1
|
Giovanni M, Angrit N, Jean Patrick B, Eduardo DM, Hugo P, Martin S, Martin A. Indications, contraindications, side effects, general assessment, and outlook for the future: An International Compression Club survey. Phlebology 2024; 39:342-352. [PMID: 38300926 PMCID: PMC11129525 DOI: 10.1177/02683555241228899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND The effectiveness of compression therapy (CT) and the best compression modality choice are questioned in many clinical stages of chronic venous disease (CVD). This work aims to obtain information on indications, contraindications, and the best treatment option for CT in different clinical scenarios of CVD. METHOD An online survey was made among members of the International Compression Club, experts in CT. RESULTS The experts apply CT in all clinical stages of CVD, even when evidence is missing. Regarding compression materials, experts use inelastic materials in the advanced stages of CVD and compression stockings in the early or chronic stages of CVD. CONCLUSION The authors highlight the gap between experts' practical use of CT and evidence-based medicine results. They also suggested that, given the cost of randomized clinical trials aimed at specifying specific indications for different devices, artificial intelligence could be used for large-scale practice surveys in the future.
Collapse
Affiliation(s)
- Mosti Giovanni
- Angiology Department, MD Barbantini Clinic, Lucca, Italy
| | - Namislo Angrit
- Clinical Regulatory Affairs, Lohmann & Rauscher GmbH & Co KG, Neuwied, Germany
| | | | - Da Matta Eduardo
- Pró Circulação - Clinic of Angiology and Vascular Surgery, Xanxerê, Brazil
| | | | | | - Abel Martin
- Clinical Regulatory Affairs, Lohmann & Rauscher GmbH & Co KG, Neuwied, Germany
| |
Collapse
|
2
|
Mosti G, Gasparis A, Oropallo A, Labropoulos N. Pressure and stiffness of a new air-inflated compression wrap. Phlebology 2024:2683555241246606. [PMID: 38613486 DOI: 10.1177/02683555241246606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
OBJECTIVE To report pressure and stiffness, in healthy volunteers, of a new compression device with an air bladder inflated by a pump to regulate pressure. METHODS The device was applied to 60 legs of 30 volunteers and set to exert different pressures of 20-50 mmHg. The exerted pressure was measured in supine and standing positions and during simple physical exercises; static stiffness index, dynamic stiffness index, and walking pressure amplitudes were calculated. RESULTS The exerted pressure showed a good correlation with the expected pressure at each pressure range. The stiffness indices were >10 mmHg in the range of inelastic materials. The device was considered very easy to apply and use by the testing researchers. CONCLUSIONS The device stiffness is in the same range as the inelastic bandages. Consequently, similar hemodynamic effectiveness could be expected but must be proved. Unlike inelastic bandages, this device was easy to apply and use.
Collapse
Affiliation(s)
- Giovanni Mosti
- Angiology Department, Clinica MD Barbantini, Lucca, Italy
| | | | - Alisha Oropallo
- Department of Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| |
Collapse
|
3
|
Mosti G, Wittens C, Caggiati A. Black holes in compression therapy: A quest for data. J Vasc Surg Venous Lymphat Disord 2024; 12:101733. [PMID: 38092227 DOI: 10.1016/j.jvsv.2023.101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Although compression therapy (CT) is considered a crucial conservative treatment in chronic venous disease, strong evidence is missing for many clinical indications. This literature review aims to point out what strong evidence we have for CT and all the clinical scenarios where strong evidence still needs to be included. METHODS The research was conducted on MEDLINE with PubMed, Scopus and Web of Science. The time range was set between January 1980 and October 2022. Only articles in English were included. RESULTS The main problem with CT is the low scientific quality of many studies on compression. Consequently, we have robust data on the effectiveness of CT only for advanced venous insufficiency (C3-C6), deep vein thrombosis and lymphedema. We have data on the efficacy of compression for venous symptoms control and in sports recovery, but the low quality of studies cannot result in a strong recommendation. For compression in postvenous procedures, superficial venous thrombosis, thromboprophylaxis, post-thrombotic syndrome prevention and treatment, and sports performance, we have either no data or very debated data not allowing any recommendation. CONCLUSIONS We need high-level scientific studies to assess if CT can be effective or definitely ineffective in the clinical indications where we still have a paucity of or contrasting data.
Collapse
Affiliation(s)
- Giovanni Mosti
- Clinica MD Barbantini, Angiology Department, Lucca, Italy.
| | - Cees Wittens
- Department of Venous Surgery, Rotterdam, the Netherlands
| | | |
Collapse
|
4
|
Da Matta ES, Mosti G, Corralo VDS, Moura GPD, Quadros LBD, De Sá CA. Effects of lower limb muscle strengthening on interface pressure in older adults undergoing inelastic compression: Randomized controlled clinical trial. Phlebology 2024:2683555241235042. [PMID: 38369821 DOI: 10.1177/02683555241235042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To analyze the effects of lower limb muscle strengthening on interface pressure (IP), static stiffness index (SSI), dynamic stiffness index (DSI), and walking pressure amplitude (WPA) in older adults undergoing inelastic compression therapy. METHOD Forty-three healthy older adults of both sexes (Age: 66.2 ± 4.4 years) met the eligibility criteria and completed all stages of the study (Resistance Training - RT: N = 20; Control - CONT: N = 23). Body composition, strength and functional mobility of lower limbs, IP, SSI, DSI, and WPA were evaluated before and after intervention. RESULTS The two-way ANOVA with repeated measures demonstrated a significant time-group interaction effect on muscular strength for 1-RM [F (1, 41) = 21.091; p ≤ 0.001], IP in the orthostatic position [F (1, 41) = 5.124; p ≤ 0.05], minimum WPA [F (1, 41) = 10.999; p ≤ 0.05], maximum WPA [F (1, 41) = 8.315; p ≤ 0.05], DSI minimum (F (1, 41) = 4.608; p ≤ 0.05), DSI maximum (F (1, 41) = 8.926; p ≤ 0.05), and on the delta DSI (F (1, 41) = 7.891; p ≤ 0.05). CONCLUSIONS In RT group, the increase in lower limb muscle strength was accompanied by an increase in IP in foot dorsiflexion and plantar flexion maneuvers, both in the standing position (DSI) and during gait (WPA).
Collapse
Affiliation(s)
- Eduardo Simões Da Matta
- Postgraduate Program in Health Sciences, School of Health, Universidade Comunitária da Região de Chapecó, Chapecó, Brazil
- Pró-Circulação™ - Angiology and Vascular Surgery Clinic, Xanxerê, Brazil
| | | | - Vanessa da Silva Corralo
- Postgraduate Program in Health Sciences, School of Health, Universidade Comunitária da Região de Chapecó, Chapecó, Brazil
| | | | - Luciano Branco de Quadros
- Pró-Circulação™ - Angiology and Vascular Surgery Clinic, Xanxerê, Brazil
- Life Sciences and Health Area, Universidade Do Oeste de Santa Catarina, Xanxerê, Brazil
| | - Clodoaldo Antônio De Sá
- Postgraduate Program in Health Sciences, School of Health, Universidade Comunitária da Região de Chapecó, Chapecó, Brazil
| |
Collapse
|
5
|
Phillips N, Wright T. Comparing easywrap with six other adjustable wraps for compression therapy in venous and lymphatic disease by variation in pressure, stiffness and elasticity. J Wound Care 2024; 33:S10-S14. [PMID: 38150280 DOI: 10.12968/jowc.2024.33.sup1.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND There is no clear guidance or comprehensive comparative evidence to help clinicians select between adjustable wraps for compression therapy. However, adjustable wraps could be compared with three metrics used for compression bandages: variation in pressure, stiffness and elasticity. AIMS To determine whether easywrap (Haddenham Healthcare) had lower standard deviation (SD) in lying pressure, greater static stiffness index (SSI) and/or a greater mean elongation ratio than six other adjustable wraps. METHODS In this preliminary exploratory study, seven adjustable wraps were tested in vivo 20 times each (140 tests in total), on 20 people (with a variable number of readings per participant), to give the SD in lying pressure and mean SSI. The same wraps were tested in vitro five times each to give the mean elongation ratio. FINDINGS Of all seven adjustable wraps, easywrap had the second lowest SD in lying pressure at 5.9 mmHg, compared with 8.9 mmHg overall; the highest mean SSI at 13.2 mmHg, compared with 9.5 mmHg overall; and the highest mean elongation ratio at 137.0%, compared with 107.1% overall. CONCLUSIONS These metrics suggest that easywrap has clinical advantages over other adjustable wraps. A lower variation in lying pressure suggests more consistent application of pressures within intended therapeutic levels. Higher SSI indicates greater resistance to stretching, which is linked to improved venous function and oedema reduction. Higher elongation ratio demonstrates greater tensile strength, which should maintain therapeutic pressure for longer without readjustment.
