1
|
Zaleska MT, Krzesniak NE. High Pressure 3 × 30 Minute Compression Methods for Advanced Lower Limb Lymphedema Patients. Lymphat Res Biol 2024; 22:153-162. [PMID: 38593454 DOI: 10.1089/lrb.2023.0064] [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: 04/11/2024] Open
Abstract
Introduction: In advanced lymphedema of lower limbs, stage III bandaging under the routinely applied pressure of 40-60 mmHg remains largely ineffective. This is caused by skin and subcutaneous tissue stiffness due to fibrosis. Edema fluid accumulates deep in the subcutaneous tissue. Evacuating this fluid requires a high external compression force to overcome the resistance of fibrous tissue. We aimed to investigate the effectiveness of the compression method, with high pressure lasting for 3 days. Methods and Results: Twenty-one patients with lower limb lymphedema, stage III, of the postinflammatory type were included. Patients with acute inflammatory symptoms, venous thrombosis, profuse varicose veins, diabetes, and cardiac insufficiency with edema were excluded. A 10-cm-wide rubber bandage was applied to the foot and calf. The interface pressure measured using PicoPress ranged from 58 to 120 mmHg. Skin and deep tissue tonometry, skin water concentration, leg circumference, and drop of interface pressure were measured. Ultrasound examination was done before and after each compression session. The calf circumference decreased by 15.9 ± 5.4%, deep tissue stiffness by 58.9 ± 18.9%, skin stiffness by 69.6 ± 13.5%, and skin water concentration by 43.8 ± 11.5%. Interface pressure dropped to 66.3 mmHg (28-110 mmHg); ultrasonography images showed less fluid in the tissue. Conclusions: High-pressure 30-minute leg compression can remove excess edema fluid within 3 days and enable adjustment of nonstretch compression stockings. This method is more effective in advanced lymphedema at the beginning of therapy than the standard 30-50-mmHg bandaging as it provides an immediate effect.
Collapse
Affiliation(s)
- Marzanna T Zaleska
- Clinical and Research Department of Applied Physiology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
- Department of Vascular Surgery, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - Natalia E Krzesniak
- Department of Plastic and Reconstructive Surgery, Medical Centre of Postgraduate Education, Warsaw, Poland
| |
Collapse
|
2
|
Dissemond J, Protz K, Stücker M. Compression therapy in dermatology. J Dtsch Dermatol Ges 2023; 21:1003-1019. [PMID: 37565365 DOI: 10.1111/ddg.15161] [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: 01/18/2023] [Accepted: 05/28/2023] [Indexed: 08/12/2023]
Abstract
Compression therapy is a conservative therapy that can be used in many patients with dermatological conditions, especially those associated with edema. In addition to its well-established use in venous and lymphatic disorders, there is increasing evidence that compression therapy supports the healing of inflammatory dermatoses. The presence of edema, regardless of its etiology, is an indication for the use of compression therapy. Nowadays, a variety of materials and treatment options are available for compression therapy, each with their own advantages and disadvantages. Often, compression therapy with low resting pressures is sufficient for effective therapy and is better tolerated by patients. The main contraindications to compression therapy are advanced peripheral arterial disease and decompensated heart failure. Individual factors and economic considerations should be taken into account when deciding on compression therapy with the patient. Patient self-management should be encouraged whenever possible. This requires education and support tools.
Collapse
Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
| | - Kerstin Protz
- Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Markus Stücker
- Department for Dermatology, Venerology and Allergology, Ruhr-University Bochum, Vein Center of Dermatology and Vascular Surgery, Bochum, Germany
| |
Collapse
|
3
|
Dissemond J, Protz K, Stücker M. Kompressionstherapie in der Dermatologie. J Dtsch Dermatol Ges 2023; 21:1003-1020. [PMID: 37700410 DOI: 10.1111/ddg.15161_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/28/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie Kompressionstherapie ist eine konservative Therapie, die bei vielen Patienten mit dermatologischen Krankheiten durchgeführt werden kann, insbesondere wenn diese mit Ödemen assoziiert sind. Neben den wissenschaftlich sehr gut belegten Indikationen bei venösen und lymphatischen Erkrankungen, gibt es auch zunehmend wissenschaftliche Hinweise, dass durch die Kompressionstherapie die Abheilung entzündlicher Dermatosen unterstützt wird. Wenn Ödeme vorliegen, handelt es sich, unabhängig von deren Genese, um einen Einsatz im Rahmen der Zulassung der Kompressionstherapie.Für die Kompressionstherapie stehen heute verschiedene Materialien und Versorgungsoptionen mit systemspezifischen Vor‐ und Nachteilen zur Verfügung. Oft ist eine Kompressionstherapie mit niedrigen Ruhedruckwerten für einen Therapieerfolg ausreichend und wird von den Patienten besser toleriert. Als wichtigste Kontraindikationen der Kompressionstherapie sind die fortgeschrittene periphere arterielle Verschlusskrankheit und die dekompensierte Herzinsuffizienz zu beachten.Bei der gemeinsam mit dem Patienten getroffenen Entscheidung für eine Kompressionstherapie, sollten individuelle Faktoren und wirtschaftliche Aspekte berücksichtigt werden. Wann immer möglich, ist ein Selbstmanagement des Patienten zu unterstützen. Hierfür sind Edukation und Hilfsmittel erforderlich.
