Classification of compression bandages: practical aspects

Continuous muscle pump activation by neuromuscular electrical stimulation of the common peroneal nerve in the treatment of patients with venous leg ulcers: A position paper

The standard treatment for patients with confirmed Venous Leg Ulcers (VLUs) is compression therapy to improve the function of the calf muscle pump. There is a significant cohort of patients who are unable to tolerate optimal compression therapy or indeed any level of compression therapy. In addition, there is a cohort of patients who can tolerate compression whose ulcers show little or no evidence of healing. There is a need for ways to further improve calf muscle pump function and to improve venous ulcer healing in these patients. Published data were reviewed on the use of Muscle Pump Activation (MPA) using common peroneal nerve neuromuscular electrical stimulation (NMES) to improve calf muscle pump function. There is physiological evidence that MPA can improve calf muscle pump function and venous return in both control subjects and in patients with venous disease. The use of MPA has also been shown to improve venous flow volume and venous flow velocity on ultrasound scanning in patients with venous disease. MPA has been shown to improve microcirculation in the skin using Laser Doppler and laser Doppler Speckle Contrast Imaging, in both normal subjects as well as in patients with venous disease and VLU. A recent randomized controlled trial of MPA plus compression therapy compared with compression therapy alone, found significantly faster rates of healing with the use of MPA in addition to compression therapy. There are indications for the use of MPA as an adjunctive treatment to enhance calf muscle pump function in patients with VLU: who cannot tolerate compression therapy who can only tolerate suboptimal, low-level compression whose ulcer healing remains slow or stalled with optimal compression.

Extremity Pressure in Splints Wrapped With an Elastic Bandage Versus Bias Cut Stockinette: An Experimental Model

BACKGROUND

Many variables affect the pressure caused by splinting or casting. The purpose of this study was to compare pressure underlying a splint wrapped with either an elastic bandage or a bias cut stockinette.

METHODS

Thirty-two plaster volar resting splints were applied to a simulated extremity with a saline bag secured to it. A pressure transducer was connected to the saline bag to monitor changes in pressure once splints were applied, and 15 mL increments of saline were added to the bag to simulate swelling. Each dressing type was tested with normal application and tight application.

RESULTS

Normal application splints wrapped with either bias cut stockinette or an elastic bandage demonstrated similar initial splint pressures (P = .81). With simulated swelling, splints wrapped with bias cut stockinette demonstrated a 15 mmHg (95% confidence interval [CI], 1.5-28.5) higher average pressure than those wrapped with an elastic bandage (P = .035). Tight application splints with an elastic bandage wrap demonstrated a 46 mmHg (95% CI, 16-77) higher initial splint pressure than those wrapped with bias cut stockinette (P = .009).

CONCLUSIONS

Splints wrapped using either an elastic bandage or bias cut stockinette appear to have a similar safety profile, although in cases of excessive swelling, an elastic bandage may provide additional compliance. Tight splint application appears to be more hazardous with the use of an elastic bandage compared with a bias cut stockinette. Further study of the use of elastic bandages and bias cut stockinettes in the clinical setting may be warranted.

Compression for preventing recurrence of venous ulcers

BACKGROUND

Up to 1% of adults will have a leg ulcer at some time. Most leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or damaged valves. Venous ulcer prevention and treatment typically involves the application of compression bandages/stockings to improve venous return and thus reduce pressure in the legs. Other treatment options involve removing or repairing veins. Most venous ulcers heal with compression therapy, but ulcer recurrence is common. For this reason, clinical guidelines recommend that people continue with compression treatment after their ulcer has healed. This is an update of a Cochrane review first published in 2000 and last updated in 2014.

OBJECTIVES

To assess the effects of compression (socks, stockings, tights, bandages) for preventing recurrence of venous leg ulcers.

SEARCH METHODS

In August 2023, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, three other databases, and two ongoing trials registries. We also scanned the reference lists of included studies and relevant reviews and health technology reports. There were no restrictions on language, date of publication, or study setting.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that evaluated compression bandages or hosiery for preventing the recurrence of venous ulcers.

DATA COLLECTION AND ANALYSIS

At least two review authors independently selected studies, assessed risk of bias, and extracted data. Our primary outcome was reulceration (ulcer recurrence anywhere on the treated leg). Our secondary outcomes included duration of reulceration episodes, proportion of follow-up without ulcers, ulceration on the contralateral leg, noncompliance with compression therapy, comfort, and adverse effects. We assessed the certainty of evidence using GRADE methodology.

MAIN RESULTS

We included eight studies (1995 participants), which were published between 1995 and 2019. The median study sample size was 249 participants. The studies evaluated different classes of compression (UK class 2 or 3 and European (EU) class 1, 2, or 3). Duration of follow-up ranged from six months to 10 years. We downgraded the certainty of the evidence for risk of bias (lack of blinding), imprecision, and indirectness. EU class 3 compression stockings may reduce reulceration compared with no compression over six months (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.27 to 0.76; 1 study, 153 participants; low-certainty evidence). EU class 1 compression stockings compared with EU class 2 compression stockings may have little or no effect on reulceration over 12 months (RR 1.70, 95% CI 0.67 to 4.32; 1 study, 99 participants; low-certainty evidence). There may be little or no difference in rates of noncompliance over 12 months between people using EU class 1 stockings and people using EU class 2 stockings (RR 1.22, 95% CI 0.40 to 3.75; 1 study, 99 participants; low-certainty evidence). UK class 2 hosiery compared with UK class 3 hosiery may be associated with a higher risk of reulceration over 18 months to 10 years (RR 1.55, 95% CI 1.26 to 1.91; 5 studies, 1314 participants; low-certainty evidence). People who use UK class 2 hosiery may be more compliant with compression treatment than people who use UK class 3 hosiery over 18 months to 10 years (RR for noncompliance 0.69, 95% CI 0.49 to 0.99; 5 studies, 1372 participants; low-certainty evidence). There may be little or no difference between Scholl UK class 2 compression stockings and Medi UK class 2 compression stockings in terms of reulceration (RR 0.77, 95% CI 0.47 to 1.28; 1 study, 166 participants; low-certainty evidence) and noncompliance (RR 0.97, 95% CI 0.84.1 to 12; 1 study, 166 participants; low-certainty evidence) over 18 months. No studies compared different lengths of compression (e.g. below-knee versus above-knee), and no studies measured duration of reulceration episodes, ulceration on the contralateral leg, proportion of follow-up without ulcers, comfort, or adverse effects.