Collapse
|
6
|
Phillips N, Wright T. Comparing easywrap with six other adjustable wraps for compression therapy in venous and lymphatic disease by variation in pressure, stiffness and elasticity. J Wound Care 2024; 33:S10-S14. [PMID: 38194310 DOI: 10.12968/jowc.2024.33.sup1a.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND There is no clear guidance or comprehensive comparative evidence to help clinicians select between adjustable wraps for compression therapy. However, adjustable wraps could be compared with three metrics used for compression bandages: variation in pressure, stiffness and elasticity. AIMS To determine whether easywrap (Haddenham Healthcare) had lower standard deviation (SD) in lying pressure, greater static stiffness index (SSI) and/or a greater mean elongation ratio than six other adjustable wraps. METHODS In this preliminary exploratory study, seven adjustable wraps were tested in vivo 20 times each (140 tests in total), on 20 people (with a variable number of readings per participant), to give the SD in lying pressure and mean SSI. The same wraps were tested in vitro five times each to give the mean elongation ratio. FINDINGS Of all seven adjustable wraps, easywrap had the second lowest SD in lying pressure at 5.9 mmHg, compared with 8.9 mmHg overall; the highest mean SSI at 13.2 mmHg, compared with 9.5 mmHg overall; and the highest mean elongation ratio at 137.0%, compared with 107.1% overall. CONCLUSIONS These metrics suggest that easywrap has clinical advantages over other adjustable wraps. A lower variation in lying pressure suggests more consistent application of pressures within intended therapeutic levels. Higher SSI indicates greater resistance to stretching, which is linked to improved venous function and oedema reduction. Higher elongation ratio demonstrates greater tensile strength, which should maintain therapeutic pressure for longer without readjustment.
Collapse
|
7
|
Stanek A, Mosti G, Nematillaevich TS, Valesky EM, Planinšek Ručigaj T, Boucelma M, Marakomichelakis G, Liew A, Fazeli B, Catalano M, Patel M. No More Venous Ulcers-What More Can We Do? J Clin Med 2023; 12:6153. [PMID: 37834797 PMCID: PMC10573394 DOI: 10.3390/jcm12196153] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Venous leg ulcers (VLUs) are the most severe complication caused by the progression of chronic venous insufficiency. They account for approximately 70-90% of all chronic leg ulcers (CLUs). A total of 1% of the Western population will suffer at some time in their lives from a VLU. Furthermore, most CLUs are VLUs, defined as chronic leg wounds that show no tendency to heal after three months of appropriate treatment or are still not fully healed at 12 months. The essential feature of VLUs is their recurrence. VLUs also significantly impact quality of life and could cause social isolation and depression. They also have a significant avoidable economic burden. It is estimated that the treatment of venous ulceration accounts for around 3% of the total expenditure on healthcare. A VLU-free world is a highly desirable aim but could be challenging to achieve with the current knowledge of the pathophysiology and diagnostic and therapeutical protocols. To decrease the incidence of VLUs, the long-term goal must be to identify high-risk patients at an early stage of chronic venous disease and initiate appropriate preventive measures. This review discusses the epidemiology, socioeconomic burden, pathophysiology, diagnosis, modes of conservative and invasive treatment, and prevention of VLUs.
Collapse
Affiliation(s)
- Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
| | - Giovanni Mosti
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Angiology Department, MD Barbantini Clinic, Via del Calcio 2, 55100 Lucca, Italy
| | - Temirov Surat Nematillaevich
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Specialized Surgery, Central Hospital of Ministry of Internal Affairs, Chimboy St. 2 A, Almazar District, Tashkent 100095, Uzbekistan
| | - Eva Maria Valesky
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Dermatology, Venereology and Allergology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Tanja Planinšek Ručigaj
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Dermatovenereological Clinic, University Medical Centre Ljubljana, Gradiskova 10 Street, 1000 Ljubljana, Slovenia
| | - Malika Boucelma
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Internal Medicine, University of Algiers, Bachir Mentouri Hospital, Algiers 16208, Algeria
| | - George Marakomichelakis
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- 4th Department of Internal Medicine, General Hospital of Evangelismos, 16676 Athens, Greece
| | - Aaron Liew
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Medicine, Portiuncula University Hospital, University of Galway, H91 TK33 Galway, Ireland
| | - Bahar Fazeli
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- Support Association of Patients of Buerger’s Disease, Buerger’s Disease NGO, Mashhad 9183785195, Iran
| | - Mariella Catalano
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Biomedical, Clinical Sciences L Sacco Hospital, Inter-University Research Center on Vascular Disease, University of Milan, 20157 Milan, Italy
| | - Malay Patel
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Vascular Surgery, Apollo CVHF, Heart Institute, Ahmedabad 380059, India
| |
Collapse
|
8
|
Ehmann S, Mayrovitz HN. Variation in Leg Tissue Dielectric Constant Values of Healthy Young Adult Females With and Without Compression Bandaging. Cureus 2023; 15:e38647. [PMID: 37292526 PMCID: PMC10245081 DOI: 10.7759/cureus.38647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/05/2023] [Indexed: 06/10/2023] Open
Abstract
Background The clinical efficacy of a compression application has been often limited to the assessment of the change in limb volume, change in clinical symptoms (i.e., wound size, pain, range of motion, incidence of cellulitis), or vascular hemodynamics of the whole limb. Assessing compression-related biophysical changes of a localized area, such as around a wound, or in an area outside of an extremity cannot be objectively assessed by these measurements. Tissue dielectric constant (TDC) values, which provide a measure of the local tissue water (LTW) content, offer an alternative method to document variation in the LTW content of the skin in a specific location. The goals of the present research were (1) to characterize TDC values, expressed as percentage tissue water, from multiple areas along the medial aspect of the lower leg of healthy volunteers and (2) to explore the potential utilization of the TDC values to assess change in tissue water content in a localized area following compression applications. Methods TDC was measured at 10, 20, 30, and 40 cm proximal to the medial malleolus on the medial aspect of the right leg of 18 young adult healthy women with an age range of 18-23 years and a body mass index of 18.7 to 30.7kg/m2.. TDC was measured at baseline and after 10 minutes of exercise with compression in place on three separate days during which three different compression applications were assessed: a longitudinal elastic stockinette, a two-layer cohesive compression kit, and a combination of the two. Leg circumferences and compression-related interface pressures were also measured. Results Test-Retest Reliability of circumferential measurements and TDC values evaluated using Intraclass correlation coefficient (ICC 3,1) revealed excellent and moderate-to-good reliability, respectively. Analysis of TDC values along the length of the limb using Friedman's test, revealed a small but statistically significant overall difference among baseline TDC values attributable to a smaller value at 40 cm. The largest difference in cumulative average was 7.7% which occurred between 20 and 40 cm, with all other differences between locations less than 1%. No significant differences between the compression applications were observed. Conclusion The present findings demonstrate the utility of TDC measurements as a modality to assess compression-related changes in the legs of healthy women as a foundation for their potential use in assessing outcomes of compression treatments for persons with lower extremity edema or lymphedema. The absence of a significant change in TDC values in these healthy non-edematous conditions and the demonstrated reliability of the TDC measurements on three different days provides further support for the utility of such applications of TDC measurements. The extension to patients with lower extremity edema or lymphedema needs to be evaluated.
