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da Silva JMP, Araújo RDD, da Silva Santos FC, Fabro EAN, de Mello Pinto MV, de Aguiar SS, Thuler LCS, Bergmann A. Complex physical therapy employing self-adjusting garment (ReadyWrap®) in breast cancer-related lymphedema cases in Brazilian women: a protocol for a randomized controlled trial. Trials 2023; 24:549. [PMID: 37608354 PMCID: PMC10464195 DOI: 10.1186/s13063-023-07460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/13/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Lymphedema is a common complication following breast cancer treatment. The aim of this study is to evaluate the effectiveness of a self-adjusting compression garment (ReadyWrap®) in reducing (phase 1) and maintaining (phase 2) upper limb volume in women presenting breast cancer-related lymphedema. METHODS This study will comprise a randomized, controlled, single-blind clinical trial concerning women with breast cancer-related lymphedema undergoing treatment at a public cancer treatment reference hospital in the city of Rio de Janeiro, Brazil. The intervention will be carried out by adapting self-dressing versus the standard treatment of compressive bandaging (phase 1) and compressive mesh (phase 2). Both groups will be assessed at the beginning and end of intensive treatment and followed up for up to 12 months to evaluate immediate and late outcomes. Assessments will be carried out by physical upper limb examination (inspection, palpation, volume, dynamometry, and thermography) and questionnaires application to assess patient's quality of life pertaining to the health, functionality, and symptoms of the affected upper limb, as well adverse effects and adherence to treatment. Data will be analyzed descriptively and analytically through univariate and multiple linear regressions. P values < 0.05 will be considered statistically significant. DISCUSSION This study will evaluate the effectiveness of a self-adjustable garment (ReadyWrap®) in the treatment of lymphedema secondary to breast cancer in Brazilian women compared to the gold standard treatment for limb volume reduction (phase 1) and maintenance (phase 2) phases comprising, respectively, a compressive bandaging and a compressive mesh. The outcome results will provide data based on both quantitative responses and self-reported participant outcomes. The study will also assess the cost-effectiveness of the ReadyWrap® treatment versus standard care. Finally, we expect to reaffirm one more product/therapy as a treatment for this extremely complex and impactful condition following the data analysis. TRIAL REGISTRATION NCT04934098 [Clinical trials phase 1]. Registered on June 22, 2021. NCT04881604 [Clinical trials phase 2]. Registered on May 11, 2021.
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Affiliation(s)
- Jéssica Malena Pedro da Silva
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Raul Denner Duarte Araújo
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | | | - Erica Alves Nogueira Fabro
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | | | - Suzana Sales de Aguiar
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Luiz Claudio Santos Thuler
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Anke Bergmann
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil.
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Duygu-Yildiz E, Bakar Y, Hizal M. The effect of complex decongestive physiotherapy applied with different compression pressures on skin and subcutaneous tissue thickness in individuals with breast cancer-related lymphedema: a double-blinded randomized comparison trial. Support Care Cancer 2023; 31:383. [PMID: 37285046 DOI: 10.1007/s00520-023-07843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effect of compression bandage applied with different pressures on the skin and subcutaneous thickness in individuals with breast cancer-related lymphedema (BCRL). METHODS 21 individuals with stage 2 unilateral BCRL participated in the study. Individuals were randomly allocated into two groups as low-pressure bandage (20-30 mmHg) (n: 11) and high-pressure bandage (45-55 mmHg) (n: 10). Skin and subcutaneous tissue thickness, extremity volume, sleep quality, treatment benefit, and comfort were evaluated by ultrasound from 6 reference points (as hand dorsum, wrist volar, forearm volar, arm volar, forearm dorsum, and arm dorsum), volumetric measurement, Pittsburgh Sleep Quality Index, Patient Benefit Index-Lymphedema, and visual analog scale, respectively. Complex decongestive physiotherapy was applied to both groups. Compression bandage was applied according to their group. Individuals were evaluated at the baseline, 1st session, 10th session, 20th session, and at 3-month follow-up. RESULTS Skin thickness decreased significantly in the volar reference points of the extremity in the high-pressure bandage group (p = 0.004, p = 0.031, and p = 0.003). Subcutaneous tissue thickness significantly decreased at all reference points in the high-pressure bandage group (p < 0.05). In the low-pressure bandage group, skin thickness only decreased in the forearm dorsum and the arm dorsum (p = 0.002, p = 0.035) and subcutaneous tissue thickness changed for all points (p < 0.05) except for hand and arm dorsum (p = 0.064, p = 0.236). Edema decreased in a shorter time in the high-pressure bandage group (p < 0.001). No significant differences were found in sleep quality, treatment benefit, and comfort for both groups (p = 0.316, p = 0.300, and p = 0.557, respectively). CONCLUSION High pressure was more effective in reducing subcutaneous tissue thickness in the dorsum of hand and arm. The usage of high-pressure can be recommended especially in cases which have edema in the dorsum of hand and arm which is difficult to resolve. Also, high-pressure bandage can provide faster edema resolution and can be used in rapid volume reduction as desired. Treatment outcomes may improve with high-pressure bandage without any impairment in comfort, sleep quality, and treatment benefit. TRIAL REGISTRATION NUMBER AND DATE NCT05660590, 12/26/2022 retrospectively registered.