AUTHORS' CONCLUSIONS

Compression with EU class 3 compression stockings may reduce reulceration compared with no compression over six months. Use of EU class 1 compression stockings compared with EU class 2 compression stockings may result in little or no difference in reulceration and noncompliance over 12 months. UK class 3 compression hosiery may reduce reulceration compared with UK class 2 compression hosiery; however, higher compression may lead to lower compliance. There may be little to no difference between Scholl and Medi UK class 2 compression stockings in terms of reulceration and noncompliance. There was no information on duration of reulceration episodes, ulceration on the contralateral leg, proportion of follow-up without ulcers, comfort, or adverse effects. More research is needed to investigate acceptable modes of long-term compression therapy for people at risk of recurrent venous ulceration. Future trials should consider interventions to improve compliance with compression treatment, as higher compression may result in lower rates of reulceration.

Comparative Efficacy of Postoperative Compression Methods After EVLT for Great Saphenous Vein Insufficiency

Introduction: The preference for endovascular techniques in treating varicose veins, particularly in the great saphenous vein (GSV), has increased due to their minimally invasive nature and reduced complications. Post-operative care, especially involving compression therapy, remains crucial to improve outcomes, prevent varicose vein recurrence, and enhance overall recovery. This study aimed to evaluate the efficacy of eccentric compression therapy compared to alternative post-operative care methods following endovenous laser treatment (EVLT) for GSV insufficiency. Methods: This prospective randomized clinical trial encompassed 88 EVLT procedures for GSV insufficiency. The participants were divided into two groups, each receiving different postoperative compression methods, and were evaluated over a specified period. The primary outcome was the pain scale after EVLT; meanwhile, the secondary outcome measured in the present study was the rate of GSV occlusion after EVLT. Results: Both groups underwent all EVLT procedures successfully without any complications. At the one-month duplex ultrasound (DUS) follow-up, the sapheno-femoral junction occlusion rates were 97% (43 out of 44) for group A (eccentric compression plus gradual compression stocking) and 95% (42 out of 44) for group B (only gradual compression stocking). Ecchymosis was observed in only 12 patients across both groups, accounting for an overall occurrence of 13.6%. Group A patients reported significantly lower analgesic usage (10%) compared to group B (18%), although this difference did not reach statistical significance. Analysis of postoperative pain data utilizing the visual analog scale (VAS) showed a median value of 5.5 in group B patients, which decreased to 3.1 with the application of eccentric compression. Moreover, there was less ecchymosis in group A observed by one week. Conclusion: This study contributes to the ongoing discourse on the efficacy of postoperative compression in varicose vein treatment. It underscores the necessity for more comprehensive, well-designed studies to yield clearer conclusions and provide better guidance for post-procedure care.

Kompressionstherapie in der Dermatologie

Die 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.

Complete decongestive therapy versus compression bandaging alone in advanced secondary lymphedema

Background. Secondary lymphedema results from a known insult to the lymphatic system. Worldwide, secondary lymphedema is more common than primary lymphedema. Compression therapy is the mainstay of management for all stages of lymphedema. Purpose. To compare between the effectiveness of compression bandaging (CB) alone to the international standard treatment of (CDT) in patients with advanced secondary lymphedema. Methods. Sixty patients of both genders with lower limb secondary lymphedema (stage II and III) aged from 40 to 55 years old, with body mass index (BMI) less than 35 and duration of illness ranged from 3-9 years were included in the study. They were randomly assigned into two groups of equal numbers. Group A: Thirty patients received CDT (Manual lymph drainage, CB, exercises, and skin care). Group B: Thirty patients received MCB using short stretch bandages alone. The treatment sessions consisted of twelve sessions, three times per week for a total duration of four weeks. The assessment of limb volume was done using water displacement method and truncated cone volumetric measurements (pre-treatment and after 12 sessions (post-treatment)). Results. Within both groups, there was a significant reduction in water displacement volumetric measurements pre vs. post treatment in groups (A& B) p-value = 0.0001, p-value = 0.0001 respectively. As well, there was a significant reduction in truncated cone lower extremity volumetric measurements between pre and post treatment in groups (A & B) p-value = 0.0001, p-value = 0.028 respectively. However, there were no significant differences in the mean values of water displacement volumetric measurements and truncated cone mean volumetric values between both groups (p = 0.835, p = 0.397) respectively. Conclusion. Compression bandaging alone is as effective as complete decongestive therapy in advanced secondary lymphedema.

Elective Hand Surgery in Patients With History of Axillary Node Dissection: Risks and Patient Education

Objective: To determine if patients with a prior history of axillary lymph node dissection (ALND) secondary to breast cancer surgery and other procedures are at an increased risk of postoperative complications including lymphedema and infection following elective upper extremity surgery. Furthermore, the study aimed to evaluate the extent of patient education regarding lymphedema as a possible complication of upper extremity surgery.