Collapse
Affiliation(s)
- Suzie Ehmann
- Physical Therapy, Nova Southeastern University, Fort Lauderdale, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| |
Collapse
|
9
|
Arias-Guzman S, Oberg C, Jones R, Call E. Comparing the Energy-Stretch Properties of Two Compression Bandage Systems in a Laboratory-Based Test under Controlled Conditions. Adv Skin Wound Care 2022; 35:605-612. [PMID: 36264752 PMCID: PMC9586827 DOI: 10.1097/01.asw.0000875052.14511.ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the characteristics of two commercially available compression systems, a dual-compression bandage system (DCS) and a traditional two-layer bandage (TLB), using a laboratory bench test. METHODS The compression systems were evaluated in a computer-controlled tensile test to generate force-deflection curves for each sample. The compressive work and the theoretical pressure applied to the limb by the respective compression bandages were calculated at the maximum stretch and a stretch instructed by the manufacturers. The manufacturer of the DCS provides reference points on how much the bandage should be stretched to provide the desired pressure, and the TLB stretch was calculated from the product’s datasheet. RESULTS The combined results of layers 1 and 2 for the DCS showed greater load and work than the TLB at both the maximum and recommended stretch. The recommended stretch for DCS and TLB was less than 50% of the deflection up to the breaking point. CONCLUSIONS The high work provided by the two layers of the DCS suggests a wider range of performance than the TLB when applied to the lower limb, especially after the limb volume is initially reduced by compression. Moreover, using the tensile test and the guide of the reference points on layers 1 and 2 from DCS, the calculated pressure achieved the expected values stated by the manufacturer. Human studies should be conducted to determine whether the reference points provided by DCS are beneficial for obtaining repeatable values.
Collapse
|
10
|
Pannier F, Noppeney T, Alm J, Breu FX, Bruning G, Flessenkämper I, Gerlach H, Hartmann K, Kahle B, Kluess H, Mendoza E, Mühlberger D, Mumme A, Nüllen H, Rass K, Reich-Schupke S, Stenger D, Stücker M, Schmedt CG, Schwarz T, Tesmann J, Teßarek J, Werth S, Valesky E. S2k guidelines: diagnosis and treatment of varicose veins. DER HAUTARZT; ZEITSCHRIFT FUR DERMATOLOGIE, VENEROLOGIE, UND VERWANDTE GEBIETE 2022; 73:1-44. [PMID: 35438355 PMCID: PMC9358954 DOI: 10.1007/s00105-022-04977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- F Pannier
- Praxis für Dermatologie und Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
The Effect of an Educational Intervention on Self-Care in Patients with Venous Leg Ulcers-A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084657. [PMID: 35457524 PMCID: PMC9028307 DOI: 10.3390/ijerph19084657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
Background: Although patients with venous leg ulcers are involved in ulcer management, little is known about why and how these patients self-treat their ulcers without direct supervision by health professionals. Yet patients’ knowledge of ulcer management can be important for achieving ulcer closure and/or preventing recurrence. This study thus investigates the effects of an educational intervention on knowledge of self-care among patients with venous leg ulcers, mainly on wound dressing practice, compression therapy, physical activity and nutrition. Methods and participants: This research was conducted in three outpatient hospitals in central Croatia. An educational brochure was made and distributed to patients; patients were surveyed about caring for venous leg ulcers before the brochure was distributed and after 3 months. Results: In total, 208 patients were involved in the study: 112 in the experimental group and 96 in the control group. The educational intervention increased awareness of compression therapy, knowledge of recurrence prevention, appropriate lifestyle habits, and warning signs related to venous leg ulcers. Conclusions: Patient education on illness and self-care is necessary to achieve positive effects in self-care knowledge. In this study, patients learned how to change dressings, learned how to improve their lifestyle, and were empowered to deal with their illness.
Collapse
|
12
|
Muldoon J. 24-hour interval compression: a plan to balance effectiveness and tolerability for chronic oedema. Br J Community Nurs 2022; 27:S28-S31. [PMID: 35373613 DOI: 10.12968/bjcn.2022.27.sup4.s28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As one of the mainstays for the management of chronic oedema, compression is unquestionably an efficacious and important element in treatment pathways during the intensive acute, transition and maintenance phases. Despite the variety of compression technologies on the market, devices to aid application and innovative methods employed by caregivers to encourage adherence to treatment, concordance remain a challenge. Balancing clinical effectiveness and patient comfort, the 24-hour interval plan considers wearer lifestyle and treatment options to tailor types of compression and times during the day and night when compression is worn. This article reviews previously published theories and evidence on which the 24-hour compression plan has been based (Bock et al, 2022).
Collapse
Affiliation(s)
- Jeanette Muldoon
- Registered Nurse and Independent Clinical Researcher, Maidenhead, UK
| |
Collapse
|
13
|
Bock KJ, Ehmann JS, Muldoon J. The 24-hour interval compression plan: part 2-lifestyle and therapeutic regimens to manage chronic oedema case series. J Wound Care 2022; 31:218-223. [PMID: 35199599 DOI: 10.12968/jowc.2022.31.3.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this case series was to retrospectively assess the impact on volume control and patients' quality of life (QOL) when a night-time garment was added to their previous compression regimen for a full 24-hour interval compression plan. METHOD Patients who had a history of chronic oedema presented to one of two oedema management centres in the US for treatment for oedema exacerbation and/or suboptimal performance of their current garments. Objective data examined were circumferential limb volume (cm3) measurements and QOL measured with the Lymphoedema QOL Tool (LYMQOL-Leg and LYMQOL-Arm). Subjective comments on functional abilities and perception of improvement with a compression plan that comprised a 24-hour interval were documented. RESULTS All three patients presented in this case series had a reduction in limb volume and improvement in QOL when their daytime regimen of garments was updated and new night-time garments were added. Their subjective comments indicated improvement in activities of daily living and ease of controlling daytime oedema with a 24-hour interval compression plan. CONCLUSION This case series illustrates the need for clinicians to create a partnership with the patient to promote concordance and adherence as part of their individual 24-hour interval compression plan. This partnership allows the plan to be uniquely changed and adjusted to allow each patient to feel in control of refreshing their mood, their skin and their garments.
Collapse
Affiliation(s)
- Karen J Bock
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, US
| | | | | |
Collapse
|
14
|
De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 178] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
|
15
|
Bock KJ, Muldoon J. A 24-hour interval compression plan for managing chronic oedema: part 1-the science and theory behind the concept. J Wound Care 2022; 31:S4-S9. [PMID: 35148639 DOI: 10.12968/jowc.2022.31.sup2.s4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Compression, skin care, manual lymph drainage and exercise form the mainstays of treatment of chronic limb oedema. The compression aspect of the regimen is often prescribed and used without conscious concern for the patient's ability for self-adjustment and skin hygiene. This article will focus on the action of compression therapy using a new concept of encouraging patients to apply and reapply an adjustable compression garment or multiple garment types during a 24-hour interval. The benefits of this focus on interval compression therapy on all aspects of care will be explained and case studies presented.
Collapse
Affiliation(s)
- Karen J Bock
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, US
| | | |
Collapse
|
16
|
Benigni JP, Balet F, Guidet B, Tacca O. Statischer Stiffness-Index von zwei Multikomponenten-Bandagen-Kompressionssystemen: Ergebnisse einer randomisierten kontrollierten Studie an gesunden Probanden. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1487-4194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Zweck Vergleich der Leistung von zwei Mehrkomponenten-Kompressionssystemen.
Methoden In dieser randomisierten, kontrollierten Studie wurden beide Beine von 25 gesunden Probanden nach dem Zufallsprinzip entweder mit einem Kompressionssystem der neuen Generation (UrgoK1, eine einzige Binde) oder einem etablierten System (UrgoK2, zwei Binden) als Kontrolle bandagiert. Beide Systeme wurden Tag und Nacht getragen. Arbeits- und Ruhegrenzflächendruck wurden unmittelbar nach dem Anlegen und nach 4 h, 24 h, 48 h und 72 h gemessen und der Static Stiffness Index (SSI) berechnet.
Ergebnisse Nach 4 Stunden wurden mit beiden Systemen ähnlich hohe Arbeitsdrücke und mäßige Ruhedrücke registriert. Im Zeitverlauf folgten die Druckänderungen und des SSI den gleichen Kurven. Nach 48 h wurde ein SSI ≥ 10 mmHg bei 88 % der getesteten und 76 % der Kontrollsysteme erreicht, was die Nichtunterlegenheit des Testsystems bestätigt (p = 0,016). Beide Systeme wiesen gute Halteeigenschaften auf und waren gut verträglich, aber das getestete System wurde von der Mehrheit der Probanden als deutlich angenehmer empfunden und schließlich dem Kontrollsystem vorgezogen.
