Measurement of Lower Leg Compression In Vivo: Recommendations for the Performance of Measurements of Interface Pressure and Stiffness

Personalized compression therapeutic textiles: digital design, development, and biomechanical evaluation

Physical-based external compression medical modalities could provide sustainable interfacial pressure dosages for daily healthcare prophylaxis and clinic treatment of chronic venous disease (CVD). However, conventional ready-made compression therapeutic textiles (CTs) with improper morphologies and ill-fitting of pressure exertions frequently limit patient compliance in practical application. Therefore, the present study fabricated the personalized CTs for various subjects through the proposed comprehensive manufacturing system. The individual geometric dimensions and morphologic profiles of lower extremities were characterized according to three-dimensional (3D) body scanning and reverse engineering technologies. Through body anthropometric analysis and pressure optimization, the knitting yarn and machinery variables were determined as the digital design strategies for 3D seamless fabrication of CTs. Next, to visually simulate the generated pressure mappings of developed CTs, the subject-specific 3D finite element (FE) CT-leg modelings with high accuracy and acceptability (pressure prediction error ratio: 11.00% ± 7.78%) were established based on the constructed lower limb models and determined tissue stiffness. Moreover, through the actual in vivo trials, the prepared customized CTs efficiently (Sig. <0.05; ρ = 0.97) distributed the expected pressure requirements referring to the prescribed compression magnitudes (pressure error ratio: 10.08% ± 7.75%). Furthermore, the movement abilities and comfortable perceptions were evaluated subjectively for the ergonomic wearing comfort (EWC) assessments. Thus, this study promotes the precise pressure management and clinical efficacy for targeted users and leads an operable development approach for related medical biomaterials in compression therapy.

Fibre Bragg Grating Based Interface Pressure Sensor for Compression Therapy

Compression therapy is widely used as the gold standard for management of chronic venous insufficiency and venous leg ulcers, and the amount of pressure applied during the compression therapy is crucial in supporting healing. A fibre optic pressure sensor using Fibre Bragg Gratings (FBGs) is developed in this paper to measure sub-bandage pressure whilst removing cross-sensitivity due to strain in the fibre and temperature. The interface pressure is measured by an FBG encapsulated in a polymer and housed in a textile to minimise discomfort for the patient. The repeatability of a manual fabrication process is investigated by fabricating and calibrating ten sensors. A customized calibration setup consisting of a programmable translation stage and a weighing scale gives sensitivities in the range 0.4–1.5 pm/mmHg (2.6–11.3 pm/kPa). An alternative calibration method using a rigid plastic cylinder and a blood pressure cuff is also demonstrated. Investigations are performed with the sensor under a compression bandage on a phantom leg to test the response of the sensor to changing pressures in static situations. Measurements are taken on a human subject to demonstrate changes in interface pressure under a compression bandage during motion to mimic a clinical application. These results are compared to the current gold standard medical sensor using a Bland–Altman analysis, with a median bias ranging from −4.6 to −20.4 mmHg, upper limit of agreement (LOA) from −13.5 to 2.7 mmHg and lower LOA from −32.4 to −7.7 mmHg. The sensor has the potential to be used as a training tool for nurses and can be left in situ to monitor bandage pressure during compression therapy.

Statischer Stiffness-Index von zwei Multikomponenten-Bandagen-Kompressionssystemen: Ergebnisse einer randomisierten kontrollierten Studie an gesunden Probanden

Zweck Vergleich der Leistung von zwei Mehrkomponenten-Kompressionssystemen.

Methoden In dieser randomisierten, kontrollierten Studie wurden beide Beine von 25 gesunden Probanden nach dem Zufallsprinzip entweder mit einem Kompressionssystem der neuen Generation (UrgoK1, eine einzige Binde) oder einem etablierten System (UrgoK2, zwei Binden) als Kontrolle bandagiert. Beide Systeme wurden Tag und Nacht getragen. Arbeits- und Ruhegrenzflächendruck wurden unmittelbar nach dem Anlegen und nach 4 h, 24 h, 48 h und 72 h gemessen und der Static Stiffness Index (SSI) berechnet.

Ergebnisse Nach 4 Stunden wurden mit beiden Systemen ähnlich hohe Arbeitsdrücke und mäßige Ruhedrücke registriert. Im Zeitverlauf folgten die Druckänderungen und des SSI den gleichen Kurven. Nach 48 h wurde ein SSI ≥ 10 mmHg bei 88 % der getesteten und 76 % der Kontrollsysteme erreicht, was die Nichtunterlegenheit des Testsystems bestätigt (p = 0,016). Beide Systeme wiesen gute Halteeigenschaften auf und waren gut verträglich, aber das getestete System wurde von der Mehrheit der Probanden als deutlich angenehmer empfunden und schließlich dem Kontrollsystem vorgezogen.

Schlussfolgerung Das neue Kompressionssystem erreichte ähnliche Leistungen wie die Kontrolle, aber seine bessere Akzeptanz könnte ein Vorteil für die Patientencompliance sein. Diese vielversprechenden Ergebnisse müssen in einer klinischen Studie an Patienten mit Unterschenkelulcera und/oder Ödemen bestätigt werden.

Effect of Postoperative Compression Therapy on the Success of Liposuction in Patients with Advanced Lower Limb Lymphedema

Objective: There is limited information on postoperative care after liposuction for lymphedema limb. The aim of this retrospective study was to identify the threshold compression pressure and other factors that lead liposuction for lower limb lymphedema to success. Materials and Methods: Patients were divided according to whether they underwent compression therapy with both stockings and bandaging (SB group), stockings alone (S group), or bandaging alone (B group) for 6 months after liposuction. The postoperative compression pressure and rate of improvement were compared according to the postoperative compression method. We also investigated whether it was possible to decrease the compression pressure after 6 months. Liposuction was considered successful if improvement rate was >15. Results: Mean compression pressure was significantly lower in the S group than in the SB group or B group. The liposuction success rate was significantly higher in the SB group than in the B group or S group. There was not a significant difference between the values at 6 months after liposuction and at 6 months after a decrease in compression pressure in the successful group. Conclusion: Our results suggest that stable high-pressure postoperative compression therapy is key to the success of liposuction for lower limb lymphedema and is best achieved by using both stockings and bandages. The postoperative compression pressure required for liposuction to be successful was >40 mmHg on the lower leg and >20 mmHg on the thigh. These pressures could be decreased after 6 months.

Relationship Between Interface Pressures and Pneumatic Cuff Inflation Pressure at Different Assessment Sites of the Lower Limb to Aid Soft Exoskeleton Design

OBJECTIVE

The aim was to develop a means of predicting interface pressure from cuff inflation pressure during circumferential compression at the lower limb, in order to inform the design of soft exoskeletons.

BACKGROUND

Excessive mechanical loading of tissues can cause discomfort and soft tissue injury. Most ergonomic studies on exoskeletons are of interface pressure, but soft exoskeletons apply circumferential pressures similar to tourniquet cuffs by way of cuff inflation pressure. This study details the relationship between interface and cuff inflation pressures for pneumatic tourniquet cuffs.