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Affiliation(s)
- Elif Duygu-Yildiz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey.
| | - Yesim Bakar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Mustafa Hizal
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Chandralekha B, Tripathy T, Phukan P, Lynser D. A Modified Manual Compression Technique for the Treatment of Traumatic Pseudoaneurysm of Superficial Temporal Artery. Neurol India 2022; 70:345-347. [PMID: 35263910 DOI: 10.4103/0028-3886.338709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Traumatic Pseudoaneurysm of Superficial temporal artery (STA) is an uncommon entity. Surgical management is the treatment of choice, and endovascular management is also equally feasible particularly for the proximal STA aneurysm. The manual compression for the treatment of STA aneurysm is also described, but it has a high chance of failure. We report a case of traumatic pseudoaneurysm of STA in a pregnant female, successfully treated with a modified manual compression technique.
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Affiliation(s)
- Baruah Chandralekha
- Department of Radiodiagnosis, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Taraprasad Tripathy
- Department of Radiodiagnosis, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Pranjal Phukan
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Donboklang Lynser
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Abstract
The first-line treatment for venous leg ulcers (VLUs) is compression therapy, most commonly, with compression bandages. A similar treatment measure is used for lymphoedema in the form of Velcro compression wraps (VCWs). However, the use of VCWs for VLUs is less evident, and a direct comparison to compression bandaging is not evident. This review explores the evidence to support the use of VCWs for the treatment of VLUs in order to raise awareness of alternative forms of compression therapy. Nine primary research studies were analysed, from which four key themes emerged: quality of life, cost of treatment, ulcer healing time and pressure maintenance. The findings suggest that VCWs decrease material costs by at least 50%, and further savings may be realised by reducing the costs associated with nursing time. The benefits of promoting self-care, maintaining compression, and eliciting greater healing rates are clearly evident, and the impact on quality of life is substantiated.
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Affiliation(s)
- Amy Cox
- Respiratory Registered Nurse, Royal Derby Hospital-University Hospitals of Derby and Burton
| | - Chrissie Bousfield
- Associate Professor, School of Health Sciences, University of Nottingham
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Sharma SK, Thakur K, Mudgal SK, Kumar B. Efficacy of Transparent vs. Pressure Dressing in Prevention of Post-Cardiac Catheterization Pain, Discomfort and Hematoma: A Systematic Review and Meta-analysis of RCTs. J Caring Sci 2021; 10:103-110. [PMID: 34222120 PMCID: PMC8242292 DOI: 10.34172/jcs.2021.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: There is lack consensus on superiority of transparent vs. pressure dressing for prevention of post-cardiac catheterization pain, discomfort and hematoma. Therefore, we conducted this systematic review and meta-analysis of available RCTs on this subject. Methods: We performed a systematic search of RCTs published between in 2000-2019 in English language using databases including PubMed Medline, EMBASE, CINAHL, Cochrane Library, ERMED Journals, Clinical trials database, DELNET, Google Scholar and Discovery Search. Studies conducted on adult patients with femoral dressing after cardiac catheterization measuring pain, discomfort, hematoma as intended outcomes have been included. Data extraction, critical appraisal, assessment of risk bias was done and decisions on quality were made on mutual consensus. Mantel-Haenszel (MH) and odds ratio for dichotomous variables was calculated by Review Manager 5.3 software. Results: Out of all identified studies, only 5 studies comprising 664 patients fulfilled the inclusion criteria and met the quality assessment. Incidence of discomfort (25, 333) were significantly less in transparent dressing group as compared to pressure dressing group (149, 331); odds ratio 0.10, 95% confidence interval [CI] 0.06-0.15; I2 = 0%, P= 0.00. Four studies reported significantly lower number of pain cases in transparent dressing (17, 203) as compared to pressure dressing (57, 201); odds ratio 0.13, 95% confidence interval [CI] 0.03-0.59; I2 = 47%, P= 0.01). However, incidence of hematoma did not reveal any significant difference between two groups. Conclusion: Transparent dressing is a better option in patients with femoral/groin dressing after cardiac catheterization as it is more effective in prevention of pain and discomfort.