Schlussfolgerung Das neue Kompressionssystem erreichte ähnliche Leistungen wie die Kontrolle, aber seine bessere Akzeptanz könnte ein Vorteil für die Patientencompliance sein. Diese vielversprechenden Ergebnisse müssen in einer klinischen Studie an Patienten mit Unterschenkelulcera und/oder Ödemen bestätigt werden.
Collapse
Affiliation(s)
| | | | - Bérengère Guidet
- Klinische Projektleiterin, Intertek Clinical Research Services, Paris, Frankreich
| | - Olivier Tacca
- Direktor der Abteilung für präklinische und klinische Forschung, Urgo Research Innovation and Development, Chenôve, Frankreich
| |
Collapse
|
17
|
Saffar HA. How Can Adjustable Velcro Wraps Help in the Management of Lymphedema in the Absence of Complex Physical Therapy Facilities. Lymphat Res Biol 2021; 20:435-440. [PMID: 34788145 DOI: 10.1089/lrb.2021.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Lymphedema is a progressive disorder characterized by impairment of lymph flow from tissues to the blood circulation due to damage of lymphatics. Treatment can be surgical or nonsurgical. A great number of operative procedures described in the literature demonstrate no single method exists that could be regarded as a standard. Nonsurgical therapy consists of a set of four physiotherapeutic measures, if properly performed; it treats the cause of lymphedema in a manner free of side effects, this set is called complex physical therapy (CPT). Criteria and facilities of CPT are not available in Iraq now. Materials and Methods and Results: Below is a short clinical experience of seven cases (nine diseased lower limbs) presented at our clinic for management of lymphedema who were all managed successfully during the decongestive period using adjustable Velcro wraps (AVW). Conclusions: In the absence of ideal CPT facilities, AVW can be used as a single therapeutic modality for treatment of lymphedema.
Collapse
Affiliation(s)
- Hayder Al Saffar
- Department of Surgery, College of Medicine, University of Babylon, Hilla City, Iraq
| |
Collapse
|
18
|
Berszakiewicz A, Sieroń A, Krasiński Z, Cholewka A, Stanek A. Compression therapy in venous diseases: physical assumptions and clinical effects. Postepy Dermatol Alergol 2020; 37:842-847. [PMID: 33603600 PMCID: PMC7874878 DOI: 10.5114/ada.2019.86990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/09/2019] [Indexed: 12/04/2022] Open
Abstract
Compression therapy (CT) is an established treatment method in chronic venous disease. Despite years of clinical experience, choosing the optimum compression therapy, including grade and pressure distribution, which determine the efficacy of treatment poses a challenge. The paper discusses CT physical assumptions (stiffness, elasticity, static and dynamic stiffness indices), clinical effects and contraindications to CT.
Collapse
Affiliation(s)
- Andrzej Berszakiewicz
- Department of Internal Medicine, Angiology and Physical Medicine, Specialist Hospital No. 2, Bytom, Poland
- Fresenius Dialysis Centre No. 38 in Oswiecim, Fresenius Nephrocare Polska, Oswiecim, Poland
| | - Aleksander Sieroń
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Bytom, Poland
| | - Zbigniew Krasiński
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Armand Cholewka
- Department of Medical Physics, Chelkowski Institute of Physics, University of Silesia, Katowice, Poland
| | - Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Bytom, Poland
| |
Collapse
|
19
|
Compression Therapy Is Not Contraindicated in Diabetic Patients with Venous or Mixed Leg Ulcer. J Clin Med 2020; 9:jcm9113709. [PMID: 33227909 PMCID: PMC7699243 DOI: 10.3390/jcm9113709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to investigate if compression therapy (CT) can be safely applied in diabetic patients with Venous Leg Ulcers (VLU), even when a moderate arterial impairment (defined by an Ankle-Brachial Pressure Index 0.5–0.8) occurs as in mixed leg ulcers (MLU). Materials and methods: in one of our previous publications we compared the outcomes of two groups of patients with recalcitrant leg ulcers. Seventy-one patients were affected by mixed venous and arterial impairment and 109 by isolated venous disease. Both groups were treated by tailored inelastic CT (with compression pressure <40 mm Hg in patients with MLU and >60 mm Hg in patients with VLU) and ultrasound guided foam sclerotherapy (UGFS) of the superficial incompetent veins with the reflux directed to the ulcer bed. In the present sub analysis of the same patients we compared the healing time of 107 non-diabetic patients (NDP), 69 with VLU and 38 with MLU) with the healing time of 73 diabetic patients (DP), 40 with VLU and 33 with MLU. Results: Twenty-five patients were lost at follow up. The results refer to 155 patients who completed the treatment protocol. In the VLU group median healing time was 25 weeks for NDP and 28 weeks in DP (p = 0.09). In the MLU group median healing time was 27 weeks for NDP and 29 weeks for DP (p = −0.19). Conclusions: when providing leg ulcer treatment by means of tailored compression regimen and foam sclerotherapy for superficial venous refluxes, diabetes has only a minor or no effect on the healing time of recalcitrant VLU or MLU.
Collapse
|
20
|
Karafa M, Karafova A. Kikuhime Device in the Management of Venous Leg Ulcers. Clin Interv Aging 2020; 15:1533-1539. [PMID: 32943856 PMCID: PMC7478371 DOI: 10.2147/cia.s264567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
The effectiveness of compression therapy in the treatment of venous leg ulcers has been confirmed in many scientific studies. The healing process depends on many of its parameters, such as the type of compression bandages, their elastic properties and sub-bandage pressure. However, there is no standard protocol that would ensure success for all patients. A pressure of about 83 mmHg provides complete compression for both superficial and deep veins; however, applying compression bandages under such high pressure is a difficult task, even for experienced therapists. Here, we present the case of a 61-year-old woman with approximately 2.5-year-old venous ulcer in her left leg due to chronic venous insufficiency (CVI). Our study aimed to show that routine pressure control at each bandage renewal using the Kikuhime device, as well as their twice daily application in the first week of therapy reduced the healing time of a venous leg ulcer with an area of about 20 cm2 to four weeks.
Collapse
Affiliation(s)
- Marian Karafa
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Anna Karafova
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, Gdansk, Poland
| |
Collapse
|
21
|
Lantis JC, Barrett C, Couch KS, Ehmann S, Greenstein E, Ostler M, Tickner A. A dual compression system: preliminary clinical insights from the US. J Wound Care 2020; 29:S29-S37. [PMID: 32924806 DOI: 10.12968/jowc.2020.29.sup9.s29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is growing evidence on an interconnection between the venous and lymphatic systems in venous leg ulceration, and the possible effects of prolonged oedema and lymphatic impairment in delayed wound healing. Compression therapy is a widely accepted treatment for venous and lymphatic disorders, as it decreases recurrence rates and prolongs the interval between recurrences. Compression bandages improve venous return, increase the volume and rate of venous flow, reduce oedema and stimulate anti-inflammatory processes. The pressure at the interface (IP) of the bandage and the skin is related to the elastic recoil of the product used and its resistance to expansion. The pressure difference between the IP in the supine and standing positions is called the static stiffness index (SSI). Elastic materials provide little resistance to muscle expansion during physical activity, resulting in small pressure differences between resting and activity, with an SSI <10mmHg. Stiff, inelastic materials with a stretch of <100% resist the increase of muscle volume during physical activity, producing higher peak pressures, an SSI of >10mmHg and a greater haemodynamic benefit than elastic systems. UrgoK2 is a novel dual-layer high-compression system consisting of an inelastic (short stretch) and elastic (long stretch) bandage, resulting in sustained tolerable resting pressure and elevated working pressures over extended wear times. It is indicated for the treatment of active venous leg ulcers and the reduction of chronic venous oedema. Each bandage layer has a visual aid to enable application at the correct pressure level. Published European studies have assessed this compression system, exploring its consistency of application, tolerability and efficacy. This article presents the first reports of health professionals' clinical experience of using the compression system in the US, where it has been recently launched. Initial feedback is promising.