Methods: A review of 312 patients presenting to the clinic with upper extremity pathologies was performed of which 15 patients had a history of surgeries secondary to breast cancer and 297 had no prior history of breast cancer. Nine out of 15 patients with prior breast procedures and 66 out of 297 patients with no such history underwent elective hand surgeries, with 22 out of the 75 patients having a history of ALND. Incidences of postoperative complications including lymphedema and infection were recorded. Afterward, a survey inquiring about patient education was conducted to assess whether the patients were educated regarding lymphedema and if so, when and from whom they received the counseling.

Results: No patients with a prior history of ALND secondary to breast cancer or other surgeries developed a postoperative infection or onset of lymphedema, and no patients with preoperative lymphedema had any worsening of lymphedema or infection postoperatively. The survey conducted afterward revealed that 61% of the patients with a prior history of breast cancer-related procedures including lymph node dissection were never counseled regarding lymphedema as a possible complication of hand surgery. Furthermore, 75% of the survey participants wished they were given more information about possible causes and complications of, and ways to prevent or minimize the possibility of lymphedema developing postoperatively.

Conclusion: Prior history of ALND did not make patients more susceptible to postoperative complications, thus a history of isolated ALND or breast cancer surgery including ALND should not preclude elective hand surgical procedures from being performed ipsilaterally. Additionally, improvements in the degree of patient counseling regarding postoperative complications following hand surgery are needed as increased patient education is shown to be associated with a lower rate of complications and faster recovery times.

Investigating the microbial and metalloprotease sequestration properties of superabsorbent wound dressings

Exudate production is a natural part of the wound healing process, however levels of exudate need to be appropriately managed to maintain a moist wound environment which supports healing. An overly-exuding wound creates an environment favourable to bacterial growth. In recent years, a significant increase in commercially available superabsorbent dressings have become available which claim to absorb and retain excess exudate and its components. However, the effectiveness of these dressings in sequestering and retaining bacteria and host-derived proteins has not been compared. We have therefore investigated several superabsorbent dressings for their ability to absorb and retain bacteria (Staphylococcus aureus and Pseudomonas aeruginosa), their impact on bacterial viability, and their ability to sequester matrix metalloproteinases (MMP)-2 and 9 over 7 days. Whilst all dressings could sequester bacteria, some dressings internalised bacteria more effectively. There was considerable variation in bacterial viability within the dressings’ core, as well as differences in bacterial retention. Some dressings effectively internalised and retained bacteria over time, whereas other dressings retained significantly less. These differences were reflected visually using scanning electron microscopy. Most dressings fully sequestered MMP-2 and 9. These data illustrate differences in the ability of superabsorbent dressings to absorb and retain exudate and its components.

Treatment of chronic venous disorder: A comprehensive review

Chronic venous disorder (CVD) is highly prevalent vascular disorder affecting up to 45% of the general population, with clinical manifestations ranging from teleangiectasias to venous leg ulcers (VLUs). We examined the currently available data in order to provide an updated, comprehensive review on treatment options of CVD. We searched MEDLINE, Cochrane, Scopus, EMBASE, ClinicalTrials, and OpenGrey databases for relevant articles in English published until November 2020. Compression treatment is the mainstay of conservative treatment. Pharmacological treatment can provide significant symptomatic relief and hence it should be considered as part of conservative treatment. Transcutaneous Lacer treatment (TCL) is a safe and effective alternative option to sclerotherapy for treatment of C1 stage. High ligation and stripping (HL/S), ultrasound-guided foam sclerotherapy (UGFS), endovenous thermal ablation (EVTA) systems and non thermal non tumescent ablation (NTNT) systems are safe and efficacious first-line options for treatment of saphenous insufficiency. Interventional treatment of co-existing incompetent perforator veins (IPVs) is not supported by contemporary evidence. Regarding deep venous insufficiency (DVI), treatment of symptomatic femoroiliocaval occlusive venous disease refractory to conservative treatment with percutaneous transluminal venoplasty stenting has produced encouraging results.

Lymphatic Dysfunction Detected by Multi-lymphosome Indocyanine Green Lymphography and Lymphatic Ultrasound

Investigation into the cause of lower extremity edema is essential for successful treatment; however, it is sometimes difficult to diagnose. In this case report, we present a patient with bilateral lower extremity edema in whom abnormalities were detected with multi-lymphosome indocyanine green (ICG) lymphography and lymphatic ultrasound. An 87-year-old woman underwent total hysterectomy and pelvic lymphadenectomy for uterine cancer when she was 55 years old. Ten years ago, she was prescribed with a diuretic agent for bilateral edema of the lower extremities; however, the edema did not subside. Conventional general examination, including blood tests, electrocardiography, echocardiography, duplex ultrasound for the legs, and lymphoscintigraphy, did not show any significant abnormalities that may occur with lower limb edema. We performed multi-lymphosome ICG lymphography by injecting ICG in the first web space of the foot, the lateral ankle, and the lateral thigh. This helped us detect lymphatic dysfunction in both lower extremities. Additionally, we performed lymphatic ultrasound and found dilated lymphatic vessels in both lower limbs, indicating lymphatic accumulation within these vessels. Injecting ICG into multiple lymphosomes appears to be useful in diagnosing the causes of lower extremity edema as well as evaluating the lymphatic function of those lymphosomes. Furthermore, lymphatic ultrasound can be used to scan the whole lower extremity because it does not rely on the flow of a contrast agent to produce an image. We believe that combining these diagnostic examinations will make it possible to diagnose patients who have previously been misdiagnosed due to insufficient screening measures.

