten getroffenen Entscheidung für eine Kompressionstherapie, sollten individuelle Faktoren und wirtschaftliche Aspekte berücksichtigt werden. Wann immer möglich, ist ein Selbstmanagement des Patienten zu unterstützen. Hierfür sind Edukation und Hilfsmittel erforderlich.
Collapse
Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Kerstin Protz
- CompetenzzentrumVersorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Bochum
| |
Collapse
|
3
|
[Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC) : S2k guideline of the German Phlebology Society (DGP) in cooperation with the following professional associations: DDG, DGA, DGG, GDL, DGL, BVP. German version]. Hautarzt 2021; 72:137-152. [PMID: 33301064 DOI: 10.1007/s00105-020-04734-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
4
|
Rabe E, Földi E, Gerlach H, Jünger M, Lulay G, Miller A, Protz K, Reich-Schupke S, Schwarz T, Stücker M, Valesky E, Pannier F. Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC) : S2k guideline of the German Phlebology Society (DGP) in cooperation with the following professional associations: DDG, DGA, DGG, GDL, DGL, BVP. Hautarzt 2021; 72:37-50. [PMID: 33386416 PMCID: PMC8692288 DOI: 10.1007/s00105-020-04706-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Affiliation(s)
- E Rabe
- Emeritus Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Germany.
| | - E Földi
- Földiklinik, Rösslehofweg 2-6, 79856, Hinterzarten, Germany
| | - H Gerlach
- , Zehntstr. 25, 68519, Viernheim, Germany
| | - M Jünger
- Klinik und Poliklinik f. Hautkrankheiten, Universitätsmedizin, Ferdinand Sauerbruchstraße, 17475, Greifswald, Germany
| | - G Lulay
- Klinik für Gefäß- u. Endovaskularchirurgie, Phlebologie-Lymphologie, Frankenburgstr. 31, 48431, Rheine, Germany
| | - A Miller
- Dermatologische Praxis, Wilmersdorfer Str. 62, 10627, Berlin, Germany
| | - K Protz
- Wundforschung, Universitätsklinikum Hamburg-Eppendorf, Bachstr. 75, 22083, Hamburg, Germany
| | - S Reich-Schupke
- Privatpraxis für Haut- und Gefäßmedizin, Wundtherapie, Hertener Str. 27, 45657, Recklinghausen, Germany
| | - T Schwarz
- Praxis für Gefäßmedizin, Konrad Goldmann Str. 5b, 79100, Freiburg, Germany
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - F Pannier
- Praxis für Dermatologie & Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany
- Dermatologische Universitätsklinik Köln, Cologne, Germany
| |
Collapse
|
5
|
[Compression bandages with and without padding : Observational controlled survey of pressure and comfort]. Hautarzt 2019; 69:653-661. [PMID: 29696354 DOI: 10.1007/s00105-018-4167-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the context of compression therapy, padded bandages are designed to prevent skin damage, increase adherence and support the success of therapy. Routine use is discussed, because comparative studies are lacking. OBJECTIVES This study examines effectiveness, comfort, and impact of short-stretch bandages without padding compared to underpadded bandages. PARTICIPANTS AND METHODS In all, 61 healthy participants wore padded bandages foam or synthetic cotton wool on one leg and nonpadded bandages on the other. On both sides, a resting pressure of 50 mm Hg was generated. After 60 min resting pressure, skin condition, comfort, pain, and fitting of the bandages were assessed. RESULTS All bandages showed pressure losses after 1 h; 82.0% of nonpadded bandages had a pressure drop of 9 mm Hg or more. The following were observed in unpadded bandages: constrictions (100.0%), severe redness (77.0%) and bruises (42.6%). Comfort was rated as pleasant by 3.3% without padding, by 83.9% with foam padding, and by 73.3% with synthetic cotton wool padding. Nonpadded compression bandages caused in 62.3% pain from 1-3 (numerical rating scale 0-10). CONCLUSIONS Padded compression bandages maintain the therapy-relevant pressure better, provide more comfort, and cause less pain and skin problems than nonpadded compression bandages. These aspects are crucial for adherence, and therapeutic success. After 1 h of use on the healthy leg, there were obvious differences. Significantly more side effects may appear after several hours of use on previously damaged skin. Therefore, compression bandages should always be padded.