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Affiliation(s)
- Suresh K Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kalpana Thakur
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shiv K Mudgal
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Christensen LMR, Arnesen CE, Möller S, Hyldig N. The effect of compression therapy on post-surgical swelling and pain after total knee arthroplasty. Int J Orthop Trauma Nurs 2020; 41:100815. [PMID: 33339752 DOI: 10.1016/j.ijotn.2020.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that the use of a graduated medical elastic thigh compression stocking for 14 days after total knee arthroplasty would reduce swelling by 2 cm and reduce pain among patients with a BMI ≥30 kg/m2. The aim of this pilot study was to provide preliminary data and information about feasibility. The specified objectives were to investigate: 1) the level of post-surgical swelling and, 2) the level of post-surgical pain, 14 days after surgery. METHODS In a randomized controlled pilot study, 44 patients were allocated to a graduated medical elastic thigh compression stocking or standard treatment for 14 days after total knee arthroplasty. Outcome measures were knee, calf, and ankle swelling and pain. Study feasibility included acceptable rates of written consent and compliance with the use of the compression stocking. Data was analyzed using two-sample t-test for equality of mean. RESULTS Overall, 68.8% of eligible patients gave written consent to participate in the study and 41.2% complied with use of the graduated medical elastic thigh compression stocking for 14 days post-surgery. No significant difference was found between the groups regarding knee, calf and ankle swelling or pain. INTERPRETATION Knee swelling was reduced in both groups after 14 days, but was slightly more in the intervention group. The result is not statistically significant but indicates that a graduated medical elastic thigh compression stocking may have a positive effect on reduction of swelling after total knee arthroplasty. Initiating a larger scale randomized controlled study to determine effectiveness requires a higher level of compliance.
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Affiliation(s)
| | | | - Sören Möller
- OPEN Open Patient data Explorative Network, Odense University Hospital, Denmark
| | - Nana Hyldig
- OPEN Open Patient data Explorative Network, Odense University Hospital, Denmark
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Scheicher ME, Fonseca LCS, Bortolloto TB, de Carvalho IF. A patellar bandage improves mobility but not static balance in elderly female fallers. J Bodyw Mov Ther 2018; 22:482-6. [PMID: 29861254 DOI: 10.1016/j.jbmt.2017.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The deterioration in the somatosensory and motor systems observed with increasing age can cause balance problems. Studies have shown that the use of infrapatellar bandages can enhance proprioception and improve postural balance. AIMS To evaluate the effect of an infrapatellar bandage on static balance and mobility in elderly female fallers and non-fallers. METHODS Forty older women (20 fallers and 20 non-fallers) were evaluated. Mobility (Timed Up and Go test) and balance (force platform) were measured in the presence and absence of additional sensory information (elastic infrapatellar bandage). RESULTS Mobility differed in fallers (p = 0.0001), but not in non-fallers (p = 0.27), when the patellar bandage was applied. Additional sensory information did not improve static balance in either group (p > 0.05), but a trend towards improvement was observed in fallers. CONCLUSION Additional sensory input from an infrapatellar bandage improves mobility but not bipedal stance in elderly fallers.