Collapse
Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Kerstin Protz
- CompetenzzentrumVersorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Bochum
| |
Collapse
|
4
|
Mallow PJ. Health Economic Analysis of Two-Layer Bandage System for Treatment of Chronic Venous Insufficiency. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:39-43. [PMID: 37641715 PMCID: PMC10460629 DOI: 10.36469/001c.82159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/26/2023] [Indexed: 08/31/2023]
Abstract
Background: Compression therapy is the gold standard for the treatment of chronic venous insufficiency (CVI). Two-layer bandage (2LB) systems have been shown to be a safe and effective treatment option. Objective: To estimate the total cost per response (CPR) for the resolution of edema and wounds in patients with CVI treated with a 2LB system as part of their overall wound healing regimen. Methods: A probabilistic decision tree model was developed to estimate the incremental CPR for a 2LB system. The model simulated 10 000 patients to estimate the CPR for the resolution of edema and wound healing. The analysis was performed using clinical data from a published single-arm, multicenter prospective study of CVI indicated for compression therapy. The response outcomes of interest were resolution of edema and rate of wound healing. The follow-up time was a maximum of 6 weeks, and the perspective of the study was a US outpatient treatment center. Economic data for compression therapy were based on the public prices of a 2LB system. Dressing changes occurred per manufacturer instructions for use. Results: The study comprised 702 patients (56% female), with a total of 414 wounds. The median duration of the wounds was 42 days, and the median size at the initial visit was 3.5 cm2. The average pain reduction fell by 67% using a visual analog score. Bandages were typically changed once or twice a week (51.7%). Wound healing occurred in 128 of the 414 wounds (30.9%). The expected incremental CPR of a 2LB system for the resolution of edema was $65.67 (range, $16.67-$124.32). The expected incremental CPR of a 2LB system for the healing of a wound was $138.71 (range, $35.71-$273.53). Conclusion: This economic evaluation complements previous clinical effectiveness and safety studies of 2LB systems for the treatment of CVI. The results demonstrate that the costs of incorporating 2LB into standard wound-healing protocols are negligible compared with overall treatment costs. Two-layer bandages may be considered a cost-effective first-line system for the treatment of wounds caused by CVI.
Collapse
|
5
|
Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
6
|
[Classification and nomenclature of current materials for compression therapy]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:270-281. [PMID: 36754895 PMCID: PMC10050045 DOI: 10.1007/s00105-023-05108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/10/2023]
Abstract
Compression therapy has been an essential part of conservative therapy for people with chronic wounds and edema of the lower extremities for hundreds of years. The initiated therapy can be divided into the decongestion phase, maintenance phase, and prevention. The choice of the respective compression materials is based, among other factors, on these phases, the clinical stage and symptoms, the needs of the affected person and their physical abilities. Today, a wide range of different materials and methods are available for compression therapy. Thus, it is increasingly difficult to keep an overview of these treatment options, especially since the nomenclature used by the manufacturers is often inconsistent. Thus, the materials and methods for compression therapy currently available in German-speaking countries and their clinical indications are described in this review article. In addition, a uniform nomenclature is proposed, on the basis of which an appropriate exchange between all those involved in the care of people with compression therapy is guaranteed.