Collapse
Affiliation(s)
- John C Lantis
- Mount Sinai Morningside and West Hospitals, Icahn School of Medicine, New York, US
| | - Christopher Barrett
- The Centers for Wound Healing, Crozer Keystone Health System, Springfield, Pennsylvania, US
| | - Kara S Couch
- George Washington University Hospital, Washington DC, US
| | - Suzie Ehmann
- Atrium Health Stanly, Albemarle, North Carolina, US
| | | | | | - Anthony Tickner
- Saint Vincent Hospital/RestorixHealth, Wound Healing Center, Worcester, Massachusetts, US, and Board of Directors, Massachusetts Foot and Ankle Society
| |
Collapse
|
22
|
Jindal R, Balet F, Filori P, Kaur T, Dhillon S, Thapa S, Chaudhary P. Interest of a standardized treadmill test to evaluate pressure drops and stiffness indices under short stretch bandages. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
23
|
Riebe H, Konschake W, Westphal T, Jünger M. Innovationen der medizinischen Kompressionstherapie. Hautarzt 2019; 71:24-31. [DOI: 10.1007/s00105-019-04516-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Abstract
Interface pressures with compression depend on many factors relating to the science of measurement and intrinsic, patient-related factors, including limb size and tissue texture. While it is important for manufacturers of compression devices to measure pressures, it may not always be relevant to clinical practice where application methods and oedematous limbs may affect final pressures. Accurate performance of any compression system relies on the use of the right technology for the right condition and patient lifestyle. Correct application following training and in accordance with instructions for use may be adapted according to individual patient comfort and needs, including mobility, tissue texture and the stage of management. In order to provide treatment regimens that are safe, effective and well tolerated by patients, as well as being easy to apply and demonstrate sound economic practice, science needs to meet clinical practice. Patient reporting is an important for successful treatment, matching clinical effectiveness with patient acceptance during reassessment and monitoring.
Collapse
|
25
|
Ehmann S, Bock K. Case report to demonstrate the need for selection criteria for optimal adjustable Velcro wrap prescription. J Wound Care 2019; 27:S10-S17. [PMID: 29334016 DOI: 10.12968/jowc.2018.27.sup1.s10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compression, in the form of either a compression bandage or a compression stocking, has been touted as the gold standard for treatment of swelling and venous leg ulcers (VLUs). Adjustable Velcro wraps have been marketed as compression alternative. Although there is a growing body of evidence to support use of these products, there has not been a critical evaluation of the functionality of the devices to best matching product to patient presentation and ability to use the device effectively. Unlike compression garments, which are classified by compression category (class I/II or flat knit/circular), there is not an algorithm to direct health professionals to best match a specific adjustable Velcro wrap to an individual patient presentation. This small case series demonstrates that although each product performed as marketed in vitro, performance in clinical setting varied greatly dependent on patient presentation and functional skill level.
Collapse
|
26
|
Szary C, Wilczko J, Grzela T, Partsch H. Which pressure of adjustable compression wrap system is necessary to reduce deep vein cross section area in post-thrombotic patients? A proof-of-concept study. Phlebology 2019; 35:207-214. [PMID: 31488043 DOI: 10.1177/0268355519873808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The conservative treatment of post-thrombotic syndrome includes application of compression on the affected extremity. However, the type and the level of compression required to manage post-thrombotic syndrome are still unclear. The aim of our proof-of-concept study was to assess the compression required to reduce cross section area of post-thrombotic deep veins in 22 patients with post-thrombotic syndrome. Methods The circumference and cross section area of posterior tibial veins and saphenous vein trunk were assessed on mid-calf level using 3T magnetic resonance scanner, at increasing compression (0, 30, 40, and 50 mmHg), provided by a novel adjustable Velcro compression wrap, the CircAid JuxtaLite®. Results A significant reduction of baseline vein cross section area in post-thrombotic syndrome patients in the lying position required compression of at least 30 mmHg for posterior tibial veins, and at least 40 mmHg for the saphenous trunk. Apart from morphological changes of the compressed veins, we observed extinction of T2w signal at compression above 40 mmHg, which corresponded to accelerated blood flow in the veins, and therefore may be considered as a hemodynamic marker of compression effectiveness. Conclusion CircAid adjusted to compression level ≥40 mmHg accelerates blood flow in affected deep veins, thus it may facilitate post-thrombotic syndrome management.
Collapse
Affiliation(s)
| | | | - Tomasz Grzela
- Clinic of Phlebology, Warsaw, Poland.,Medical University of Warsaw, Warsaw, Poland
| | - Hugo Partsch
- Emeritus Medical University of Vienna, Vienna, Austria
| |
Collapse
|
27
|
Couzan S, Pouget JF, Le Hello C, Chapelle C, Laporte S, Mismetti P. High tolerance of progressive elastic compression in peripheral arterial disease. VASA 2019; 48:413-417. [DOI: 10.1024/0301-1526/a000799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary. Background: Theoretically progressive compression stockings, which produce a higher compression at the calf than at the ankle level, improve venous return flow without exacerbating peripheral arterial insufficiency (PAD). We aimed to evaluate the short-term tolerance of elastic progressive compression stockings on peripheral arterial vascularisation in patients with symptomatic PAD and associated mild venous insufficiency. Patients and methods: Monocentric, prospective, open pilot study of 18 patients (acceptability study, 6 x 6 plan) evaluating the short-term tolerance of progressive compression stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in patients with PAD (ankle brachial index ABI > 0.60 < 0.75) and chronic venous insufficiency (C1s–C4 stages of the CEAP classification). Day 15 tolerance was evaluated by a composite primary criteria comprising: no decrease > 15 % of ABI on each side, no decrease > 15 % of toe brachial index (TBI) on each side and no decrease > 25 % of the number of active plantar flexions performed while standing. Results: The proportion of men was 77.8 %, mean age was 77.3 ± 7.5 years and no patient were diabetic. At inclusion, the mean low ABI was 0.60 ± 0.04 and the mean high ABI was 0.77 ± 0.18. The mean low TBI was 0.32 ± 0.09 and the mean high TBI 0.46 ± 0.15. The mean number of active standing plantar flexions was 33.0 ± 5.0. The majority of the patients were classified in CEAP C2s and C3 classes (class 2: 16.7 %, class C2s: 27.8 %, class C3: 44.4 %, class C4: 5.6 % and class C4s: 5.6 %). Poor tolerance occurred in no patient. By day 30, no patient had worsening of their arterial and venous symptoms. No adverse events occurred during the study. Conclusions: These results suggest a high tolerance of progressive elastic stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in symptomatic PAD.
Collapse
Affiliation(s)
- Serge Couzan
- Clinique Mutualiste, Saint-Étienne, France
- INSERM, U1059 Sainbiose, Université de Lyon, Saint-Étienne, France
| | - Jean-François Pouget
- Clinique Mutualiste, Saint-Étienne, France
- INSERM, U1059 Sainbiose, Université de Lyon, Saint-Étienne, France
| | - Claire Le Hello
- INSERM, U1059 Sainbiose, Université de Lyon, Saint-Étienne, France
- Campus Santé et Innovations, Université Jean Monnet, St-Priest-en-Jarez, France
- Département de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire, Saint-Étienne, France
| | - Céline Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie, Saint-Étienne, France
| | - Silvy Laporte
- INSERM, U1059 Sainbiose, Université de Lyon, Saint-Étienne, France
- Campus Santé et Innovations, Université Jean Monnet, St-Priest-en-Jarez, France
- Unité de Recherche Clinique Innovation et Pharmacologie, Saint-Étienne, France
| | - Patrick Mismetti
- INSERM, U1059 Sainbiose, Université de Lyon, Saint-Étienne, France
- Campus Santé et Innovations, Université Jean Monnet, St-Priest-en-Jarez, France
- Département de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire, Saint-Étienne, France
- Unité de Recherche Clinique Innovation et Pharmacologie, Saint-Étienne, France
| |
Collapse
|
28
|
Abstract
BACKGROUND The pressure exerted by a compression device on a part of the body corresponds to the dosage of the compression therapy. Therefore, the pressure course under compression materials should be investigated in different clinical situations. MATERIAL AND METHODS Pressure measurements were carried out under different compression materials in lying, standing and walking positions within the framework of training, self-experimentation and in patients with venous leg ulcers. RESULTS The results showed that the pressure varied considerably depending on the material used, the firmness of application, the local configuration (body position) and the time interval between applications. A loss of pressure occurred under each compression therapy, especially under inelastic short-stretch material, mainly due to movement and edema reduction. This pressure loss is decisive for the timing of dressing changes and a reason for the good tolerance of high-pressure levels in mobile patients. CONCLUSION Low pressures are particularly suitable for edema reduction. Hemodynamic effects require higher pressures (60-80 mmHg). For this purpose, inelastic materials are preferred which enable lower pressures when lying down (40-60 mmHg). As compression bandages are too loosely applied by many users, pressure indicators on bandages or adaptive bandages with templates are helpful to apply the material with the correct pressure. As a consequence of these findings it is postulated that, at least in studies comparing different compression media, pressure measurements should be carried out in the future, whereby the measuring point and body position should be documented.