METHOD

Pneumatic cuffs of different widths were inflated to target pressures on (A) a rigid cylinder, (B) the dominant thigh and calf, and (C) knee of healthy participants standing still. Interface pressures were measured under the cuffs using a pressure-sensing mat. Average interface pressures were then compared to cuff inflation pressures. The influence of cuff width, cuff inflation pressure, and participants' anthropometric data on pressure transmission was assessed.

RESULTS

A strong linear relationship between cuff inflation pressures and interface pressures was observed. Interface pressures were generally higher than cuff inflation pressures. The efficiency of pressure transmission to the lower limb depended on assessment site, adipose tissue thickness, cuff size, cuff inflation pressure, and possibly limb circumference. Regression equations were developed to predict interface pressures at the thigh, calf, and knee.

CONCLUSION

Interface pressures under pneumatic cuffs are influenced by the cuff size, cuff inflation pressure, and tissue compressibility. Predicted interface pressure from cuff inflation pressure and vice versa can be used to aid the design of soft exoskeletons.

Development of a Care Labelling Process for Compression Stockings Based on Natural (Cotton) Fibers

This study is to investigate to what extent the performance of compression stockings with cotton components deteriorates after repeated washing processes. Four compression stockings having at least one cotton constituent yarn and two all-nylon stockings as reference samples were produced under controlled commercial conditions. After analysing the data obtained, a care labelling process for the compression socks with cotton components was developed such that they can preserve their compression properties over successive laundering treatments.

Postural differences in the immediate effects of active exercise with compression therapy on lower limb lymphedema

PURPOSE

Although regarded as an important treatment for lymphedema, the therapeutic effects of active exercise with compression therapy (AECT) are supported by little evidence. The purpose of this study was to determine the relative benefits of AECT with different postures for patients with lower limb lymphedema (LLL).

METHODS

Eighteen women with LLL secondary to surgical treatment of gynecological cancer, completed (1) AECT in a seated position (seated AECT), (2) AECT in a supine position (supine AECT), and (3) compression-only therapy in a supine position (CT) in this randomized, controlled, crossover trial. AECT was performed on a bicycle ergometer while wearing elastic compression bandages. Each intervention was performed for 15 min, and the three conditions were separated by a 1-week washout period. Lower-limb volumes were evaluated using a Perometer^TM sensor (Pero-system, Wuppertal, Germany), and symptom severity was assessed before and after each intervention using a visual analog scale (pain, heaviness) and palpation (pitting, stiffness). The effects of the interventions were estimated using linear mixed-effect models.

RESULTS

The magnitude of limb volume decreases differed significantly among the interventions, with a greater decrease after supine AECT than after CT. Pre-intervention pitting severity and skin stiffness were significantly correlated with the magnitude of volume decrease after all interventions and after AECT in the supine position, respectively.

CONCLUSIONS

Supine AECT using a bicycle ergometer has marked immediate effects to decrease the fluid volume of severe LLL.

CLINICAL TRIAL REGISTRATION

UMIN clinical trial registry (UMIN-CTR; ID000020129) by CONSORT 2010, TRN R000023253, December 9, 2015.

The ICC Compression Questionnaire: A Comprehensive Tool to Evaluate Compression Materials or Devices Applied in Subjects with Lymphedema or Chronic Venous Disease

Background:

Compression therapy is an important part of the treatment of patients with lymphedema or chronic venous disease. However, there is no validated questionnaire evaluating the effect of compression and its acceptance by the patient. Therefore, the aims of this study were to construct a questionnaire evaluating the effect of compression and its acceptance by the patient, that is, the Dutch ICC Compression Questionnaire (ICC-CQ), to investigate its reliability and validity, and to translate it into English.

Methods and Results:

Eleven experts in applying compression and 51 Dutch patients with experience of using compression were involved in the construction process. One part of the ICC-CQ has to be completed by the patient and evaluates seven domains. The other part has to be completed by the health care provider and comprises three domains. Reliability and validity of the final version was investigated in a new group of 79 Dutch-speaking patients with lymphedema or chronic venous disease, wearing compression garments (N = 52) or bandages (N = 27). Except for one domain, the Intraclass Correlation Coefficients for test–rest/interrater reliability ranged from 0.55 to 0.93. Cronbach's alpha for internal consistency ranged from 0.71 to 0.97. Eighty-nine percent of the patients fully understood the questionnaire indicating good face validity, and 87% found it complete indicating good content validity. Construct validity was considered good since 10 out of 11 hypotheses were accepted.

Conclusion:

The ICC-CQ is the first reliable and valid questionnaire evaluating different kinds of compression and the experience by patients with lymphedema or chronic venous disease.

Mechanical and Morphological Assessment of an Innovative Textile for Patient Positioning Applications: Comparison to Two Standard Bandage Systems

In the healthcare environment, bandage systems are versatile medical devices to position and fix patients’ torsos or extremities. In this study, the mechanical and morphological properties of an innovative patient position system, iFix, were assessed and compared to two commercially available bandages. Morphological properties were investigated using a scanning electron microscope (SEM). The iFix bandage showed anisotropic mechanical properties, with a more rigid behavior in the longitudinal direction and a more elastic behavior in the transverse direction. This behavior results from the organization of the fibers visible in the SEM images. All three materials investigated in this study were able to support similar maximum loads. In cases where a rigid fixation of patient limbs or torso is necessary, the authors recommend the usage of iFix. In vivo studies should be carried out to prove safety in a surgical environment before its clinical usage.

Primary lymphedema French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins)

Primary lymphedema is a rare chronic pathology associated with constitutional abnormalities of the lymphatic system. The objective of this French National Diagnosis and Care Protocol (Protocole National de Diagnostic et de Soins; PNDS), based on a critical literature review and multidisciplinary expert consensus, is to provide health professionals with an explanation of the optimal management and care of patients with primary lymphedema. This PNDS, written by consultants at the French National Referral Center for Primary Lymphedema, was published in 2019 (https://has-sante.fr/upload/docs/application/pdf/2019-02/pnds_lymphoedeme_primaire_final_has.pdf). Primary lymphedema can be isolated or syndromic (whose manifestations are more complex with a group of symptoms) and mainly affects the lower limbs, or, much more rarely, upper limbs or external genitalia. Women are more frequently affected than men, preferentially young. The diagnosis is clinical, associating mild or non-pitting edema and skin thickening, as confirmed by the Stemmer’s sign (impossibility to pinch the skin on the dorsal side or the base of the second toe), which is pathognomonic of lymphedema. Limb lymphoscintigraphy is useful to confirm the diagnosis. Other causes of swelling or edema of the lower limbs must be ruled out, such as lipedema. The main acute lymphedema complication is cellulitis (erysipelas). Functional and psychological repercussions can be major, deteriorating the patient’s quality of life. Treatment aims to prevent those complications, reduce the volume with low-stretch bandages, then stabilize it over the long term by exercises and wearing a compression garment. Patient education (or parents of a child) is essential to improve observance.