Compression bandages or stockings versus no compression for treating venous leg ulcers

BACKGROUND

Leg ulcers are open skin wounds on the lower leg that can last weeks, months or even years. Most leg ulcers are the result of venous diseases. First-line treatment options often include the use of compression bandages or stockings.

OBJECTIVES

To assess the effects of using compression bandages or stockings, compared with no compression, on the healing of venous leg ulcers in any setting and population.

SEARCH METHODS

In June 2020 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions by language, date of publication or study setting.

SELECTION CRITERIA

We included randomised controlled trials that compared any types of compression bandages or stockings with no compression in participants with venous leg ulcers in any setting.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, and risk-of-bias assessment using the Cochrane risk-of-bias tool. We assessed the certainty of the evidence according to GRADE methodology.

MAIN RESULTS

We included 14 studies (1391 participants) in the review. Most studies were small (median study sample size: 51 participants). Participants were recruited from acute-care settings, outpatient settings and community settings, and a large proportion (65.9%; 917/1391) of participants had a confirmed history or clinical evidence of chronic venous disease, a confirmed cause of chronic venous insufficiency, or an ankle pressure/brachial pressure ratio of greater than 0.8 or 0.9. The average age of participants ranged from 58.0 to 76.5 years (median: 70.1 years). The average duration of their leg ulcers ranged from 9.0 weeks to 31.6 months (median: 22.0 months), and a large proportion of participants (64.8%; 901/1391) had ulcers with an area between 5 and 20 cm². Studies had a median follow-up of 12 weeks. Compression bandages or stockings applied included short-stretch bandage, four-layer compression bandage, and Unna's boot (a type of inelastic gauze bandage impregnated with zinc oxide), and comparator groups used included 'usual care', pharmacological treatment, a variety of dressings, and a variety of treatments where some participants received compression (but it was not the norm). Of the 14 included studies, 10 (71.4%) presented findings which we consider to be at high overall risk of bias. Primary outcomes There is moderate-certainty evidence (downgraded once for risk of bias) (1) that there is probably a shorter time to complete healing of venous leg ulcers in people wearing compression bandages or stockings compared with those not wearing compression (pooled hazard ratio for time-to-complete healing 2.17, 95% confidence interval (CI) 1.52 to 3.10; I² = 59%; 5 studies, 733 participants); and (2) that people treated using compression bandages or stockings are more likely to experience complete ulcer healing within 12 months compared with people with no compression (10 studies, 1215 participants): risk ratio for complete healing 1.77, 95% CI 1.41 to 2.21; I² = 65% (8 studies with analysable data, 1120 participants); synthesis without meta-analysis suggests more completely-healed ulcers in compression bandages or stockings than in no compression (2 studies without analysable data, 95 participants). It is uncertain whether there is any difference in rates of adverse events between using compression bandages or stockings and no compression (very low-certainty evidence; 3 studies, 585 participants). Secondary outcomes Moderate-certainty evidence suggests that people using compression bandages or stockings probably have a lower mean pain score than those not using compression (four studies with 859 participants and another study with 69 ulcers): pooled mean difference -1.39, 95% CI -1.79 to -0.98; I² = 65% (two studies with 426 participants and another study with 69 ulcers having analysable data); synthesis without meta-analysis suggests a reduction in leg ulcer pain in compression bandages or stockings, compared with no compression (two studies without analysable data, 433 participants). Compression bandages or stockings versus no compression may improve disease-specific quality of life, but not all aspects of general health status during the follow-up of 12 weeks to 12 months (four studies with 859 participants; low-certainty evidence). It is uncertain if the use of compression bandages or stockings is more cost-effective than not using them (three studies with 486 participants; very low-certainty evidence).

AUTHORS' CONCLUSIONS

If using compression bandages or stockings, people with venous leg ulcers probably experience complete wound healing more quickly, and more people have wounds completely healed. The use of compression bandages or stockings probably reduces pain and may improve disease-specific quality of life. There is uncertainty about adverse effects, and cost effectiveness. Future research should focus on comparing alternative bandages and stockings with the primary endpoint of time to complete wound healing alongside adverse events including pain score, and health-related quality of life, and should incorporate cost-effectiveness analysis where possible. Future studies should adhere to international standards of trial conduct and reporting.

The efficacy of different bandaging methods in patients with breast cancer-related lymphedema: A prospective, randomized study

Objectives

The aim of this study was to evaluate the comparative efficacy of 3MTM CobanTM 2 layer system and conventional multi-layer short-stretch bandaging in terms of volume reduction, ultrasonographic measurements, functional status, and quality of life (QoL) in the treatment of patients with breast cancer-related lymphedema (BCRL).

Patients and methods

This prospective, single-blind, randomized study included a total of 60 BCRL patients (60 females; mean age 54.9±9.6 years; range, 30 to 73 years). The patients were randomly allocated to Group 1 (n=30) and Group 2 (n=30). Both groups received complex decongestive therapy (CDT) including skin care, lymphedema exercises, and manual lymphatic drainage (MLD) combined with traditional multi-layer short-stretch bandaging five times per week for three weeks in Group 1 and with 3MTM CobanTM 2 layer system bandaging two times per week for three weeks in Group 2. Differences in volumes, excess volumes, ultrasonographic measurements, QoL, and functional assessment scores were evaluated at baseline, after three weeks of intensive treatment period, and at two months of follow-up. Functional status was evaluated by the Quick Disability of Arm Shoulder and Hand Questionnaire (Q-DASH), while the QoL was assessed using the Turkish version of Lymphedema Quality of Life Questionnaire-Arm (LYMQOL-Arm). The duration and easiness of applying bandages by physiotherapists and comfortableness of bandages according to patients and physiotherapists were also evaluated using a questionnaire.