Collapse
|
6
|
Protz K, Reich-Schupke S, Klose K, Augustin M, Heyer K. [Compression devices for decongestion therapy : A cross-sectional observational survey of handling, pressure, and comfort]. Hautarzt 2019; 69:232-241. [PMID: 29184983 DOI: 10.1007/s00105-017-4084-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND If compression bandaging is not performed in a professional manner, the objectives of the therapy may not be achieved and side effects or complications may result. OBJECTIVES This cross-sectional observational survey examines the handling of the treatment options: short-stretch bandages with padding, multicomponent compression systems, and adaptive compression bandages. PARTICIPANTS AND METHODS During several training sessions on the topic of compression therapy, 137 participants performed compression bandagings on each other. In this regard, they were asked to achieve a predetermined pressure range (short-stretch bandages: 50-60 mm Hg, multicomponent compression systems: 40-50 mm Hg, adaptive compression bandage: 35-45 mm Hg). To evaluate the efficiency, the time used for application, the achieved pressure value, and the comfort were determined. RESULTS Of the 302 bandagings (n = 137 participants), 28.4% lay within the given target pressure value range. This included 11.2% of performed short-stretch bandages, 35.2% of multicomponent compression systems, and 85.0% of adaptive compression bandages. Significant differences in the mean deviations are found between the treatment options. The bandage was described as being comfortable by 37.7% of users of short-stretch bandages with padding, by 65.0% of those wearing a multicomponent compression system, and by 94.6% of participants with an adaptive compression bandage. CONCLUSIONS In practice, short-stretch bandages are still the most frequently used care option for the creation of a phlebological compression bandage. In this survey, they proved to be unsafe, time-consuming, and uncomfortable in relation to other treatment options. Multicomponent compression systems and adaptive compression bandages are treatment options that may be a contemporary alternative which also bares more comfort for the patient.
Collapse
Affiliation(s)
- K Protz
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, Bethanien-Höfe Eppendorf, 20246, Hamburg, Deutschland.
| | - S Reich-Schupke
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Ruhr-Universität Bochum, Bochum, Deutschland
| | - K Klose
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, Bethanien-Höfe Eppendorf, 20246, Hamburg, Deutschland
| | - M Augustin
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, Bethanien-Höfe Eppendorf, 20246, Hamburg, Deutschland
| | - K Heyer
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, Bethanien-Höfe Eppendorf, 20246, Hamburg, Deutschland
| |
Collapse
|
7
|
Stoffels-Weindorf M, Stoffels I, Jockenhöfer F, Dissemond J. [Quality of self-applied compression bandages in patients with chronic venous ulcers : Results of a prospective clinical study]. Hautarzt 2017; 69:306-312. [PMID: 29184985 DOI: 10.1007/s00105-017-4086-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND For effective compression therapy in patients with venous leg ulcers, sufficient pressure is essential. In everyday life, it is often the patients themselves who apply the compression bandages. Many of these patients have restriction in their movement and had been rarely trained adequately. Hence, there was the question of how efficient are the autonomously applied compression bandages of those patients. PATIENTS AND METHODS In all, 100 consecutive patients with venous leg ulcer were asked to apply compression bandages on their own leg. We documented both the achieved compression and formal criteria of correct performance. RESULTS A total of 59 women and 41 men with an average age of 70.3 years were included in the study. Overall 43 patients were not able to apply a compression bandage because of physical limitations. The measured pressure values in the remaining 57 patients ranged between 6 and 93 mm Hg (mean 28.3 mm Hg). Eleven patients reached the prescribed effective compression pressure. Of these, formal errors were found in 6 patients, so that only 5 patients had correctly applied the compression bandages. CONCLUSION Our data show that most patients with venous leg ulcers are not able to apply effective compression therapy with short-stretch bandages to themselves. Multilayer systems, adaptive compression bandages, and ulcer stocking systems today are possibly easier and more effective therapy options. Alternatively short-stretch bandages could be applied by trained persons but only under the control with pressure measuring probes.