Thin-Film Flexible Wireless Pressure Sensor for Continuous Pressure Monitoring in Medical Applications

Physiological pressure measurement is one of the most common applications of sensors in healthcare. Particularly, continuous pressure monitoring provides key information for early diagnosis, patient-specific treatment, and preventive healthcare. This paper presents a thin-film flexible wireless pressure sensor for continuous pressure measurement in a wide range of medical applications but mainly focused on interface pressure monitoring during compression therapy to treat venous insufficiency. The sensor is based on a pressure-dependent capacitor (C) and printed inductive coil (L) that form an inductor-capacitor (LC) resonant circuit. A matched reader coil provides an excellent coupling at the fundamental resonance frequency of the sensor. Considering varying requirements of venous ulceration, two versions of the sensor, with different sizes, were finalized after design parameter optimization and fabricated using a cost-effective and simple etching method. A test setup consisting of a glass pressure chamber and a vacuum pump was developed to test and characterize the response of the sensors. Both sensors were tested for a narrow range (0–100 mmHg) and a wide range (0–300 mmHg) to cover most of the physiological pressure measurement applications. Both sensors showed good linearity with high sensitivity in the lower pressure range <100 mmHg, providing a wireless monitoring platform for compression therapy in venous ulceration.

Compression Therapy Is Not Contraindicated in Diabetic Patients with Venous or Mixed Leg Ulcer

The aim of this study was to investigate if compression therapy (CT) can be safely applied in diabetic patients with Venous Leg Ulcers (VLU), even when a moderate arterial impairment (defined by an Ankle-Brachial Pressure Index 0.5–0.8) occurs as in mixed leg ulcers (MLU). Materials and methods: in one of our previous publications we compared the outcomes of two groups of patients with recalcitrant leg ulcers. Seventy-one patients were affected by mixed venous and arterial impairment and 109 by isolated venous disease. Both groups were treated by tailored inelastic CT (with compression pressure <40 mm Hg in patients with MLU and >60 mm Hg in patients with VLU) and ultrasound guided foam sclerotherapy (UGFS) of the superficial incompetent veins with the reflux directed to the ulcer bed. In the present sub analysis of the same patients we compared the healing time of 107 non-diabetic patients (NDP), 69 with VLU and 38 with MLU) with the healing time of 73 diabetic patients (DP), 40 with VLU and 33 with MLU. Results: Twenty-five patients were lost at follow up. The results refer to 155 patients who completed the treatment protocol. In the VLU group median healing time was 25 weeks for NDP and 28 weeks in DP (p = 0.09). In the MLU group median healing time was 27 weeks for NDP and 29 weeks for DP (p = −0.19). Conclusions: when providing leg ulcer treatment by means of tailored compression regimen and foam sclerotherapy for superficial venous refluxes, diabetes has only a minor or no effect on the healing time of recalcitrant VLU or MLU.

A Novel Capacitance-Based In-Situ Pressure Sensor for Wearable Compression Garments

This paper pertains to the development & evaluation of a dielectric electroactive polymer-based tactile pressure sensor and its circuitry. The evaluations conceived target the sensor’s use case as an in-situ measurement device assessing load conditions imposed by compression garments in either static form or dynamic pulsations. Several testing protocols are described to evaluate and characterize the sensor’s effectiveness for static and dynamic response such as repeatability, linearity, dynamic effectiveness, hysteresis effects of the sensor under static conditions, sensitivity to measurement surface curvature and temperature and humidity effects. Compared to pneumatic sensors in similar physiological applications, this sensor presents several significant advantages including better spatial resolution, compact packaging, manufacturability for smaller footprints and overall simplicity for use in array configurations. The sampling rates and sensitivity are also less prone to variability compared to pneumatic pressure sensors. The presented sensor has a high sampling rate of 285 Hz that can further assist with the physiological applications targeted for improved cardiac performance. An average error of ± 5.0 mmHg with a frequency of 1–2 Hz over a range of 0 to 120 mmHg was achieved when tested cyclically.

Case-control evaluation of the impact of below 20 mmHg elastic compression stockings on lower limb volume serial variations in standardized flights

Background

Graduated compression stocking (GCS) use during flights demonstrated to positively impact leg oedema. Nevertheless, these data were collected in a single flight, mainly at the ankle, and using greater than 20 mmHg GCS. This investigation reports data from 16 flights in which the same passenger’s leg circumferences variation were assessed wearing non-graduated ankle-sock or a below-knee 15–20 mmHg GCS.

Methods

The limb was divided by the circumferences in eight sectors, every 4 cm, labelled from 1 to 8, starting from the ankle up. The assessment was done at the take-off and after a 4-h flight time, for a total of 16 flights. The subject used non-graduated ankle socks (elastic band at 4 cm from B-point) during the outgoing flight and below-knee GCS (15–20 mmHg) during the return flight. Interface pressure was assessed at the ankle point of minimum girth (B) and ascending proximally every 4 cm (B+cm) for the GCS, and at B and at the elastic band level (B + 4 cm) for the sock.

Results

GCS interface pressure was 13.3 ± 2.5 mmHg in B and 18.1 ± 2.4 mmHg in B + 4 cm. The sock interface pressure was 3.1 ± 0.7 mmHg in B and 8.1 ± 0.9 mmHg at the band level (B + 4 cm). Socks led to a significant total volume increase (117.3 ± 25.8 mL; 5.2% ±1.1%; P < 0.0001). GCS led to a non-significant total volume decrease (–3.1 ± 14.4 mL; –0.1 ± 0.6%; P = 0.3964) and did not allow for volume increase. The different sectors showed a heterogeneous volume variation, not following a precisely graduated or progressive compression profile.

Conclusions

Leg oedema following a 4-h flight is controlled by <20 mmHg GCS. Leg fluids, with and without GCS, are mobilized in a non-graduated profile from the ankle to the knee after prolonged sitting on a plane.

Adjustable compression wrap devices are cheaper and more effective than inelastic bandages for venous leg ulcer healing. A Multicentric Italian Randomized Clinical Experience

Introduction

Compression therapy by inelastic bandages is highly effective in achieving venous leg ulcer healing. Inelastic bandages may be expensive as they need to be changed and discarded at every dressing change. In addition, correct application is difficult in the clinical practice, even by expert healthcare personnel. The aim of our work was to assess whether adjustable compression wraps are more cost effective and more effective than inelastic bandage to achieve venous leg ulcer healing.

Methods

Sixty-six venous leg ulcer patients were randomized to be treated by adjustable compression wrap (CircAid® JuxtaCure®) ( n = 33) and inelastic bandage (Coban 2 Layer®) ( n = 33). Study duration was 12 weeks. During weekly visits, the ulcers were cleansed and dressed with the same products, and the only variable was the compression device. Ulcer size, ulcer pain, patient’s perception of compression systems, and compression pressure were assessed during the visits, and the material cost was evaluated at the 12th week.