Collapse
|
29
|
Bjork R, Ehmann S. S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity. J Wound Care 2019; 28:1-44. [DOI: 10.12968/jowc.2019.28.sup6a.s1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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
Collapse
Affiliation(s)
- Robyn Bjork
- International Lymphedema and Wound Training Institute, Alaska, US
| | | |
Collapse
|
30
|
A Wearable Compression Device to Normalise Calf Muscle Pump Function in Chronic Venous Insufficiency for Each Postural Position. Eur J Vasc Endovasc Surg 2019; 57:702-707. [PMID: 31003934 DOI: 10.1016/j.ejvs.2018.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND For the currently used compression therapy, the applied compression pressure is usually inadequate to exert an effective impact on the veins in different body positions. The aim was to assess the venous ejection fraction achieved by a new compression device which automatically adjusts the interface pressure to body position in an acute experimental setting. METHODS A new portable, battery driven compression device providing pressure adjusted to allow for body position, and connected to a less or very stiff calf cuff wrap was tested. In patients with superficial venous incompetence, the ejection fraction (EF) of the calf pump was measured by strain gauge plethysmography. Applied in a random sequence, values achieved without compression, with the two cuffs, and with compression stockings exerting 23-32 mmHg, were compared. The applied compression pressures were simultaneously recorded in the supine and standing positions, and during walking. Comfort was assessed by a visual analogue scale (VAS) with 0 corresponding to very low comfort and 10 to very comfortable. RESULTS In 16 patients with CEAP clinical stage C3-C6, EF without compression was 37%, increasing to 46.9% with stockings, to 64.8% (p < .001) by less stiff and to 75.5% (p < .001) by stiffer wraps. The median interface pressure (supine/standing) was 31/56 mmHg for the less stiff device, 32/68 mmHg for the stiffer device, and 23/26 mmHg for the stockings. The static stiffness index and the walking pressure amplitudes were significantly higher than those generated by the stocking, and the highest values were found with the stiffer wrap material. The device comfort was high both in the supine and standing positions (VAS 8 ± 2). CONCLUSIONS The tested devices were comfortable at rest and haemodynamically effective during walking by automatically adjusting compression pressures to body position. They are significantly more effective than elastic stockings in improving EF. The system is able to overcome the problems of fast pressure loss by continuously re-adjusting the compression pressure.
Collapse
|
31
|
Boxall SL, Carville K, Leslie GD, Jansen SJ. Controlling compression bandaging pressure in leg ulcer research trials: A summary of the literature. Phlebology 2019; 34:501-514. [PMID: 30674236 DOI: 10.1177/0268355519825590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.
Collapse
Affiliation(s)
- Sharon L Boxall
- 1 School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
| | - Keryln Carville
- 2 Curtin University and Silver Chain Group, Bentley, Australia
| | - Gavin D Leslie
- 1 School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Australia
| | | |
Collapse
|
32
|
Mosti G, Cavezzi A. Compression therapy in lymphedema: Between past and recent scientific data. Phlebology 2019; 34:515-522. [PMID: 30626269 DOI: 10.1177/0268355518824524] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim To extrapolate and discuss the scientific data on compression in lymphedema treatment, so to review old and innovative concepts about pressure, stiffness and other interplaying factors related to its efficacy and comfort. Material and methods Narrative review based on search in Medline/Google Scholar through key-words related to compression in lymphedema. Results Currently available literature lacks relevant details about data on protocol, devices, techniques, interface pressure, stiffness, as well as biases are represented by the different descriptions to present the outcomes. More recent evidence from adjustable wrap devices and elastic garments question the need for high pressure (especially for the upper limb) and stiffness in lymphedema treatment. Conclusions At present time a very strong compression pressure exerted by material with high stiffness seem to be questionable in lymphedema treatment. A low pressure provides the best outcomes in arm lymphedema, while a pressure in the range of 40–60 mm Hg seems to provide higher efficacy in lower limb lymphedema, provided it is maintained overtime. A high stiffness seems to be unnecessary to treat chronic edema. Future clinical trials, including proper description of treatment methodology and adequate investigating instrumental tools, are awaited to possibly corroborate the conclusive outcomes of our review.
Collapse
Affiliation(s)
- Giovanni Mosti
- 1 Angiology Department, MD Barbantini Clinic, Lucca, Italy
| | - Attilio Cavezzi
- 2 Eurocenter Venalinfa, San Benedetto del Tronto (AP), Italy
| |
Collapse
|
33
|
Partsch H, Schuren J, Mosti G, Benigni JP. The Static Stiffness Index: an important parameter to characterise compression therapy in vivo. J Wound Care 2018; 25 Suppl 9:S4-S10. [PMID: 27608740 DOI: 10.12968/jowc.2016.25.sup9.s4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The compression pressure, which corresponds to the dosage of compression therapy, has been widely neglected up to now, not only concerning scientific literature, but also in clinical practice. It is evident that compression pressures in the upright position and during walking are clinically more relevant than just the resting pressure. The Static Stiffness Index (SSI), which is the difference between standing and resting pressure, is a valuable parameter characterising the efficacy of a specific compression product to narrow/occlude the venous lumen. This is a prerequisite for reducing venous reflux and exerting a massaging effect necessary to improve the venous pumping function during movement. This article provides an overview of the recent literature on the SSI, which supports the recommendations of the International Compression Club. In addition, it aims to provide an insight on the importance of the SSI in daily practice, as an educational tool as well as in defining the properties of applied compression therapy in clinical research.
Collapse
Affiliation(s)
- H Partsch
- Professor Emeritus, Medical University of Vienna, Austria
| | - J Schuren
- Retired from 3M Deutschland GmbH, Linne, the Netherlands
| | - G Mosti
- Head of the Angiology Department, Clinica Barbantini, Lucca, Italy
| | | |
Collapse
|
34
|
Franks PJ, Barker J, Collier M, Gethin G, Haesler E, Jawien A, Laeuchli S, Mosti G, Probst S, Weller C. Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice. J Wound Care 2018; 25 Suppl 6:S1-S67. [PMID: 27292202 DOI: 10.12968/jowc.2016.25.sup6.s1] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).