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Heyer K, Protz K, Augustin M. Compression therapy - cross-sectional observational survey about knowledge and practical treatment of specialised and non-specialised nurses and therapists. Int Wound J 2017; 14:1148-1153. [PMID: 28744967 DOI: 10.1111/iwj.12773] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/04/2017] [Accepted: 05/13/2017] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Kristina Heyer
- Comprehensive Wound Center (CWC), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kerstin Protz
- Comprehensive Wound Center (CWC), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Comprehensive Wound Center (CWC), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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9
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Abstract
Compression therapy is well-tried treatment with only few side effects for most patients with leg ulcers and/or edema. Despite the very long tradition in German-speaking countries and good evidence for compression therapy in different indications, recent scientific findings indicate that the current situation in Germany is unsatisfactory. Today, compression therapy can be performed with very different materials and systems. In addition to the traditional bandaging with Unna Boot, short-stretch, long-stretch, or multicomponent bandage systems, medical compression ulcer stockings are available. Other very effective but far less common alternatives are velcro wrap systems. When planning compression therapy, it is also important to consider donning devices with the patient. In addition to compression therapy, intermittent pneumatic compression therapy can be used. Through these various treatment options, it is now possible to develop an individually accepted, geared to the needs of the patients, and functional therapy strategy for nearly all patients with leg ulcers.
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Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - K Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), CWC - Comprehensive Wound Center, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
| | | | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - K Kröger
- Klinik für Gefäßmedizin, Angiologie, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland
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Park WY, Jung SJ, Joo SY, Jang KU, Seo CH, Jun AY. Effects of a Modified Hand Compression Bandage for Treatment of Post-Burn Hand Edemas. Ann Rehabil Med 2016; 40:341-50. [PMID: 27152286 PMCID: PMC4855130 DOI: 10.5535/arm.2016.40.2.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/16/2015] [Indexed: 11/07/2022] Open
Abstract
Objective To evaluate the effect of a modified hand compression bandage in patients with a post-burn hand edema. Methods Patients were recruited from burn centers. We classified the patients into two groups: the modified hand compression bandage group comprising of 22 patients who had a modified hand compression bandage and received conventional physical therapy and the conventionally treated group, comprising of 20 patients who received only conventional physical therapy during the 4-week period post-burn. Hand circumference, hand skin thickness, and hand function were evaluated by grip strength, active range of motion (ROM), Jebsen hand function test, and visual analogue scale (VAS). These assessments were used to evaluate treatment effectiveness prior to the first treatment, 2 weeks after the first treatment, 4 weeks after the first treatment, and 4 months after the first treatment. Results As a result of repeated-measures analysis of variance on hand circumference, skin thickness, VAS, and each metacarpophalangeal joint ROM, we found significant differences that corresponded to time effect (p<0.05) and time×group (reciprocal action) effect (p<0.05). The results of grasp power, Jebsen hand function test, and each proximal interphalangeal joint ROM, show significant differences in accordance with the time effect (p<0.05), however, there was no reciprocal action effect (p>0.05). Conclusion The modified hand compression bandage will be clinically useful for the treatment of patients with post-burn hand edemas.
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Affiliation(s)
- Won Yong Park
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Soo Jin Jung
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - So Young Joo
- Department of Rehabilitation Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - Ki Un Jang
- Department of Rehabilitation Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - Ah Young Jun
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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Abstract
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").