Results

Adjustable compression wraps were significantly cheaper than bandages (p < 0.0001) and were also more effective (not significantly) in achieving ulcer healing. To heal one ulcer patient, €228 had to be spent when applying an adjustable compression wrap and €381 if inelastic bandages were used. About 26/33 (78.8%) patients in the adjustable compression wrap group were healed after 12 weeks versus 23/33 (69.7%) in the inelastic bandage group (n.s.). Ulcer pain was reduced by both compression devices. Patient perception of compression pressure was similar with both compression devices. Compression pressure was similar at application but better maintained by adjustable compression wrap over time.

Conclusions

Adjustable compression wraps are significantly cheaper and more effective (not significantly) in achieving venous leg ulcer healing. Self-applicable, adjustable compression wraps are therefore a powerful, cost-effective alternative to inelastic bandages in treating venous leg ulcer.

Effect of subsurface pressure on the interface pressure measurement in an in vitro experiment

Introduction

It was hypothesized that subsurface pressure (mimicking subcutaneous pressure) variation may affect interface pressure measurement.

Method

BISCO® (Rogers, CT) foam was placed on a cylinder cuff model for the experiment. Picopress® and a piezoresistive sensor were used for interface pressure measurement. External pressure was applied using an automated pressure cuff at 40 mmHg. Subsurface pressure mimicking subcutaneous pressure from 3 mmHg to 12 mmHg was generated by a pressure pump underneath the foam. Interface pressure was compared between the true pressure, 40 mmHg, versus Picopress® and the piezoresistive sensor using linear mixed effect model (SAS software, version 9.4, SAS Institute, Cary, NC).

Result

Interface pressure measurement using Picopress® did not differ between the incremental subsurface pressures (mean 45.4 ± 0.4) ( P = 0.54), in contrast to piezoresistive sensor, which demonstrated a difference (mean 42.65 ± 2.7) ( P < 0.001). This difference appeared to be linearly related.

Conclusion

Subsurface pressure mimicking subcutaneous pressure may affect the overall interface pressure measurement according to the piezoresistive sensor but not Picopress®.

Compression Vest Treatment for Symptomatic Breast Edema in Women Treated for Breast Cancer: A Pilot Study

Background: Lymphedema of the breast/chest wall after breast cancer treatment is often associated with pain and reduced quality of life. We conducted a pilot study to evaluate whether the use of a compression vest reduced symptoms of breast/chest wall edema in breast cancer patients. Methods and Results: This single-center study included patients (n = 25) with symptomatic breast/chest wall edema with a pain score of ≥3 on the Numerical Rating Scales (range 1-10). The patients were instructed to wear a compression vest (Lymphatrex, Class II) for 6 months. Wilcoxon signed-rank tests were used to compare differences in patient-reported pain intensity/severity. Analyses included all patients with available data. In total, 17 (68%) continued to wear their vests for 6 months, whereas the other 8 withdrew prematurely. At baseline, median pain severity (4.9, interquartile range [IQR] 3.6-6.0) and pain interference (4.3, IQR 2.1-5.9) scores were significantly higher compared with pain scores after wearing the compression vest for 6 months (1.8 IQR 1.0-4.8 and 1.4 IQR 0.9-4.4, resp.). Patient-reported breast/chest wall swelling decreased from 92% (n = 22) at baseline to 71% (n = 12) at 6 months. The prevalence of moderate/severe patient-reported breast/chest wall pain declined from 63% (n = 15) at baseline to 18% (n = 3) at 6 months. Physical, emotional, and social functioning improved over time and was comparable to scores of the Dutch reference population. Conclusion: The results of this pilot study suggest that a compression vest could be an acceptable and effective treatment option for patients with painful breast/chest wall edema. In compliant patients, swelling and pain was significantly reduced.

[Importance of adequate pressure in compression therapy : Basis for successful treatment]

BACKGROUND

The pressure exerted by a compression device on a part of the body corresponds to the dosage of the compression therapy. Therefore, the pressure course under compression materials should be investigated in different clinical situations.

MATERIAL AND METHODS

Pressure measurements were carried out under different compression materials in lying, standing and walking positions within the framework of training, self-experimentation and in patients with venous leg ulcers.

RESULTS

The results showed that the pressure varied considerably depending on the material used, the firmness of application, the local configuration (body position) and the time interval between applications. A loss of pressure occurred under each compression therapy, especially under inelastic short-stretch material, mainly due to movement and edema reduction. This pressure loss is decisive for the timing of dressing changes and a reason for the good tolerance of high-pressure levels in mobile patients.

CONCLUSION

Low pressures are particularly suitable for edema reduction. Hemodynamic effects require higher pressures (60-80 mmHg). For this purpose, inelastic materials are preferred which enable lower pressures when lying down (40-60 mmHg). As compression bandages are too loosely applied by many users, pressure indicators on bandages or adaptive bandages with templates are helpful to apply the material with the correct pressure. As a consequence of these findings it is postulated that, at least in studies comparing different compression media, pressure measurements should be carried out in the future, whereby the measuring point and body position should be documented.

Controlling compression bandaging pressure in leg ulcer research trials: A summary of the literature

Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.

Compression Garments for Medical Therapy and Sports

Compression garments are elastic clothing with an engineered compression gradient that can be worn on limbs, upper, lower, or full body to use for therapy and sports. This article presents an overview and review on the compression garments and concentrates on the design of compression garments with an appropriate pressure for specific applications. It covers the types of compression garments, fibers and yarns, knitted fabric construction, garment design, an evaluation system, and pressure measurement and modeling. The material properties, fabric properties, pressure modeling, and the garment design system presents the prediction, design, and fabrication of the compression garments. Lastly, the research status and directions are discussed.

Evaluation of Flexible Force Sensors for Pressure Monitoring in Treatment of Chronic Venous Disorders

The recent use of graduated compression therapy for treatment of chronic venous disorders such as leg ulcers and oedema has led to considerable research interest in flexible and low-cost force sensors. Properly applied low pressure during compression therapy can substantially improve the treatment of chronic venous disorders. However, achievement of the recommended low pressure levels and its accurate determination in real-life conditions is still a challenge. Several thin and flexible force sensors, which can also function as pressure sensors, are commercially available, but their real-life sensing performance has not been evaluated. Moreover, no researchers have reported information on sensor performance during static and dynamic loading within the realistic test conditions required for compression therapy. This research investigated the sensing performance of five low-cost commercial pressure sensors on a human-leg-like test apparatus and presents quantitative results on the accuracy and drift behaviour of these sensors in both static and dynamic conditions required for compression therapy. Extensive experimental work on this new human-leg-like test setup demonstrated its utility for evaluating the sensors. Results showed variation in static and dynamic sensing performance, including accuracy and drift characteristics. Only one commercially available pressure sensor was found to reliably deliver accuracy of 95% and above for all three test pressure points of 30, 50 and 70 mmHg.