Collapse
Affiliation(s)
- Peter J Franks
- Centre for Research & Implementation of Clinical Practice, 128 Hill House, 210 Upper Richmond Road, London SW15 6NP, United Kingdom
| | | | - Mark Collier
- United Lincolnshire Hospitals NHS Trust (ULHT), c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9QS, United Kingdom
| | | | - Emily Haesler
- Wound Management and Healing Node, Curtin University, Perth, Australia & Academic Unit of General Practice, Australian National University, Canberra, Australia (Visiting Fellow)
| | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland
| | - Severin Laeuchli
- University Hospital Zürich, Department of Dermatology, Gloriastrasse 31, CH-8091 Zürich, Switzerland
| | | | - Sebastian Probst
- School of Health, University of Applied Sciences Western Switzerland, HES-SO Genève, Avenue de Champel 47, CH-1206 Geneva, Switzerland
| | - Carolina Weller
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
| |
Collapse
|
35
|
Partsch H. Reliable self-application of short stretch leg compression: Pressure measurements under self-applied, adjustable compression wraps. Phlebology 2018; 34:208-213. [PMID: 30099955 DOI: 10.1177/0268355518793467] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Self-application of properly performed compression bandages is generally considered as problematic. Therefore, the aim of this study was to measure the pressure of self-applied short stretch adjustable compression wrap compression systems (Juxta fit™) and to compare the results with the pressure achieved by bandaging other legs using the same material. METHODS In the two training courses for nurses, specifically interested in leg ulcer treatment, the new bandage type of adjustable compression wrap was explained and workshops were organized, in which the interface pressure achieved by Juxta fit™ was measured. In the first course, the nurses applied the compression system to each other, and in the second course, another group did it on their own legs. Bandagers were instructed to apply the system strongly, with a target range of more than 50-60 mmHg. RESULTS In the first course with mutual application ( n = 34), the median pressure at the medial lower leg was 58.5 mmHg (minimal 31, maximal value 137 mmHg), in the second course in which self-application was tested ( n = 36), the corresponding values were 61.5 mmHg (minimum 35, maximum 102 mmHg). No pressures less than 30 mmHg were seen on the distal calf in either group. CONCLUSIONS In contrast to short stretch bandages that are frequently applied by bandagers with too low pressure, the adjustable compression wrap devices handled by the patients themselves produce more appropriate and more consistent pressure.
Collapse
Affiliation(s)
- Hugo Partsch
- Department of Dermatology, Vienna Medical University, Vienna, Austria
| |
Collapse
|
36
|
Abstract
SummaryCompression therapy is one of cornerstone in the treatment of venous and lymphatic disorders.It may be applied by means of different elastic or inelastic stockings, bandages, or other devices. Inelastic material is much more effective improving venous impaired haemodynamics than elastic material. Due to its physical properties inelastic material is able to exert a significantly higher pressure than elastic devices moving to the standing from the supine pressure; furthermore it is able to exert significantly higher pressure peaks during muscle exercise. This high pressure can overcome the intravenous pressure and cause intermittent occlusion of leg veins, restoring a kind of valve mechanism. Elastic material gives way to the muscle expansion during standing and walking and the pressure increase in these conditions is very low. Due to this low increase with muscle activity, elastic material does not exert an intermittent pressure but rather a sustained pressure not able to overcome the intravenous pressure. As a consequence, elastic material is hardly able to influence the venous diameter and its haemodynamic effects are minimal.Compared to elastic, inelastic material is significantly more effective in reducing venous reflux, increasing venous pumping function and reducing ambulatory venous hypertension.Compression therapy proved to be beneficial, over time, in every clinical condition from CEAP C1 to C6.Due to their characteristics and effects, in-elastic compression needs to be applied in the acute stages of venous disorders when a strong haemodynamic effect is necessary, while elastic stockings may be used in the chronic stages to maintain the results and prevent recurrences.A new concept in compression therapy is the inversely graduated compression pressure profile, higher over the calf than over the ankle, also named “progressive compression.” Both specially designed elastic stockings and appropriately applied bandages can exert a progressive compression which showed some interesting outcomes both in experimental and clinical settings in patients with chronic venous disorders and in athletes. Nevertheless its effectiveness in many pathological conditions (oedema treatment, venous leg ulcer, thromboprophylaxis, etc.) needs to be proved in future trials.
Collapse
|
37
|
A New Two Component Compression System Turning an Elastic Bandage into an Inelastic Compression Device: Interface Pressure, Stiffness, and Haemodynamic Effectiveness. Eur J Vasc Endovasc Surg 2017; 55:126-131. [PMID: 29146151 DOI: 10.1016/j.ejvs.2017.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/28/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Bandage application does not exert consistent compression pressure, leading to extremely variable compression when applied to patients. A new elastic bandage can exert a predefined pressure independently of healthcare providers and the size of the wrapped limb. The bandage system includes a series of non-stretchable patches that when applied to the bandage make it stiff. The aim of this work was to assess, in an experimental setting, the venous ejection fraction (EF) from the lower leg and the tolerability of this new bandage in a group of patients affected by superficial venous incompetence. METHODS EF was measured using strain gauge plethysmography under baseline conditions and the bandage was applied with a supine pressure of 20 and 30 mmHg, with and without the stiff patches, in 25 patients with severe venous reflux in the great saphenous vein. The interface pressure of the bandages was measured simultaneously in the medial gaiter area. RESULTS All patients showed EF values that were significantly reduced compared with normal individuals. Elastic bandages with an average pressure of 20 and 30 mmHg in the supine position achieved a slight improvement in EF, and, after applying non-stretchable patches on the same bandage with similar resting pressure, EF was restored to its normal range (p < .001). Improvement in EF correlates with the pressure differences between standing and lying pressure and between muscle systole and diastole during exercise. CONCLUSION This study confirms that inelastic is much more effective than elastic compression for improving impaired venous haemodynamics. The test material can be applied with a predetermined pressure, which considerably enhances the consistency of application, and it is easily transformed into an inelastic system just by applying stiff patches without any stretch and without significantly increasing the comfortable supine pressure.
Collapse
|
38
|
Andriessen A, Apelqvist J, Mosti G, Partsch H, Gonska C, Abel M. Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications - a review of present guidelines. J Eur Acad Dermatol Venereol 2017; 31:1562-1568. [DOI: 10.1111/jdv.14390] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Andriessen
- Radboud UMC; Nijmegen & Andriessen Consultants; Malden The Netherlands
- International Compression Club (ICC); Berndorf Austria
| | - J. Apelqvist
- Department of Endocrinology; University Hospital of Malmö; Malmö Sweden
| | - G. Mosti
- Department of Angiology; Clinica MD Barbantini; Lucca Italy
- International Compression Club (ICC); Berndorf Austria
| | - H. Partsch
- Medical University Vienna; Vienna Austria
- International Compression Club (ICC); Berndorf Austria
| | - C. Gonska
- Medical & Regulatory Affairs; Lohmann & Rauscher GmbH & Co KG; Rengsdorf Germany
| | - M. Abel
- Medical & Regulatory Affairs; Lohmann & Rauscher GmbH & Co KG; Rengsdorf Germany
- Patient Outcome Group (POG); European Wound Management Association (EWMA); Frederiksberg Denmark
- International Compression Club (ICC); Berndorf Austria
| |
Collapse
|
39
|
Tickle J, Ovens L, Mahoney K, Hunt S, Harris E, Hodgman L. A proven alternative to compression bandaging. J Wound Care 2017; 26:S1-S24. [PMID: 28437140 DOI: 10.12968/jowc.2017.26.sup4a.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joy Tickle
- Tissue Viability Specialist and Clinical Lead, Shropshire Community Health NHS Trust
| | - Liz Ovens
- Independent Tissue Viability Specialist Nurse and Associate Lecturer, Buckinghamshire New University
| | - Kirsten Mahoney
- Clinical Nurse Specialist, Wound Healing Cardiff and Vale University Health Board and Clinical Operational and Procurement Lead, Welsh Wound Innovation Centre
| | - Sharon Hunt
- Lead Advanced Nurse Practitioner and Independent Specialist Wound Care, Wellway Medical Group, Northumberland
| | | | - Laura Hodgman
- Vascular Nurse Specialist and Senior Clinical Education Facilitator, Royal Derby Hospital
| |
Collapse
|
40
|
Harding K. Challenging passivity in venous leg ulcer care - the ABC model of management. Int Wound J 2016; 13:1378-1384. [PMID: 27146452 PMCID: PMC7949496 DOI: 10.1111/iwj.12608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/06/2016] [Indexed: 11/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Keith Harding
- Dean of Clinical InnovationCardiff UniversityCardiffUK
- Medical DirectorWelsh Wound Innovation CentreCardiffUK
| |
Collapse
|
41
|
Shepherd J. Progressive compression versus graduated compression for the management of venous insufficiency. Br J Community Nurs 2016; 21 Suppl 9:S13-S18. [PMID: 27594309 DOI: 10.12968/bjcn.2016.21.sup9.s13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Venous leg ulceration (VLU) is a chronic condition associated with chronic venous insufficiency (CVI), where the most frequent complication is recurrence of ulceration after healing. Traditionally, graduated compression therapy has been shown to increase healing rates and also to reduce recurrence of VLU. Graduated compression occurs because the circumference of the limb is narrower at the ankle, thereby producing a higher pressure than at the calf, which is wider, creating a lower pressure. This phenomenon is explained by the principle known as Laplace's Law. Recently, the view that compression therapy must provide a graduated pressure gradient has been challenged. However, few studies so far have focused on the potential benefits of progressive compression where the pressure profile is inverted. This article will examine the contemporary concept that progressive compression may be as effective as traditional graduated compression therapy for the management of CVI.
