Effectiveness of Elastic Therapeutic Tape in Reducing Edema, Pain and Trismus following Surgery for Facial Fractures: A Systematic Review and Meta-Analysis

Facial fractures cause postoperative morbidity, including edema, pain, and trismus. Elastic therapeutic tapes are used for optimizing recovery. Background: The aim of the present systematic review and meta-analysis was to evaluate the effectiveness of elastic tape Kinesio taping (KT) in reducing postoperative morbidity in facial fractures surgeries. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. Searches were conducted in the Cochrane, Medline, Scopus, Embase and Web of Science databases using a pre-established search strategy. Results: A total of 811 studies were retrieved after the duplicates were removed, and only randomized clinical trials were included. Eight trials, involving 319 participants, were deemed eligible. One study solely investigated the effect on edema, while the others analyzed at least two of the variables of interest. Results from two RCTs, where qualitative analysis was applicable, suggest a potential reduction in edema in the KT group compared to the control group on the second (RR -0.55, 95% CI -0.89 to -0.22; p = 0.01; I2 = 0%) and third postoperative days (RR -0.71, 95% CI -1.01 to -0.40; p < 0.00001; I2 = 0%). Conclusions: KT is effective in controlling postoperative edema following surgery for facial fractures. However, the effects on pain and trismus should be explored further in studies with standardized methods.

Effects of leg compression and calf muscle contraction by active ankle motion on venous hemodynamics in sitting individuals

Objectives

To clarify the effects of compression and active ankle motion on venous hemodynamics in healthy sitting individuals.

Methods

In the sitting position, 14 participants performed plantar flexion and dorsiflexion of the ankle for 3 s each without compression. Changes in the calf volume were recorded using air plethysmography. Subsequently, the process was repeated with the application of tubular elastic bandage (TEB), followed by anti-thrombotic stocking (ATS).

Results

The median interface pressure at the calf was 16 mmHg with TEB and 21 mmHg with ATS. Without compression ( N), the median venous volume was 76 mL. This was reduced to 58 mL with TEB and 56 mL with ATS ( p < .01 vs. N for both). On the other hand, ejection volume by plantar flexion in N (27 mL) was not significantly changed with TEB (31 mL) or ATS (31 mL). Also, ejection volume by dorsiflexion in N (53 mL, p < .001 vs. plantar flexion) was not significantly changed with TEB (53 mL, p < .01 vs. plantar flexion) or ATS (41 mL, p < .05 vs. plantar flexion).

Conclusions

The venous volume, which is defined as the change in enclosed calf volume from elevation to dependency, in the sitting position reduced similarly with TEB and ATS; however, the ejection volumes did not change significantly. Dorsiflexion exerted a larger ejection volume than plantar flexion in the sitting position.

[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.

S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity

The following supplement is a rare example of a paper that combines clinical experience and theoretical knowledge on textiles used in compression therapy. The authors' intention is to propose a decision support system for choosing specific compression devices, which can be adjusted to counteract the individual signs and symptoms in an optimally adopted way. The document concentrates on compression devices which can be self-applied by the patients—compression stockings and adjustable wraps. The acronym ‘S.T.R.I.D.E.’, incorporating both textile characteristics and clinical presentation, stands for: Shape, Texture, Refill, Issues, Dosage and Etiology. The intent of the mnemotechnical value is to highlight that successful compression includes more than dosage alone. In addition to dosage, etiology and patient presentation need to be incorporated, including a patient's physical ability to use compression effectively as part of the daily routine, thereby promoting adherence.

The suggested algorithms provide a valuable guide to stride across the important, but still underestimated field of medical compression therapy and will help to put the prescription of a specific product on a more rational basis. Enjoy reading!

Hugo Partsch Emeritus Professor Medical University of Vienna, Austria

Effect of lower body compression garments on hemodynamics in response to running session

Purpose. Compression garments are often worn during exercise and allegedly have ergogenic and/or physiological effects. In this study, we compared hemodynamics and running performance while wearing compression and loose-fit breeches. We hypothesized that in neutral-warm environment compression breeches impair performance by diminishing body cooling via evaporative sweat loss and redistributing blood from active musculature to skin leading to a larger rise in body temperature and prolonging recovery of hemodynamics after exercise. Methods. Changes in hemodynamics (leg blood flow, heart rate, and blood pressure during orthoclinostatic test), calf muscle tissue oxygenation, and skin and core temperatures were measured in response to 30 min running (simulation of aerobic training session) followed by maximal 400 m sprint (evaluation of running performance) in recreationally active females (25.1 ± 4.2 yrs; 63.0 ± 8.6 kg) wearing compression or loose-fit breeches in randomized fashion. Results. Wearing compression breeches resulted in larger skin temperature rise under the garment during exercise and recovery (by about 1°C, P < 0.05; statistical power > 85%), while core temperature dynamics and other measured parameters including circulation, running performance, and sensations were similar compared to wearing loose-fit breeches (P > 0.05). Conclusion. Compared with loose-fit breeches, compression breeches have neither positive nor negative physiological and performance effects for females running in thermoneutral environment.