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Affiliation(s)
- Hugo Partsch
- Emeritus Professor of Dermatology, Medical University of Vienna, Vienna, Austria
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Gorelik O, Shteinshnaider M, Tzur I, Feldman L, Cohen N, Almoznino-Sarafian D. Factors associated with prevention of postural hypotension by leg compression bandaging. Blood Press 2014; 23:248-54. [PMID: 24460143 DOI: 10.3109/08037051.2013.871787] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM We evaluated the eventual effects of leg compression on seating-induced postural hypotension (PH) in the context of various relevant clinical variables. METHODS Included were 73 hospitalized patients with various acute conditions, aged ≥ 60 years, bedridden for ≥ 8 h, with diagnosed PH [≥ 20 mmHg systolic and/or ≥ 10 mmHg diastolic blood pressure (BP) falls] at the first seating. BP, heart rhythm, dizziness and palpitations were recorded before and during 5 min of sitting. The next day, the patients were reevaluated, this time using compression bandages applied along both legs before seating. RESULTS Compared with the non-bandaged state, PH was registered in only 53% of bandaged patients (p < 0.001). Moreover, the appearance of PH symptoms decreased (p < 0.001). On the second day (bandaged), supine diastolic BP values were higher in the persisting vs non-persisting PH group (p = 0.027). In the bandaged state, PH symptoms were significantly reduced in the non-persisting PH group (p = 0.003). Even in patients with persistent PH, the magnitude of BP decline and appearance of PH symptoms were decreased while wearing bandages (p = 0.004 and 0.002, respectively). CONCLUSION During mobilization of inpatients, leg compression seems to reduce the seating-induced PH and relevant symptoms. Even in patients with persisting PH, bandaging may improve hemodynamics and attenuate associated symptoms.
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Affiliation(s)
- Oleg Gorelik
- Department of Internal Medicine "F", Assaf Harofeh Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University) , Zerifin , Israel
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Dabiri G, Hammerman S, Carson P, Falanga V. Low-grade elastic compression regimen for venous leg ulcers--an effective compromise for patients requiring daily dressing changes. Int Wound J 2013; 12:655-61. [PMID: 24267477 DOI: 10.1111/iwj.12186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/25/2013] [Accepted: 10/10/2013] [Indexed: 11/28/2022] Open
Abstract
Venous leg ulcers (VLUs) affect millions of patients worldwide and are a tremendous financial burden on our health care system. The hallmark of venous disease of the lower extremities is venous hypertension, and compression is the current mainstay of treatment. However, many patients are non-compliant, partly because of the complexity of the dressings and the difficulties with application and removal. The aim of our study was to test an effective compression dressing regimen for patients with VLUs who require changing the ulcer primary dressing twice daily. We used two layers of a latex-free tubular elastic bandage for compression. The primary endpoint of our study was increased wound-healing rate and our secondary endpoint was complete wound closure. All active study subjects had positive healing rates at week 4 and week 8. Two subjects achieved complete wound closure by week 8. We conclude that compression with a latex-free tubular elastic bandage can be safely used in patients with VLUs requiring frequent dressing changes. This type of compression allows for daily inspection of wounds, dressing changes at home, flexibility in the context of clinical trials, and is a compromise for patients who are intolerant to compression dressings.
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Affiliation(s)
- Ganary Dabiri
- Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, RI, USA
| | - Scott Hammerman
- Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, RI, USA
| | - Polly Carson
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Vincent Falanga
- Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, RI, USA.,Department of Dermatology, Boston University School of Medicine, Boston, MA, USA.,Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
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Ahmad M, Luo J, Miraftab M. Feasibility study of polyurethane shape-memory polymer actuators for pressure bandage application. Sci Technol Adv Mater 2012; 13:015006. [PMID: 27877473 PMCID: PMC5090298 DOI: 10.1088/1468-6996/13/1/015006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 02/02/2012] [Accepted: 01/03/2012] [Indexed: 06/06/2023]
Abstract
The feasibility of laboratory-synthesized polyurethane-based shape-memory polymer (SMPU) actuators has been investigated for possible application in medical pressure bandages where gradient pressure is required between the ankle and the knee for treatment of leg ulcers. In this study, using heat as the stimulant, SMPU strip actuators have been subjected to gradual and cyclic stresses; their recovery force, reproducibility and reusability have been monitored with respect to changes in temperature and circumference of a model leg, and the stress relaxation at various temperatures has been investigated. The findings suggest that SMPU actuators can be used for the development of the next generation of pressure bandages.
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Affiliation(s)
- Manzoor Ahmad
- Institute of Materials Research and Innovation, University of Bolton, Bolton BL3 5AB, UK
| | - Jikui Luo
- Institute of Materials Research and Innovation, University of Bolton, Bolton BL3 5AB, UK
- Department of Information Science and Electron Engineering, Zhejiang University, Hangzhou, 310027, People’s Republic of China
| | - Mohsen Miraftab
- Institute of Materials Research and Innovation, University of Bolton, Bolton BL3 5AB, UK
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