Collapse
Affiliation(s)
- Jan Shepherd
- Service Integration Manager, Clinic Based Services, BwD Locality, Lancashire Care NHS Foundation Trust
| |
Collapse
|
42
|
Partsch H. Commentary on ‘Haemodynamic Performance of Low strength Below knee Graduated Elastic Compression Stockings in Health, Venous Disease, and Lymphedema’. Eur J Vasc Endovasc Surg 2016; 52:113. [DOI: 10.1016/j.ejvs.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 11/29/2022]
|
43
|
Luder C, Dziunycz P, Omid N, Radetzki AL, Lang C, Hübner M, Hafner J. A Compression Kit of a Stocking and Three Superimposed Leggings Is Easy to Don and Dose Adjustable. Eur J Vasc Endovasc Surg 2016; 51:434-40. [PMID: 26810342 DOI: 10.1016/j.ejvs.2015.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Forty percent of patients with chronic venous insufficiency (CVI) do not wear their indicated and prescribed compression stockings. Difficulties in donning and a feeling of constraint are the most common reasons for non-adherence. OBJECTIVE The aim was to develop a compression stocking system that is easy to don and dose adjustable. METHODS A modular compression stocking kit composed of an understocking and three superimposable leggings (SLLLs) was developed. Substocking pressures (P) at the thinnest part above the ankle (cB level) were 17 mm (understocking) + 15 + 10 + 10 mmHg (3 superimposed leggings; Hatra method). Twenty healthy subjects and 20 patients over 65 years with CVI donned the SLLL compression kit. P was measured in vivo (Picopress method) at the transition of the Achilles tendon to the calf muscle (level cB1) during rest and ankle movements (DSI; dynamic stiffness index) and compared with a strong compression stocking of 40 mmHg (S40). RESULTS Twenty (20/20) patients aged over 65 with CVI (C4-6) successfully donned the SLLL compression kit without aid, compared with 12 (12/20) who were able to don the S40 without aid (p = .02). In vivo resting P at level cB1 was 34.3 mmHg (SLLL) compared with 37.3 mmHg (S40) (p = .1). The DSI was 16.1 (SLLL) compared with 17.9 (p = .79; S40; CVI group). CONCLUSION The physical properties of the SLLL compression stocking kit correspond to the characteristics of a strong stocking at rest and exercise (DSI). The donning success rate is excellent (100%). A further potential advantage is that the SLLL leg compression kit is dose adjustable, according to indication or patient tolerance. Wearing comfort over periods of several days and clinical effectiveness need to be investigated in future trials.
Collapse
Affiliation(s)
- C Luder
- Department of Dermatology, University Hospital Zurich, Switzerland
| | - P Dziunycz
- Department of Dermatology, University Hospital Zurich, Switzerland
| | - N Omid
- Department of Dermatology, University Hospital Zurich, Switzerland
| | - A-L Radetzki
- Department of Dermatology, University Hospital Zurich, Switzerland
| | - C Lang
- Department of Dermatology, University Hospital Zurich, Switzerland
| | - M Hübner
- SIGVARIS AG, St. Gallen, Switzerland
| | - J Hafner
- Department of Dermatology, University Hospital Zurich, Switzerland.
| |
Collapse
|
44
|
Changes in Tissue Oxygen Saturation in Response to Different Calf Compression Sleeves. JOURNAL OF SPORTS MEDICINE 2015; 2015:857904. [PMID: 26464899 PMCID: PMC4590978 DOI: 10.1155/2015/857904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/18/2015] [Indexed: 11/30/2022]
Abstract
Aim. The purpose was to examine the changes in tissue oxygen saturation (StO2) in response to the application of different commercially available calf compression sleeves. Methods. Eight subjects came to the laboratory to complete a session in seated position including 10 min of quiet rest followed by 3 min measuring calf StO2 without compression sleeves and then alternating of 3 min of passive rest and 3 min measuring StO2 with calf compression sleeves. A total of 15 different commercially available compression sleeves were studied in a randomized order. Calf StO2 was recorded using near-infrared spectroscopy. Results. StO2 was significantly increased with all compression sleeves (p < 0.05) compared with no compression (from +6.9% for the least effective to +22.6% for the most effective). Large differences were observed between compression sleeves (p < 0.05). StO2 was positively correlated with compression pressure (p < 0.05; r = 0.84). Conclusion. This study shows that wearing compression sleeves from various brands differently affects tissue oxygen saturation. Differences were linked to the compression pressure: higher compression pressures were associated with higher StO2.
Collapse
|
45
|
Partsch H, Mortimer P. Compression for leg wounds. Br J Dermatol 2015; 173:359-69. [DOI: 10.1111/bjd.13851] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- H. Partsch
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - P. Mortimer
- Department of Dermatology St George's Hospital University of London London U.K
| |
Collapse
|
46
|
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 493] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
47
|
Report from the 2013 meeting of the International Compression Club on advances and challenges of compression therapy. J Vasc Surg Venous Lymphat Disord 2014; 2:469-76. [PMID: 26993556 DOI: 10.1016/j.jvsv.2014.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/17/2014] [Indexed: 11/22/2022]
Abstract
The International Compression Club, a collaboration of medical experts and industry representatives, was founded in 2005 to develop consensus reports and recommendations regarding the use of compression therapy in the treatment of acute and chronic vascular disease. During the recent meeting of the International Compression Club, member presentations were focused on the clinical application of intermittent pneumatic compression in different disease scenarios as well as on the use of inelastic and short stretch compression therapy. In addition, several new compression devices and systems were introduced by industry representatives. This article summarizes the presentations and subsequent discussions and provides a description of the new compression therapies presented.
Collapse
|
48
|
O'Donnell TF, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, Lurie F, Henke PK, Gloviczki ML, Eklöf BG, Stoughton J, Raju S, Shortell CK, Raffetto JD, Partsch H, Pounds LC, Cummings ME, Gillespie DL, McLafferty RB, Murad MH, Wakefield TW, Gloviczki P. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg 2014; 60:3S-59S. [PMID: 24974070 DOI: 10.1016/j.jvs.2014.04.049] [Citation(s) in RCA: 361] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
49
|
Abstract
Introduction: arterial involvement may coexist in about 15–30 of venous ulcers. In this case compression therapy maybe applied, only by expert caregivers, with a reduced pressure which must not overcome the arterial pressure at ankle and foot level. It remains to assess if such a reduced pressure may be effective also on the impaired venous hemodynamics. Aim of this paper is to present an overview of the data we have, showing the effects on venous hemodynamics of a reduced compression pressure. Material and methods: in different groups of patients affected by deep and superficial venous incompetence, venous reflux and ejection fraction (EF) from the lower leg were measured in baseline conditions, without any compression, and after application of different elastic and inelastic compression devices exerting different pressure ranges from 20 to 60 mm Hg. The compression pressure was always recorded simultaneously with venous reflux of EF assessment. Results: strong pressures show the greatest effect in reducing/abolishing venous reflux and increasing EF but also a reduced pressure in the range of 20 to 40 mm Hg is effective in improving venous hemodynamics provided inelastic materials are used. Conclusions: inelastic but not elastic materials exert a standing pressure which is significantly higher than in supine position even starting from a reduced supine pressure of 40 mm Hg which does not impair the arterial inflow. This strong pressure is able to reduce and even abolish the venous reflux and improve the EF up to restoring its normal range. A reduced or modified compression pressure is able to significantly improve the venous hemodynamics without affecting the arterial inflow in patients with mixed ulcers, provided inelastic materials are used.
Collapse
Affiliation(s)
- Giovanni Mosti
- Angiology Department, Clinica MD Barbantini, Lucca - Italy
| |
Collapse
|
50
|
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").
Collapse
Affiliation(s)
- Hugo Partsch
- Emeritus Professor of Dermatology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|