Compression therapy - cross-sectional observational survey about knowledge and practical treatment of specialised and non-specialised nurses and therapists

Knowledge about methods and materials and their correct usage is the basis for compression therapy. This study compares knowledge and practical skills of participants with further training with those who had no training. This comparison provides information on whether further qualifications have an impact on knowledge and practical skills. In seminars for compression therapy, data on specific and non-specific expertise were acquired. A practical test determined the participants' skills for creating a compression bandage in a pressure value range of 50-60 mmHg. In total, 1338 participants with specific expertise and 138 participants with non-specific expertise took part. Knowledge evaluation showed that 7·9% of the specific expertise group had knowledge regarding padding, 10% regarding multi-component systems and 13·6% regarding ulcer stocking systems. In the practical test, 12·3% of all participants achieved the target range. The majority of users in both groups is not familiar with the different compression materials or their appropriate usage. In the non-specific expertise group, knowledge concerning up-to-date materials and methods is one-third lower. The practical test showed major deficits on both sides. Appropriate exercises, for example, with pressure-measuring devices, should be mandatory for all professional groups who perform compression bandaging.

Comparison of piezoresistive sensor to PicoPress® in in-vitro interface pressure measurement

Objective

Interface pressure, the sine qua non for compression therapy, is rarely measured in clinical practice and scientific research. The goal of this study aimed to compare and examine the accuracy between a commercially available piezoresistive sensor and PicoPress® (Microlab, Padua, Italy) using the cylinder cuff model to measure in-vitro interface pressure.

Method

Ten piezoresistive sensors were calibrated using the National Institute of Standard and Technology certified manometer, and compared to PicoPress® using cylinder cuff model from 20 to 120 mmHg. Two statistical analyses were performed: (a) two-sample t-test to compare the front to back surface of the piezoresistive sensors using mean pressure value and (b) one-sample paired t-test to compare the front and back surface of the piezoresistive sensors to PicoPress® and true pressure using mean pressure value.

Result

There was no difference in interface pressure measurement between the front and back surface of the piezoresistive sensors (P > 0.05). Using mean pressure value, there was no significant difference between the front surface, back surface of the piezoresistive sensors, and PicoPress® (P > 0.05). Standard deviation was larger for the piezoresistive sensors than PicoPress® at any given pressure and this difference was more pronounced in the higher pressure range.

Conclusion

Piezoresistive sensor may represent a viable alternative to PicoPress® in interface pressure measurement.

Immediate effects of active exercise with compression therapy on lower-limb lymphedema

Purpose

Active exercise with compression therapy (AECT) is a standard treatment for gynecological cancer-related lower-limb lymphedema (LLL) in clinical situations. However, there is insufficient evidence regarding the immediate effects of the use of AECT on LLL. The purpose of this study was to evaluate the immediate effects of AECT on LLL.

Methods

Participants in this randomized controlled crossover trial comprised 23 women with LLL who completed high-load AECT, low-load AECT, and compression-only therapy (CT). AECT was performed on a bicycle ergometer with short stretch bandages. Each intervention was performed for 15 min, with successive interventions separated by a 1-week washout period. Lower-limb volume was assessed using a Perometer™ sensor (Pero-system, Wuppertal, Germany). General symptoms (pain and heaviness) and skin symptoms (pitting and stiffness) were assessed using a visual analog scale and palpation, respectively. Measurements were taken before and after each intervention. Analysis of variance using linear mixed-effect modeling was used for statistical analyses.

Results

Volume decrement differed significantly between all three interventions (P < 0.05). Lower-limb volume was significantly reduced after high-load AECT compared to that after CT. General symptoms and skin symptoms were similar across the three interventions, but severity of pre-intervention skin symptoms correlated significantly with volume decrement after high- and low-load AECT. High-load AECT using the bicycle ergometer was more effective than CT for decreasing lower-limb volume.

Conclusions

These results suggest that high-load AECT has marked effects on severe LLL.

A high-resolution tape sensor improves the accuracy of applied pressure profiles during lower-leg bandaging - results from a study using a fibre-optic sensing tape

Compression bandaging is a mainstay practice in the treatment of conditions such as chronic wounds and lymphoedema. However, the ability of practitioners to measure bandage application to a desired pressure profile is difficult because of sensor limitations. We have used a novel fibre-optic-based, high-resolution sub-bandage pressure monitor to measure adherence to a target pressure gradient during compression bandaging. Participants of various experience (n = 46) were asked to bandage a lower-leg manikin to a gradient of 40 (ankle) to 20 mmHg (proximal calf) in both a blinded trial and subsequently with sensor feedback. Mean pressures across all sensors for both the blind and sensor-guided trials approximated a target mean of 30 mmHg. However, the mean gradient achieved in the blinded trial showed an inverse pressure gradient to the target with a high-pressure region at the mid-calf (44 ± 19 mmHg). Correlation to the target gradient improved from R² = 0·62 during the blind trial to 0·93 using sensor feedback, with a gradient that closely approximated the target. This demonstrates the use of high-resolution sub-bandage pressure sensing in improving the ability of practitioners to achieve a target pressure gradient in compression bandaging for clinical use and training.

A systematic review of the compression regimes used in randomised clinical trials following endovenous ablation

Objectives

There is insufficient evidence to inform guidelines on the optimal compression strategy following ablation for varicose veins. This study aimed to identify the practice of key opinion leaders performing randomised clinical trials involving endovenous ablation.

Method

A systematic review of MEDLINE/EMBASE/CENTRAL was performed identifying the compression strategies used in randomised clinical trials where at least one comparator arm underwent endovenous ablation.

Results

Thirty-four randomised clinical trials were identified. At least 14 different compression products were used, with at least 6 different pressures in 7 different regimes with durations from 2 to 84 days. There was no evidence of any convergence of practice over time.

Conclusions

A lack of evidence as to the optimal strategy for compression has resulted in a marked variation in clinical practice. There is no suggestion that this variation is becoming less over time indicating that experience is not helping to form a consensus and, therefore, further research is required.

Interventions for helping people adhere to compression treatments for venous leg ulceration

BACKGROUND

Chronic venous ulcer healing is a complex clinical problem that requires intervention from skilled, costly, multidisciplinary wound-care teams. Compression therapy has been shown to help heal venous ulcers and to reduce recurrence. It is not known which interventions help people adhere to compression treatments. This review is an update of a previous Cochrane review.

OBJECTIVES

To assess the benefits and harms of interventions designed to help people adhere to venous leg ulcer compression therapy, to improve healing and prevent recurrence after healing.

SEARCH METHODS

In June 2015, for this first update, we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched trial registries, and reference lists of relevant publications for published and ongoing trials. There were no language or publication date restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of interventions that aim to help people with venous leg ulcers adhere to compression treatments compared with usual care, or no intervention, or another active intervention. Our main outcomes were ulcer healing, ulcer recurrence, quality of life, pain, adherence to compression therapy and number of people with adverse events.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias of each included trial, and assessed overall quality of evidence for the main outcomes in 'Summary of findings' tables.