Results

The demographic and clinical properties were similar between the groups. There were significant improvements in the volumes, excess volumes, ultrasonographic measures, functional scores, and QoL scores in both groups at the end of treatment. The improvements were sustained at two months of follow-up.

Conclusion

The 3MTM CobanTM 2 layer bandaging as a part of CDT twice a week for a period of three weeks can significantly reduce the volume and improve the disability and impaired QoL, similar to conventional short-stretch multi-layer bandages. In addition, treatment with this layer system enables a time-efficient, easy, and comfortable application of bandaging with increased mobility of the upper extremity.

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.

[Conservative treatment of varicose veins]

The treatment of varicose veins is supposed to eliminate congestive symptoms and edema, heal skin complications and prevent complications. Surgical procedures, endovenous thermal procedures, endovenous chemical procedures and conservative measures are used for treatment. Often the invasive and conservative procedures are combined. A precise examination of the varicose veins is required for therapy planning; duplex sonography is the gold standard. Conservative therapy focuses on compression therapy with compression bandages and with compression stockings. Medical adaptive compression systems are also used in the decongestion phase. Extract from red vine leafs, extract from horse chestnut seed and oxerutin are available for oral drug therapy. Conservative therapy is especially indicated when treatment of symptomatic varicose veins is not possible or when symptomatic venous disease persists even after invasive therapy.

Increasing competence in compression therapy for venous leg ulcers through training and exercise measured by a newly developed score-Results of a randomised controlled intervention study

Compression therapy with short-stretch bandages is the most common treating option for patients with venous leg ulcers in the decongestion phase in Germany. This randomised controlled intervention study examined whether a training is suitable to sustainably improve the skills of health care professionals. Altogether 55 nurses from hospitals and outpatient care participated. They were randomly assigned to case and control groups. Participants' abilities to properly apply a compression bandaging were assessed before and after a training session as well as after 1 and 3 months using a newly developed score (CCB score) based on six control parameters (CPs): padding, starting point, heel inclusion, heart direction, pressure at forefoot (A) and calf base (B1). After training, a significant increase in competence was observed, which only decreased non-significantly over the observation period: The average CCB score was 2.796 at V0, 4.89 at V1, 4.88 at V2, and 4.66 at V3. The CPs for pressure at A and B1 were met by a maximum of 42.6 and 43.6%, respectively, at all timepoints. The CP starting point was fulfilled by at least 61.7% after training, the CPs heart direction, heel and underpadding by at least 89.4, 96.4, and 97.9%, respectively. As a result of our study, it can be concluded that training improves the ability of users to apply compression bandagings, but one-off training does not appear to be suitable to improve the ability to apply compression bandagings with a therapy-relevant pressure. Therefor more training especially with pressure measuring devices would be necessary.

Effects of Different Bandaging Methods for Treating Patients With Breast Cancer-Related Lymphedema

Objective

To compare the treatment effects, satisfaction with the treatment, and performance improvement following bandage treatment using the spiral method and spica method for breast cancer-related lymphedema (BCRL).

Methods

A prospective study with 46 patients with BCRL was conducted. All patients were divided into either the spiral or spica group for non-elastic bandage therapy and received the same treatment for 2 weeks, apart from the group-specific bandaging method used. For both groups, the Quality of Life Instrument score before treatment, changes in the volume of lymphedema limb and the Disability of the Arm, Shoulder, and Hand (DASH) score before and after treatment, and treatment satisfaction after treatment were compared. The Student t-test was used to compare the parameters between the two different bandage methods.

Results

With respect to the treatment outcomes, total volume reduction and proximal part volume reduction after treatment were 98.0±158.3 mL and 56.0±65.4 mL in the spiral method group and 199.0±125.1 mL and 106.1±82.2 mL in the spica method group, respectively. Therefore, the spica method group showed a significantly better improvement (p<0.05). The DASH score changes after treatment showed that the spiral group score increased by 3.8±5.4 and the spica group score increased by 7.7±6.1; thus, a significantly better improvement was noted in the spica group (p<0.05).

Conclusion

The spica method indicated better volume reduction and DASH score improvement than the spiral method. Therefore, the spica method may be more effective for treating patients with BCRL.

[Compression bandages with and without padding : Observational controlled survey of pressure and comfort]

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.

Therapeutic compression materials and wound dressings for chronic venous insufficiency: A comprehensive review

Chronic venous insufficiency (CVI) is a common disorder worldwide. Related pathophysiological mechanisms reportedly involve venous pooling and reduced venous return, leading to heaviness, aching, itchiness, tiredness, varicosities, pigmentation, and even lower limb ulceration. Approaches adopted to manage CVI at various stages of clinical-etiology-anatomy-pathophysiology include compression therapy, pharmacological treatment, ultrasound treatment, surgery, electrical or wireless microcurrent stimulation, and pulsed electromagnetic treatment. Among these, polymer-based therapeutic compression materials and wound dressings play increasingly key roles in treating all stages of CVI because of their unique physical, mechanical, chemical, and biological functions. However, the characteristics, working mechanisms, and effectiveness of these CVI treatment materials are not comprehensively understood. The present systematic review examines the structures, properties, types, and applications of various polymer-based compression materials and wound dressings used in prophylaxis and treatment of CVI. Existing problems, limitations, and future trends of CVI treatment materials are also discussed. This review could contribute to the design and application of new functional polymer materials and dressings to enhance the efficiency of CVI treatments, thereby facilitating patients' self-care ability and long-term health improvement.

[A microcirculatory change induced by comprehensive anti-edematous therapy in patients with lower limb lymphedema]

AIM

To study the impact of comprehensive anti-edematous therapy (CAET) on the microcirculatory indicators of patients with lower limb lymphedema.