Collapse
|
7
|
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
|
8
|
Senet P, Addala A, Léger P, Chahim M, Malloizel J, Blaise S, Sauvadet A, Tacca O, Stücker M, Dissemond J. A new compression system for treatment of venous leg ulcers: a prospective, single-arm, clinical trial (FREEDOM). J Wound Care 2022; 31:734-747. [PMID: 36113543 DOI: 10.12968/jowc.2022.31.9.734] [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
OBJECTIVE To evaluate the efficacy, tolerability and acceptability of a new multicomponent compression system in one bandage for the local treatment of patients with venous leg ulcers (VLUs). METHOD This was an international, prospective, non-comparative, clinical trial, conducted in France and Germany. Eligible participants had a VLU with a wound area of 2-20cm2, lasting for a maximum of 24 months. For a period of 6 weeks, patients were treated with a new multicomponent compression system in one bandage which was worn day and night, providing high working pressure and moderate resting pressure (UrgoK1). Clinical assessments, wound measurement and photographs were planned at weeks 1, 2, 4 and 6. The primary endpoint was the relative wound area reduction (RWAR) after 6 weeks of treatment. Secondary endpoints included wound closure rate, oedema resolution, change in patient's health-related quality of life (HRQoL), acceptability, adherence to the compression therapy, local tolerance, and physician's overall satisfaction with the evaluated compression system. RESULTS A cohort of 52 patients (52% female, mean age 75.4±13.0 years) with VLUs, including oedema in 58% of cases, were recruited from 22 centres. At baseline, 42 patients had already been treated with a different compression system. VLUs had been present for 5.6±4.9 months and had a mean area of 5.7±4.3cm2. After 6 weeks of treatment, a median RWAR of 91% (interquartile range: 39.4; 100.0) was achieved. Wound closure was reported in 35% of patients. A RWAR ≥40% at week 4, predictive of wound healing at 12 weeks, was achieved in 62% of patients. At the final visit, oedema present at baseline was resolved in 57% of patients. Substantial improvements in the HRQoL of the patients were reported with a decrease of the pain/discomfort and anxiety/depression dimensions. Comfort in wearing the evaluated system was reported as 'very good' or 'good' by 79% of patients, resulting in a high patient adherence to compression therapy. Compared to previous compression systems, half of the patients reported more ease in wearing shoes, and greater satisfaction and comfort with this new system. Nine non-serious adverse events related to the device or its procedure occurred in seven patients. At the final visit, the majority of the physicians were 'very satisfied' or 'satisfied' with the new compression system overall. CONCLUSION The new multicomponent compression system in one bandage has been shown to promote rapid healing of VLUs, reduce oedema, improve HRQoL and to be well tolerated and accepted. It appears to be a viable alternative to existing compression systems.
Collapse
Affiliation(s)
- Patricia Senet
- Department of Dermatology, Paris Est University Hospitals (AP-HP) - Tenon Hospital, Paris, France
| | - Azeddine Addala
- Department of Vascular Medicine, Edouard Herriot Hospital, Lyon, France
| | - Philippe Léger
- Wound and Wound Healing Centre, Pasteur Clinic, Toulouse, France
| | - Maxime Chahim
- Department of Vascular Medicine, Corentin Celton Hospital, Issy Les Moulineaux, France
| | - Julie Malloizel
- Department of Vascular Medicine, Rangueil University Hospital, Toulouse, France
| | - Sophie Blaise
- Department of Vascular Medicine, Albert Michalon University Hospital, Grenoble, France
| | - Anne Sauvadet
- Clinical Development Department, URGO Research Innovation and Development, Chenove, France
| | - Olivier Tacca
- Clinical Development Department, URGO Research Innovation and Development, Chenove, France
| | - Markus Stücker
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
| |
Collapse
|
9
|
Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
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
|
11
|
Tai HQ, Chaen LCR, Boey J, Kime S, Rial R, Montero EC, Atkin L, Stansal A, Isabelle L, Tickner A, Vlad LG, Lantis J, Hester C, Galea E. A dual pressure indicator, two-layer compression system for treatment of venous leg ulcers: a review. J Wound Care 2021; 30:S6-S12. [PMID: 34882009 DOI: 10.12968/jowc.2021.30.sup12.s6] [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