MAIN RESULTS

One randomised controlled trial was added to this update making a total of three. One ongoing study was also identified.One trial (67 participants) compared a community-based Leg Club® that provided mechanisms for peer-support, assistance with goal setting and social interaction with home-based care. There was no clear difference in healing rates at three months (12/28 people healed in Leg Club group versus 7/28 in home-based care group; risk ratio (RR) 1.71, 95% confidence interval (CI) 0.79 to 3.71); or six months (15/33 healed in Leg Club group versus 10/34 in home-based care group; RR 1.55, 95% CI 0.81 to 2.93); or in quality of life outcomes at six months (MD 0.85 points, 95% CI -0.13 to 1.83; 0 to 10 point scale). The Leg Club may lead to a small reduction in pain at six months, that may not be clinically significant (MD -12.75 points, 95% CI -24.79, -0.71; 0 to 100 point scale, 15 point reduction is usually considered the minimal clinically important difference) (low quality evidence downgraded for risk of selection bias and imprecision).Another trial (184 participants) compared a community-based, nurse-led self-management programme of six months' duration promoting physical activity (walking and leg exercises) and adherence to compression therapy via counselling and behaviour modification (Lively Legs®) with usual care in a wound clinic. At 18 months follow-up, there were no clear differences in healing rates (51/92 healed in Lively Legs group versus 41/92 in usual care group; RR 1.24 (95% CI 0.93 to 1.67)); rates of recurrence of venous leg ulcers (32/69 with recurrence in Lively Legs group versus 38/67 in usual care group; RR 0.82 (95% CI 0.59 to 1.14)); or adherence to compression therapy (42/92 people fully adherent in Lively Legs group versus 41/92 in usual care group; RR 1.02 (95% CI 0.74 to 1.41)). The evidence from this trial was also downgraded to low quality due to risk of selection bias and imprecision.A single study compared patient education delivered via video with education delivered by text (pamphlet). However, no outcomes relevant to this review were reported.We found no studies that investigated other interventions to promote adherence to compression therapy.

AUTHORS' CONCLUSIONS

It is unclear whether interventions designed to help people adhere to compression therapy improve venous ulcer healing and reduce recurrence. There is a lack of trials of interventions that promote adherence to compression therapy for venous ulcers.

Effect of three-size too large strong stocking on venous hemodynamics in normal subjects

OBJECTIVES

To study the differences in impact on venous hemodynamics between larger size strong graduated elastic compression stockings (GECS) and appropriate size strong/moderate GECS.

METHOD

In healthy legs fitted for a small (Group S; n = 8) and large (Group L; n = 8) GECS, air plethysmography was performed without GECS, with an appropriate size strong GECS (GECS1), with a three-size too large strong GECS (GECS2), and with an appropriate size moderate GECS (GECS3) in this order.

RESULTS

In Group S, interface pressure with GECS2 was equal to or higher than that with GECS3. Decreased venous volume, unchanged ejection volume, and decreased residual volume were achieved by GECS, but differences in these parameters among GECS were not observed. Although insignificant, a similar tendency was found in Group L.

CONCLUSIONS

A larger size strong GECS seemed to have equivalent interface pressure and impact on venous hemodynamics compared to an appropriate size moderate or strong GECS.

A novel compression garment with adhesive silicone stripes improves repeated sprint performance - a multi-experimental approach on the underlying mechanisms

Background

Repeated sprint performance is determined by explosive production of power, as well as rapid recovery between successive sprints, and there is evidence that compression garments and sports taping can improve both of these factors.

Methods

In each of two sub-studies, female athletes performed two sets of 30 30-m sprints (one sprint per minute), one set wearing compression garment with adhesive silicone stripes (CGSS) intended to mimic taping and the other with normal clothing, in randomized order. Sub-study 1 (n = 12) focused on cardio-respiratory, metabolic, hemodynamic and perceptual responses, while neuronal and biomechanical parameters were examined in sub-study 2 (n = 12).

Results

In both sub-studies the CGSS improved repeated sprint performance during the final 10 sprints (best P < 0.01, d = 0.61). None of the cardio-respiratory or metabolic variables monitored were altered by wearing this garment (best P = 0.06, d = 0.71). Also during the final 10 sprints, rating of perceived exertion by the upper leg muscles was reduced (P = 0.01, d = 1.1), step length increased (P = 0.01, d = 0.91) and activation of the m. rectus femoris elevated (P = 0.01, d = 1.24), while the hip flexion angle was lowered throughout the protocol (best P < 0.01, d = 2.28) and step frequency (best P = 0.34, d = 0.2) remained unaltered.

Conclusion

Although the physiological parameters monitored were unchanged, the CGSS appears to improve performance during 30 30-m repeated sprints by reducing perceived exertion and altering running technique.

Compression for the management of venous leg ulcers: which material do we have?

Compression therapy is the most important basic treatment modality in venous leg ulcers. The review focusses on the materials which are used: 1. Compression bandages, 2. Compression stockings, 3. Self-adjustable Velcro-devices, 4. Compression pumps, 5. Hybrid devices. Compression bandages, usually applied by trained staff, provide a wide spectrum of materials with different elastic properties. To make bandaging easier, safer and more effective, most modern bandages combine different material components. Self-management of venous ulcers has become feasible by introducing double compression stockings ("ulcer kits") and self-adjustable Velcro devices. Compression pumps can be used as adjunctive measures, especially for patients with restricted mobility. The combination of sustained and intermittent compression ("hybrid device") is a promising new tool. The interface pressure corresponding to the dosage of compression therapy determines the hemodynamic efficacy of each device. In order to reduce ambulatory venous hypertension compression pressures of more than 50 mm Hg in the upright position are desirable. At the same time pressure should be lower in the resting position in order to be tolerated. This prerequisite may be fulfilled by using inelastic, short stretch material including multicomponent bandages and cohesive surfaces, all characterized by high stiffness. Such materials do not give way when calf muscles contract during walking which leads to high peaks of interface pressure ("massaging effect").

The Role of Leg Compression in the Treatment of Deep Vein Thrombosis

Up until today mobile outpatients are put into bed as soon as the diagnosis of deep vein thrombosis (DVT) is made. Fear of pulmonary embolism (PE) is the main rationale for bed-rest; additional arguments are pain and swelling which are expected to resolve faster during leg elevation. Based on previous work it is demonstrated that keeping mobile patients with acute DVT walking under exact anticoagulation does not increase the risk for symptomatic PE in comparison with bed-rest and that there is an immediate reduction of pain and swelling when good compression is applied and the patient is encouraged to walk. Immediate compression and walking seems also to reduce the incidence of a postthrombotic syndrome. One presumed mechanism of action of this adjunct treatment modality is the increase of shear stress in the microcirculation of the vein wall releasing anti-inflammatory and anti-coagulatory mediators.

Relationship between medical compression and intramuscular pressure as an explanation of a compression paradox

Background

Using standing magnetic resonance imaging (MRI), we recently showed that medical compression, providing an interface pressure (IP) of 22 mmHg, significantly compressed the deep veins of the leg but not, paradoxically, superficial varicose veins.

Objective

To provide an explanation for this compression paradox by studying the correlation between the IP exerted by medical compression and intramuscular pressure (IMP).