MATERIAL AND METHODS

The investigation enrolled 60 patients with stages I-III lower limb lymphedema (according to its classification (T.V. Savchenko and A.V. Pokrovsky, 2004). All the patients were randomly divided into two groups: 1) 30 patients received CAET; 2) 30 patients had basic therapy with a conventional lymphovenous tonic and elastic compression. The time course of microcirculatory changes were evaluated in all the patients, by using laser Doppler flowmetry.

RESULTS

Analysis of the findings revealed that all the patients had spastic and stagnant microcirculation prior to treatment. After a treatment cycle, group 1 showed positive changes in the clinical manifestations of the disease and in the microcirculation, while group 2 displayed slight reductions in sensation of heaviness, leg swelling, as well as positive changes at the level of the venules of the microcirculatory bed.

CONCLUSION

This investigation of microcirculatory indicators in patients with lower limb lymphedema revealed a considerable improvement at the level of all microcirculatory components (arterioles, precapillaries, and venules) after CAET.

[Compression devices for decongestion therapy : A cross-sectional observational survey of handling, pressure, and comfort]

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.

Improvement of Refractory Peripheral Edema With Multilayered Compression Bandaging: A Case Report

BACKGROUND AND PURPOSE

Lower extremity edema, which can be caused by several factors, is often poorly managed with commonly prescribed compression stockings and diuretics. Diuretics are often erroneously given in all forms of edema and may cause problems because their long-term application may induce chronicity of the edema due to disturbance of the renin-angiotensin relationship. Compression therapy, although effective against venous edema, is widely underused.

CASE DESCRIPTION

A 64-year-old man with a history of hypertension, coronary artery disease, psoriasis, and multiple myeloma was admitted to the hospital for neutropenic fever, right lower extremity (RLE) cellulitis, bilateral lower extremity (BLE) weakness, RLE pain, and significant BLE edema. The patient was referred to a lymphedema-certified therapist to apply lower extremity multilayered compression bandaging and document serial limb circumference measurements.

OUTCOMES

The patient's weight decreased from 94.5 kg on day 1 of compression bandaging to 86.3 kg on day 7. The circumferences of the affected limbs also decreased.

DISCUSSION

This case demonstrates the utility of multilayered compression bandaging, typically used in the management of lymphedema, in the control of peripheral edema that is refractory to diuretic therapy.

The venous ulcer continues to be a clinical challenge: an update

Venous ulcers are a common chronic problem in many countries especially in Northern Europe and USA. The overall prevalence of this condition is 1% rising to 3% in the over 65 years of age. Over the last 25 years, there have been many developments applicable to its diagnosis and treatment. These advances, notwithstanding healing response and recurrence, are variable, and the venous ulcer continues to be a clinical challenge.

The pathogenesis of venous ulcers is unrelieved or ambulatory venous hypertension resulting mostly from deep venous thrombosis leading to venous incompetence, lipodermatosclerosis, leucocyte plugging of the capillaries, tissue hypoxia and microvascular dysfunction. It is not known what initiates venous ulcers. Triggers vary from trauma of the lower extremity to scratching to relieve itchy skin over the ankle region. Venous ulcers can be painful, and this condition presents an increasing burden of care. A systematic analysis of the role of technology used for diagnosis and management strongly supports the use of compression as a mainstay of standardised care. It further shows good evidence for the potential of some treatment procedures to accelerate healing. This article reviews the pathogenetic mechanisms, current diagnostic methods and standard care and its limitations.

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.

Compression therapy in patients with venous leg ulcers

Wund-D.A.CH. is the umbrella organization of the various wound care societies in German-speaking countries. The present consensus paper on practical aspects pertinent to compression therapy in patients with venous leg ulcers was developed by experts from Germany, Austria, and Switzerland. In Europe, venous leg ulcers rank among the most common causes of chronic wounds. Apart from conservative and interventional wound and vein treatment, compression therapy represents the basis of all other therapeutic strategies. To that end, there are currently a wide variety of materials and systems available. While especially short-stretch bandages or multicomponent systems should be used in the initial decongestion phase, ulcer stocking systems are recommended for the subsequent maintenance phase. Another - to date, far less common - alternative are adaptive Velcro bandage systems. Medical compression stockings have proven particularly beneficial in the prevention of ulcer recurrence. The large number of treatment options currently available enables therapists to develop therapeutic concepts geared towards their patients' individual needs and abilities, thus resulting in good acceptance and adherence. Compression therapy plays a crucial role in the treatment of patients with venous leg ulcers. In recent years, a number of different treatment options have become available, their use and application differing among German-speaking countries. The present expert consensus is therefore meant to outline concrete recommendations for routine implementation of compression therapy in patients with venous leg ulcers.

[Indications and contraindications for modern compression therapy]

Compression therapy is a physical therapy with few side effects, which is used especially in patients with edema of the lower extremities. The indication for compression therapy is given here for edema of very different origins such as, for example, venous or lymphatic disease symptoms as well as renal insufficiency, obesity or inflammation. However, different contraindications must be considered in these patients. Of particular importance are the advanced peripheral arterial occlusive disease and the polyneuropathy, which need special attention.Due to the large number of different compression materials and systems available today, in spite of these contraindications, compression therapy can be carried out with a large proportion of patients with edema of the lower extremities. The therapy should be adapted to the comorbidities and individual needs as well as personal abilities in the context of a patient-oriented care.

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.

[Compression therapy in leg ulcers]

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.