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.

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.

Development of separated elastic stockings

Objectives

To investigate the acceptability of newly developed separated elastic stockings, which are divided into two portions at the ankle.

Methods

The difficulty in putting on and taking off stockings was compared between the original or modified separated stockings with various techniques in order to reduce the shift of the stockings and current non-separated stockings in healthy volunteers and patients with lymphoedema by applying both stockings alternately. In the modified model, the shift during daily activities was measured in healthy volunteers and patients with lymphoedema.

Results

The two items, ‘easier compared with non-separated stockings’ and ‘much easier’, were chosen at rates of 75% and 81% for putting on and taking off stockings for the original separated stockings and 75% and 75% for the modified separated stockings, respectively. Complaints during daily activities with the modified type to the stockings decreased as compared with the original type. The shift of stockings after an average 11-hour application was 1.6 ± 3.0 SD mm (range: 0–10 mm).

Conclusions

Modified separated elastic stockings are easier to put on and take off compared with current non-separated stockings, and they can be used safely because of their low-level shift during daily activities.

Interface pressures derived from oversize compression stockings

OBJECTIVES

To clarify interface pressures (IP) derived from class II and III oversize stockings.

METHODS

Healthy volunteers with legs fitting size S (n = 10), M (n = 6), or L (n = 6) stockings wore class II and III stockings of various sizes up to 5L. IPs were measured in the supine and the standing position with each stocking on.

RESULTS

In the subjects with size S legs, the IPs in the standing position while wearing S and M class III stockings were 43.5 ± 4.7 and 40.4 ± 5.4 mmHg respectively. These IPs were significantly higher than the IP while wearing the S size class II stocking (33.3 ± 5.9 mmHg). IPs derived from L, LL, 3L, 4L, 5L class III stockings were not significantly different from IP with the S size class II stocking. The results were similar for the subjects with size M legs while wearing the size M and L class III stockings and for the subjects with size L legs while wearing the size L and LL class III stockings vs. the appropriate size class II stocking.

CONCLUSION

Based on these findings, a larger size class III stocking can provide similar or even higher IPs compared to an appropriate size class II stocking.

Interface pressure and stiffness in different combinations of compression material

Objectives

To compare the interface pressure and stiffness between various combinations of compression material.

Methods

Using a stiffness-determining device, the interface pressure and stiffness were determined in several combinations of five elastic stockings and two elastic bandages.

Results

In the double stockings system, the interface pressure increased significantly and the highest stiffness was observed in double short-stretch stockings. When short-stretch bandages were applied over either short- or long-stretch stockings, a significant increase in stiffness was observed at any initial pressure compared with the single use of short-stretch stockings. In double bandage systems, when short-stretch bandages were applied over either short- or long-stretch bandages, the stiffness increased significantly. When long-stretch bandages were used over short-stretch bandages, the stiffness decreased significantly.

Conclusions

The stiffness is changeable according to the combinations of material, such as double stockings, double bandages and the wearing of bandages over stockings. The use of short-stretch bandages as the outside layer produces the highest stiffness at a high initial pressure.

Development of a device to determine the stiffness of elastic garments and bandages

Objective

To evaluate the reliability of a newly developed stiffness-determining device, composed of a leg mannequin and air-pack type analyser, for measuring the interface pressure.

Method

The correlation of stiffness values obtained employing the Hohenstein method and this new method was investigated using 17 different brands of medical elastic compression stocking.

Results

A significant correlation in stiffness values using the two methods was obtained ( P < 0.01). When this new method was applied to the bandages, the stiffness was significantly correlated with the initial pressure when assessing both short-stretch and long-stretch bandages. On the comparison of stiffness values between elastic stockings and bandages with the same initial pressure, the short-stretch bandages showed a predominantly higher value than long-stretch bandages and stockings ( P < 0.01).

Conclusion

The reliability of this new method, which can be easily applied to not only elastic stockings but also elastic bandages, was verified. In clinical practice, the compression pressure should be selected in consideration of the prospective stiffness.

Comparison of stiffness and interface pressure during rest and exercise among various arm sleeves

OBJECTIVES

To compare the interface pressure during rest and exercise among various kinds of arm sleeves.

METHODS

The interface pressure underneath nine different arm sleeves was measured during 10 maximal opening and closing movements of fingers using a pressure transducer (Air Pack Type Analyser) in 16 healthy volunteers. Furthermore, in order to evaluate the characteristics of each arm sleeve, the extensibility, stiffness and thickness were determined in vitro by several apparatuses.

RESULTS

There was a significant correlation between stiffness and extensibility. The stiffness was significantly correlated with the pressure difference between muscle contraction and relaxation during exercise. The higher the value of stiffness, the greater the pressure amplitude during exercise.

CONCLUSION

Short-stretch arm sleeves characterized with a high level stiffness, including thick round- and flat-knitted arm sleeves, are more beneficial for the augmentation of muscle pumping than long-stretch arm sleeves, in the same way as short-stretch bandages or stockings applied to the leg.