Material and methods

In 10 legs of five healthy subjects, we studied the effects of different IPs on the IMP of the medial gastrocnemius muscle. The IP produced by a cuff manometer was verified by a Picopress® device. The IMP was measured with a 21G needle connected to a manometer. Pressure data were recorded in the prone and standing positions with cuff manometer pressures from 0 to 50 mmHg.

Results

In the prone position, an IP of less than 20 did not significantly change the IMP. On the contrary, a perfect linear correlation with the IMP ( r = 0.99) was observed with an IP from 20 to 50 mmHg. We found the same correlation in the standing position.

Conclusion

We found that an IP of 22 mmHg produced a significant IMP increase from 32 to 54 mmHg, in the standing position. At the same time, the subcutaneous pressure is only provided by the compression device, on healthy subjects. In other words, the subcutaneous pressure plus the IP is only a little higher than 22 mmHg—a pressure which is too low to reduce the caliber of the superficial veins. This is in accordance with our standing MRI 3D anatomical study which showed that, paradoxically, when applying low pressures (IP), the deep veins are compressed while the superficial veins are not.

Evaluation of lower limb vein biomechanical properties and the effects of compression stockings, with an instrumented ultrasound probe

We present a new approach for the evaluation of the biomechanical properties of lower limb veins based on the simultaneous measurements of the vein cross-sectional area with B-mode ultrasound imaging and of the force exerted on the skin by the ultrasound probe. Ongoing clinical trials allowed us to identify a behavioral model of lower limb veins without and with compression stockings.

Study on different bandages and application techniques for achieving stiffer compression

OBJECTIVES

The objective of this study was to investigate the relationship between interface pressure and stiffness of compression achieved by various combinations of bandages and application techniques.

METHOD

There were eight healthy volunteers. One roll (4.5 m) of four types of bandages with different extensibilities (0, 90, 108 and 218%) was applied to the leg in single-layer bandage fashion with eight random tensions. Then, the leg was wrapped with one to eight rolls in multi-layer bandage fashion.

RESULTS

Each combination of bandage and application technique displayed an indigenous linear interface pressure-static stiffness index relationship. With single-layer bandage, lower extensibility was associated with higher static stiffness index at a given interface pressure. With multi-layer bandage, the static stiffness index at a given interface pressure was independent of the bandage type.

CONCLUSION

The stiffness at a given interface pressure was affected by the extensibility with single-layer bandage but not with multi-layer bandage.

Dogmas and controversies in compression therapy: report of an International Compression Club (ICC) meeting, Brussels, May 2011

The International Compression Club (ICC) is a partnership between academics, clinicians and industry focused upon understanding the role of compression in the management of different clinical conditions. The ICC meet regularly and from these meetings have produced a series of eight consensus publications upon topics ranging from evidence-based compression to compression trials for arm lymphoedema. All of the current consensus documents can be accessed on the ICC website (http://www.icc-compressionclub.com/index.php). In May 2011, the ICC met in Brussels during the European Wound Management Association (EWMA) annual conference. With almost 50 members in attendance, the day-long ICC meeting challenged a series of dogmas and myths that exist when considering compression therapies. In preparation for a discussion on beliefs surrounding compression, a forum was established on the ICC website where presenters were able to display a summary of their thoughts upon each dogma to be discussed during the meeting. Members of the ICC could then provide comments on each topic thereby widening the discussion to the entire membership of the ICC rather than simply those who were attending the EWMA conference. This article presents an extended report of the issues that were discussed, with each dogma covered in a separate section. The ICC discussed 12 'dogmas' with areas 1 through 7 dedicated to materials and application techniques used to apply compression with the remaining topics (8 through 12) related to the indications for using compression.

Is leg compression beneficial for alpine skiers?

BACKGROUND

This study examined the effects of different levels of compression (0, 20 and 40 mmHg) produced by leg garments on selected psycho-physiological measures of performance while exposed to passive vibration (60 Hz, amplitude 4-6 mm) and performing 3-min of alpine skiing tuck position.

METHODS

Prior to, during and following the experiment the electromygraphic (EMG) activity of different muscles, cardio-respiratory data, changes in total hemoglobin, tissue oxygenation and oscillatory movement of m. vastus lateralis, blood lactate and perceptual data of 12 highly trained alpine skiers were recorded. Maximal isometric knee extension and flexion strength, balance, and jumping performance were assessed before and after the experiment.

RESULTS

The knee angle (-10°) and oscillatory movement (-20-25.5%) were lower with compression (P < 0.05 in all cases). The EMG activities of the tibialis anterior (20.2-28.9%), gastrocnemius medialis (4.9-15.1%), rectus femoris (9.6-23.5%), and vastus medialis (13.1-13.7%) muscles were all elevated by compression (P < 0.05 in all cases). Total hemoglobin was maintained during the 3-min period of simulated skiing with 20 or 40 mmHg compression, but the tissue saturation index was lower (P < 0.05) than with no compression. No differences in respiratory parameters, heart rate or blood lactate concentration were observed with or maximal isometric knee extension and flexion strength, balance, and jumping performance following simulated skiing for 3 min in the downhill tuck position were the same as in the absence of compression.

CONCLUSIONS

These findings demonstrate that with leg compression, alpine skiers could maintain a deeper tuck position with less perceived exertion and greater deoxygenation of the vastus lateralis muscle, with no differences in whole-body oxygen consumption or blood lactate concentration. These changes occurred without compromising maximal leg strength, jumping performance or balance. Accordingly, our results indicate that the use of lower leg compression in the range of 20-40 mmHg may improve alpine skiing performance by allowing a deeper tuck position and lowering perceived exertion.

An optical fiber Bragg grating force sensor for monitoring sub-bandage pressure during compression therapy

Graduated compression bandaging of the lower limbs is the primary therapy for venous leg ulcers with its efficacy believed to be predominantly dependent on the amount and the distribution of the compressive pressure applied. There has been on-going demand for an ideal sensor to facilitate in-vivo monitoring of the sub-bandage pressure. Several methods and devices have been reported but each has its limitations, such as bulkiness, low tolerance to movement, susceptible to thermal noise and single point sensing. An optical fiber force sensor is demonstrated, consisting of two arrays of fiber Bragg grating (FBG) entwined in a double helix form and packaged with contact-force sensitivity. This sensor array has inherent temperature immunity and is capable of real-time, distributed sensing of sub-bandage pressure. The calibration results of the sensor array, as well as the validation human trial results, are presented.