Collapse
Affiliation(s)
- M Stoffels-Weindorf
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - I Stoffels
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - F Jockenhöfer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
| |
Collapse
|
8
|
Heyer K, Milde S, Schmitt J, May M, Helfrich J, Augustin M. [A standard data set for the evaluation of venous leg ulcers in selective contracts : National consensus]. Hautarzt 2017; 68:815-826. [PMID: 28567507 DOI: 10.1007/s00105-017-3990-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Selective agreements are becoming increasingly important in health care management. To date, no standard recommendations for the evaluation of selective contracts are available. OBJECTIVES Against this background, a recommendation on the evaluation of selective contracts in patients with leg ulcers (LU) was developed and approved by the nationwide consensus conference. MATERIALS AND METHODS Based on a systematic literature review and followed by a manual search through other possible evaluation indicators in the care of patients with LU, a Delphi-based consensus process was performed by various scientific societies, professional associations, insurances and supply networks. RESULTS For the evaluation of efficiency and quality of care, a recommendation on the evaluation of selective agreements with patients with LU was consented in six meetings and in five multistage online surveys. In total, 44 evaluation indicators were identified in the quality subareas structure, process, and outcome. The outcome indicators are divided into clinical, patient-related, and cost-related indicators. CONCLUSIONS The developed evaluation indicators represent the quality of care in patients with LU. The indicators can be applied individually, depending on the agreed contract-specific supply target. After implementation of this national standard, the comparability of selective agreements in the management of patients with LU can be ensured and consolidated.
Collapse
Affiliation(s)
- K Heyer
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie (IVDP), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - S Milde
- AOK-Bundesverband, Berlin, Deutschland
| | - J Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), TU Dresden, Dresden, Deutschland
| | - M May
- AOK Rheinland/Hamburg, Hamburg, Deutschland
| | | | - M Augustin
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie (IVDP), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| |
Collapse
|
9
|
Dissemond J, Protz K, Reich-Schupke S, Stücker M, Kröger K. [Compression therapy in leg ulcers]. Hautarzt 2017; 67:311-23; quiz 324-5. [PMID: 26911976 DOI: 10.1007/s00105-016-3765-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Compression therapy is well-tried treatment with only few side effects for most patients with leg ulcers and/or edema. Despite the very long tradition in German-speaking countries and good evidence for compression therapy in different indications, recent scientific findings indicate that the current situation in Germany is unsatisfactory. Today, compression therapy can be performed with very different materials and systems. In addition to the traditional bandaging with Unna Boot, short-stretch, long-stretch, or multicomponent bandage systems, medical compression ulcer stockings are available. Other very effective but far less common alternatives are velcro wrap systems. When planning compression therapy, it is also important to consider donning devices with the patient. In addition to compression therapy, intermittent pneumatic compression therapy can be used. Through these various treatment options, it is now possible to develop an individually accepted, geared to the needs of the patients, and functional therapy strategy for nearly all patients with leg ulcers.
Collapse
Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - K Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), CWC - Comprehensive Wound Center, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
| | | | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - K Kröger
- Klinik für Gefäßmedizin, Angiologie, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland
| |
Collapse
|
10
|
Abstract
SummaryCompression therapy is a complex form of therapy. It requires equally practical abilities and theoretical knowledge, as well as an understanding of available materials and the methods in question. All these mentioned aspects of today’s practical compression therapy show deficits.This article shows the current status of treatment of patients with venous leg ulcers in Germany. Based on this, strategies are described, which aim to improve the status of information of the patients, the expertise of the users and the further spread of modern and specialized materials.It is possible and appropriate to better the individual status of treatment of patients through further qualification of carers. This should include the proper usage of materials and methods.
Collapse
|
11
|
Abstract
SummaryChronic wounds are of great socioeconomic importance. Usually they are associated with a long, complicated and burdensome course of disease and require high nursing and medical expenses. The quality of life of patients with chronic wounds is substantially impaired. This article provides a systematic overview of current studies on the morbidity and the health care situation of patients with chronic wounds, especially in patients with leg ulcers in Germany.Analyses based on routine data of statutory health insurances show higher incidence and prevalence rates, for example of patients with leg ulcers, compared with previously regional surveys. The quality of care is inadequate, particularly in diagnostics and therapy of patients with leg ulcers. To date, there is undersupply and a lack of execution and deficient knowledge about the compression treatment in patients with venous leg ulcers.Thus, there is need for further action in order to establish better implementation of guidelines in the management of patients with chronic wounds.
Collapse
|