A Prospective Study in Comparison of Ambulatory Phlebectomy and Duplex Guided Foam Sclerotherapy in the Management of Varicosities with Isolated Perforator Incompetence

Perforators are those which connect the superficial and deep venous system either directly to main veins or indirectly through the muscular and soleal venous plexus. The emergence of minimally invasive techniques like ambulatory phlebectomy (AP) and foam sclerotherapy (FS) has led to increasing interest about the appropriate therapy for the treatment of isolated perforator incompetence. There have been no studies which have compared the effectiveness of these in-office procedures in isolated perforator incompetence due to the low prevalence of cases. The primary goal of this study is to compare the clinical parameters (return to normal activity, primary symptom relief), functional parameters (procedure time, change in disease severity, course of venous ulcer), and duplex parameters (recurrence in treated veins, complete occlusion of treated veins) in the management of leg varicosities having isolated primary perforator incompetence by ambulatory phlebectomy and duplex guided foam sclerotherapy. Though the procedure time was shorter with FS than AP, the other parameters of primary symptom relief such as change in disease severity, faster healing of venous ulcer, complete occlusion of treated veins in follow-up duplex examination, and lower recurrence of treated veins are better with AP than FS. In conclusion, the interruption of perforators is effective in decreasing the symptoms of chronic venous insufficiency and for the rapid healing of ulcers. The interruption of the incompetent perforating veins appears to be essential to decrease ambulatory venous hypertension. It is apparent from this study that ambulatory phlebectomy stands distinct with enormous benefits and serves as a superior alternative to foam sclerotherapy in treating patients with isolated perforator incompetence.

Challenging passivity in venous leg ulcer care - the ABC model of management

The under-utilisation of compression for venous leg ulcer (VLU) management translates into lost opportunities to heal wounds, improve patients' quality of life and maximise health care system efficiency. Although compression therapy is considered gold standard according to clinical guidelines, lack of clinician knowledge, unclear referral pathways, local unavailability of compression and patient unwillingness to receive compression, amongst other reasons, mean many candidates for compression do not receive appropriate treatment. This article presents a solution in the form of the 'ABC model of VLU management, a simplified approach that challenges passivity in the current approach to VLU treatment and supports wider adoption of appropriate compression therapy systems.

Use of customised pressure-guided elastic bandages to improve efficacy of compression bandaging for venous ulcers

Compression bandaging is a major treatment of chronic venous ulcers. Its efficacy depends on the applied pressure, which is dependent on the skill of the individual applying the bandage. To improve the quality of bandaging by reducing the variability in compression bandage interface pressures, we changed elastic bandages into a customised version by marking them with circular ink stamps, applied when the stretch achieves an interface pressure between 35 and 45 mmHg. Repeated applications by 20 residents of the customised bandage and non-marked bandage to one smaller and one larger leg were evaluated by measuring the sub-bandage pressure. The results demonstrated that the target pressure range is more often attained with the customised bandage compared with the non-marked bandage. The customised bandage improved the efficacy of compression bandaging for venous ulcers, with optimal sub-bandage pressure.

[New aspects of compression therapy]

In this review article the mechanisms of action of compression therapy are summarized and a survey of materials is presented together with some practical advice how and when these different devices should be applied. Some new experimental findings regarding the optimal dosage (= compression pressure) concerning an improvement of venous hemodynamics and a reduction of oedema are discussed. It is shown, that stiff, non-yielding material applied with adequate pressure provides hemodynamically superior effects compared to elastic material and that relatively low pressures reduce oedema. Compression over the calf is more important to increase the calf pump function compared to graduated compression. In patients with mixed, arterial-venous ulcers and an ABPI over 0.6 inelastic bandages not exceeding a sub-bandage pressure of 40 mmHg may increase the arterial flow and improve venous pumping function.

A lymphedema self-management programme: report on 30 cases

PURPOSE

Compression therapy is the most important element in the treatment and long-term management of moderate and severe lymphedema, but it is not universally accessible in Canada. For those unable to access private lymphedema treatment, physiotherapists at the McGill University Health Centre (MUHC) Lymphedema Clinic began teaching patients and caregivers how to use compression bandages safely and effectively.

METHODS

A retrospective chart review was combined with structured telephone or in-person interviews with 30 people who had attended a self-bandaging clinic in the MUHC Lymphedema Clinic between 2011 and 2012. Patients were monitored weekly until limb volume plateaued, and a compression garment was then fitted for ongoing maintenance. Monthly or quarterly surveillance continued for 1 year. Follow-up interviews were conducted 3 to 18 months after patients had received their garments.

RESULTS

The majority of participants had moderate to severe lymphedema; all achieved reduction of edema in the range of 48% to 92%. More than three-quarters of participants reported a global rate of change (GRC) of ≥80%. Themes derived from the interviews included the importance of bandaging, the feeling of being in control, and difficulties with compression garments. Participants spontaneously expressed satisfaction about having tools to manage their condition themselves.

CONCLUSION

For selected patients with lymphedema, a self-bandaging programme can be a route to lymphedema reduction, independence, and self-efficacy.

A flexible and low power telemetric sensing and monitoring system for chronic wound diagnostics

BACKGROUND

Non-healing chronic wounds, such as venous leg ulcers, can be monitored non-invasively by using modern sensing devices and wireless technologies. The development of such a wireless diagnostic tool may improve chronic wound management by providing evidence on efficacy of treatments being provided. This paper presents a low-power portable telemetric system for wound condition sensing and monitoring. The system aims at measuring and transmitting real-time information of wound-site temperature, sub-bandage pressure and moisture level from within the wound dressing.

METHODS

Commercially available non-invasive temperature, moisture, and pressure sensors are interfaced with a telemetry device on a flexible 0.15 mm thick printed circuit material to construct a light-weight, non-invasive, biocompatible, and low-power sensing device. The real-time data obtained is transmitted wirelessly to a portable receiver which displays the measured values. The performance of the whole telemetric sensing system is validated on a mannequin leg using commercial compression bandages and dressings. A number of trials on a healthy human volunteer are performed where treatment conditions were emulated using various compression bandage configurations.