Squeezing the muscle: compression clothing and muscle metabolism during recovery from high intensity exercise

The purpose of this experiment was to investigate skeletal muscle blood flow and glucose uptake in m. biceps (BF) and m. quadriceps femoris (QF) 1) during recovery from high intensity cycle exercise, and 2) while wearing a compression short applying ∼37 mmHg to the thigh muscles. Blood flow and glucose uptake were measured in the compressed and non-compressed leg of 6 healthy men by using positron emission tomography. At baseline blood flow in QF (P = 0.79) and BF (P = 0.90) did not differ between the compressed and the non-compressed leg. During recovery muscle blood flow was higher compared to baseline in both compressed (P<0.01) and non-compressed QF (P<0.001) but not in compressed (P = 0.41) and non-compressed BF (P = 0.05; effect size = 2.74). During recovery blood flow was lower in compressed QF (P<0.01) but not in BF (P = 0.26) compared to the non-compressed muscles. During baseline and recovery no differences in blood flow were detected between the superficial and deep parts of QF in both, compressed (baseline P = 0.79; recovery P = 0.68) and non-compressed leg (baseline P = 0.64; recovery P = 0.06). During recovery glucose uptake was higher in QF compared to BF in both conditions (P<0.01) with no difference between the compressed and non-compressed thigh. Glucose uptake was higher in the deep compared to the superficial parts of QF (compression leg P = 0.02). These results demonstrate that wearing compression shorts with ∼37 mmHg of external pressure reduces blood flow both in the deep and superficial regions of muscle tissue during recovery from high intensity exercise but does not affect glucose uptake in BF and QF.

Elastic multilayer bandages for chronic venous insufficiency: features of our technique

OBJECTIVES

To evaluate the interface pressure (IP) and stiffness of our elastic multilayer bandages (eMLB).

METHODS

Three medical staff wrapped the legs of 10 healthy volunteers with one to six rolls of elastic bandages. The IP was measured at the medial aspect of the lower leg at the level of transposition of the medial gastrocnemius muscle into the Achilles tendon (level of B1) with the patient supine and then standing, for each number of bandages worn. The static stiffness index (SSI) was calculated as a difference between these IPs.

RESULTS

The IPs in the standing position increased linearly for up to five bandages (21.8 ± 7.2, 32.5 ± 6.1, 41.8 ± 8.5, 52.0 ± 10.4, 60.3 ± 11.8, and 66.7 ± 13.4 mmHg, with one to six bandages). SSI also increased linearly for up to five bandages (6.8 ± 5.1, 10.2 ± 4.8, 13.4 ± 7.2, 17.4 ± 8.8, 19.7 ± 9.1, and 20.4 ± 9.4 mmHg, with one to six bandages). No significant technical variation in the IP was observed among the three operators.

CONCLUSIONS

Our eMLB provided stable, predictable and sufficient IPs and SSIs in healthy volunteers.

Prospective, randomized, controlled trial comparing the effectiveness of adjustable compression Velcro wraps versus inelastic multicomponent compression bandages in the initial treatment of leg lymphedema

BACKGROUND

Inelastic multicomponent compression (ICM) bandages applied by specialized medical staff are the standard of care for compression therapy of lymphedema of the extremities. However, new adjustable compression wraps (ACWs), which can be applied by patients themselves and, up to now, have been mainly recommended for the maintenance treatment phase of lymphedema, may be an important step toward the self-management of the initial treatment phase.

METHODS

This prospective, randomized, controlled comparative study assessed the effectiveness of an ACW in the treatment of leg lymphedema, compared with the traditional treatment with conventional IMC bandages. Included were 30 hospitalized patients admitted due to moderate to severe unilateral lymphedema (stages 2-3) of the leg. The primary outcome measures in both groups were reduction in volume of the affected leg and interface pressure after 2 and 24 hours. Patients were randomized into two groups of 15 patients: group A received ACW and group B received IMC bandages, both applied by experienced staff. After 2 hours, the staff replaced IMC bandages and the patients applied ACW, as previously instructed. Finally, compression was removed after 24 hours. Classic water displacement volumetry was performed before compression and after 2 hours and after 24 hours of compression. The interface pressure was measured immediately after application of compression, 2 hours after compression, before and after compression renewal, and finally, after 24 hours. Patients in the ACW group were allowed to adjust the wrap themselves when they considered it necessary.

RESULTS

The reduction in median volume after 2 hours was 109 mL (interquartile range [IQR], 64-271 mL; -3.1%) in the ACW group and 75 mL (IQR, 41-135; -2.4%) in the IMC group (not significant). After 24 hours, the reduction in median volume was 339 mL (IQR, 231-493 mL; -10.3%) in the ACW group and 190 mL (IQR, 113-296 mL; -5.9%) in the IMC group (P < .05). The interface pressure dropped significantly after 2 and 24 hours in the IMC group (-50% and -6%), but significantly less in the ACW group (-26% and -44%), mainly due to self-readjustment. The median pressures achieved after self-application of ACW (52 mm Hg; IQR, 44-61 mm Hg) were of the same order as those produced by the nurses after the first application of ACW (53 mm Hg; IQR, 39-59 mm Hg), with less variation.

CONCLUSIONS

In patients with moderate to severe lymphedema of the legs, ACW achieved a significantly more pronounced reduction in volume after 24 hours than IMC bandages. Patients were able to apply and adjust the device after being instructed in its use and after an initial 2-hour period of wear. Autonomous handling of ACW seemed to improve the clinical outcome and is a promising step toward self-management involving effective compression.

Effect of gaiters on muscle pump activity in healthy volunteers

OBJECTIVES

Exercise of the leg with external limb compression has been reported to be useful for preventing and reducing leg oedema. The aim of this study was to investigate the effects of leg gaiters on calf muscle pump activity.

METHODS

Continuous measurements of the interface pressure at the leg during exercise and determination of the femoral venous velocity at the groin during exercise were carried out in healthy volunteers with elastic stockings alone, leg gaiters alone and gaiters over the elastic stockings.

RESULTS

The greatest pressure difference between muscle contraction and relaxation during exercise was observed when gaiters were applied over the elastic stockings at the calf. Gaiters alone without elastic stockings led to a significantly greater pressure difference between muscle contraction and relaxation during exercise than elastic stockings alone (P < 0.01). A significantly higher value of the peak flow velocity of the femoral vein was observed with the combined use of gaiters and elastic stockings than the single use of elastic stockings.

CONCLUSIONS

Leg gaiters have a beneficial effect of augmenting venous femoral blood flow during calf muscle pump activity in volunteers with a normal valve function of leg veins.

Compression therapy: clinical and experimental evidence

AIM

A review is given on the different tools of compression therapy and their mode of action.

METHODS

Interface pressure and stiffness of compression devices, alone or in combination can be measured in vivo. Hemodynamic effects have been demonstrated by measuring venous volume and flow velocity using MRI, Duplex and radioisotopes, venous reflux and venous pumping function using plethysmography and phlebodynamometry. Oedema reduction can be measured by limb volumetry.

RESULTS

Compression stockings exerting a pressure of ~20 mmHg on the distal leg are able to increase venous blood flow velocity in the supine position and to prevent leg swelling after prolonged sitting and standing. In the upright position, an interface pressure of more than 50 mmHg is needed for intermittent occlusion of incompetent veins and for a reduction of ambulatory venous hypertension during walking. Such high intermittent interface pressure peaks exerting a "massaging effect" may rather be achieved by short stretch multilayer bandages than by elastic stockings.

CONCLUSION

Compression is a cornerstone in the management of venous and lymphatic insufficiency. However, this treatment modality is still underestimated and deserves better understanding and improved educational programs, both for patients and medical staff.