RESULTS

A reliable and repeatable performance of the system is achieved under compression bandage and with minimal discomfort to the volunteer. The system is capable of reporting instantaneous changes in bandage pressure, moisture level and local temperature at wound site with average measurement resolutions of 0.5 mmHg, 3.0% RH, and 0.2°C respectively. Effective range of data transmission is 4-5 m in an open environment.

CONCLUSIONS

A flexible and non-invasive sensing system is developed to acquire and wirelessly transmit wound parameters from within a compression bandage and wound dressing worn on a human limb. Pre-clinical results on a healthy human subject suggest its clinical usability and value to health practitioners. However, further performance evaluations of the device on a wider population of healthy human subjects and on patients with chronic wounds are required to confirm its medial usefulness and to quantify its real impact on chronic wound management.

Ultrasonographic findings and the clinical results of treatment for lymphedema

We undertook this study using ultrasonography to examine structural changes occurring in the subcutaneous tissue with lymphedema. Ultrasonographic images were taken in 178 outpatients and 29 inpatients, with the images of the subcutis fluid accumulation, which was categorized into three types ( grade 0: absent, grade 1: a minimal amount of water, grade 2: stone-paved image due to excess water). Initial percentage of excess volume was correlated with the tissue fluid (grade 0: 7.5%, grade 1: 17.1%, grade 2: 30.5%, p <0.01). The higher the grade of fluid accumulation, the more important was the absolute reduction of lymphedema volume (grade 0: 2.5%, grade 1: 14.8%, grade 2: 33.2%, p <0.01). The percentage of severe lymphedema (stage2b + 3) was higher in inpatients than outpatients(89.3% vs. 45.8%), however, a significant decrease in the percentage of volume reduction was found for inpatients (29.4 ± 15.1% vs. 15.4 ± 14.2%, p <0.01). Echographic images can help to determine whether compression therapy will reduce lymphedema and to evaluate the treatment results by measuring tissue fluid. For severe lymphedema, a compression bandage was more effective than an elastic stocking. (English translation of Jpn J Phlebol 2013; 24: 287-294).

Polidocanol versus hypertonic glucose for sclerotherapy treatment of reticular veins of the lower limbs: study protocol for a randomized controlled trial

Background

The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally invasive alternatives, promoting chemical sclerosis of the vein wall. Although this technique is routinely performed around the world, there is no consensus on the most efficacious and safe chemical agent to be used.

Methods/design

Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs, on the outer side of the leg/thigh. Patients with CEAP 2 to 6, or with allergies, pregnancy, performing breastfeeding, or with any dermatologic or clinical problems will be excluded. Patients with venous ultrasound mapping showing involvement of saphenous trunks and/or a deep venous system will also be excluded. Patients will be randomized into two groups, one receiving 75% pure glucose and the other group receiving 0.2% polidocanol diluted in 70% glucose. Just one limb and one session per patient will be performed. The sclerosing agent volume will not exceed 5 mL. Clinical follow-up will include visits on days 7 and 60, always with photographic documentation.

Discussion

This project aims to enroll 96 patients and subject them to a double-blind treatment after the randomization process. The design is intended to evaluate efficacy through a primary end point and safety through a secondary end point. Forty-eight patients have currently been enrolled. Preliminary results for these patients showed that 25 received treatment, 2 were excluded, and 22 returned after 7 days and showed no greater adverse events. To date, establishing efficacy criteria has not been possible, and no patients have reached the 60-day return point. These data may help doctors choose the best chemical agent for the treatment of reticular veins.

Trial registration

ClinicalTrials.gov Identifier: NCT02054325, 3/02/2014.

Electronic supplementary material

The online version of this article (doi:10.1186/1745-6215-15-497) contains supplementary material, which is available to authorized users.

An improved flexible telemetry system to autonomously monitor sub-bandage pressure and wound moisture

This paper presents the development of an improved mobile-based telemetric dual mode sensing system to monitor pressure and moisture levels in compression bandages and dressings used for chronic wound management. The system is fabricated on a 0.2 mm thick flexible printed circuit material, and is capable of sensing pressure and moisture at two locations simultaneously within a compression bandage and wound dressing. The sensors are calibrated to sense both parameters accurately, and the data are then transmitted wirelessly to a receiver connected to a mobile device. An error-correction algorithm is developed to compensate the degradation in measurement quality due to battery power drop over time. An Android application is also implemented to automatically receive, process, and display the sensed wound parameters. The performance of the sensing system is first validated on a mannequin limb using a compression bandage and wound dressings, and then tested on a healthy volunteer to acquire real-time performance parameters. The results obtained here suggest that this dual mode sensor can perform reliably when placed on a human limb.

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.

[Conservative lymphedema therapy - lymphological rehabilitation treatment]

The most important column in the conservative lymphedema therapy still represents the complex decongestive physical therapy/KPE.This is a multimodal therapy, which consists of four components. (1) skin restoration and/or skin care, (2) manual lymphatic drainage, (3) compression therapy and (4) decongestive exercises. The KPE is also divided into two phases. Phase 1-the decongestion-serves primarily the mobilization and transporting away the banked protein-rich oedema fluid and seamless transition into the Phase 2-the maintenance phase, which serves to preserve the achieved treatment success. The implementation of the KPE should be stage-adjusted, but depends also on the location (genital, head, face), and on co-existing comorbidities (congestive heart failure, diabetes mellitus, obesity, muscular-skeletal disorders, mental illness, etc.). It should be modified for children, elderly persons and for patients with malignant lymphedema.