OBJECTIVE Venous leg ulcers (VLUs) are considered the most frequent category of hard-to-heal limb ulcers. Although evidence-based care of VLUs suggests that compression therapy plays a pivotal role in the standard of care, patient adherence is considered low, with at least 33% non-compliance, either due to perceived problems from clinicians regarding their own competency in applying the bandages, or from the patient finding the wrapping bothersome. For many years, four-layer bandaging has been considered the 'gold standard', but application can be difficult and may also prove uncomfortable for patients. Accurate application may be facilitated by a stretch indicator which has been engineered to act as a surrogate for appropriate pressure application that can address the skill concern, while fewer layers can save clinicians' time and improve the quality of life of patients. Here, we review the literature supporting a two-layer system which combines elastic (long stretch) and inelastic (short stretch) components as well as both layers having graphic markers to define that the dressing has been applied at the proper tension. METHOD An initial search was conducted on PubMed and then followed up by a manual search of Google Scholar to retrieve evidence of different levels, in order to evaluate the outcomes of use of the specific two-layer compression system with pressure indicators in the management of patients presenting with VLUs. RESULTS A total of four papers discussing the specific compression system in question were identified from 32 publications retrieved from PubMed, while a further six were retrieved from Google Scholar. These 10 publications were considered relevant to the two-layer system and were analysed for the outcomes of care, including wound healing, appropriate application, time-saving and better patient acceptance and adherence. CONCLUSION Previous authors have demonstrated that two-layer systems are equivalent to four-layer systems. However, the ability to reproducibly apply appropriate compression has remained a question. The papers reviewed demonstrate that evidence suggests that the two-layer compression bandage system with indicators provides continuous, consistent and comfortable treatment that may be easier to apply with accurate pressure levels due to their indicator systems, and therefore, is a procedure that may increase patient adherence and acceptability to the wound therapy.
Collapse
Affiliation(s)
- Hong Qian Tai
- Department of Vascular and Endovascular Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Johnson Boey
- National University Hospital, Department of Podiatry, Singapore
| | - Sally Kime
- Bolton Clarke At Home Support, Victoria, Australia
| | - Rodrigo Rial
- Angiology and Vascular Surgery Department, University Hospital of Torrelodones, Madrid, Spain
| | - Elena Conde Montero
- Department of Dermatology, Hospital Universitario Infanta Leonor and Hospital Virgen-de-la-Torre, Madrid, Spain
| | - Leanne Atkin
- Division of Podiatry and Clinical Sciences, University of Huddersfield, UK
| | | | | | - Anthony Tickner
- Saint Vincent Hospital/RestorixHealth Wound Healing Centre, Worcester, US
| | - Lucian G Vlad
- Wound Care & Hyperbaric Clinic, Atrium Health Wake Forest Baptist, Winston-Salem, US
| | - John Lantis
- Mount Sinai West Hospital, Icahn School of Medicine, New York, US
| | - Colboc Hester
- Sorbonne University, Geriatrics and Wound Care Unit, Rothschild Hospital, AP-HP, Paris, France
| | | |
Collapse
|
12
|
Stücker M, Münter KC, Erfurt-Berge C, Lützkendorf S, Eder S, Möller U, Dissemond J. Multicomponent compression system use in patients with chronic venous insufficiency: a real-life prospective study. J Wound Care 2021; 30:400-412. [PMID: 33979221 DOI: 10.12968/jowc.2021.30.5.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Compression therapy is the cornerstone of therapeutic management of patients with chronic venous insufficiency (CVI). This study aimed to evaluate the efficacy and safety of a multicomponent compression system in an unselected population of patients with CVI problems under real-life conditions. METHOD A prospective, multicentre, observational study with a multicomponent two-bandage compression system (UrgoK2, Laboratoires Urgo, France) was conducted in 103 centres in Germany. Main outcomes included wound healing rate, wound healing progression, assessment of oedema and ankle mobility, local tolerability and acceptance of the compression therapy. RESULTS A total of 702 patients with venous leg ulcers (VLU) and/or with lower limb oedema due to CVI were treated with the evaluated system for a mean (±standard deviation) duration of 27±17 days. By the last visit, 30.9% of wounds had healed and 61.8% had improved. Limb oedema was resolved in 66.7% of patients and an improvement of ankle mobility was reported in 44.2% of patients. The skin condition under the compression therapy was also considered as improved in 73.9% of patients and a substantial reduction of pain was achieved, both in number of patients reporting pain and in pain intensity. Compression therapy with the evaluated system was 'very well' or 'well' tolerated and 'very well' or 'well' accepted by >95% of patients. These positive outcomes were in line with the general opinion of physicians on the evaluated compression bandages, which were judged 'very useful' or 'useful' for >96.6% of patients. Similar results were reported regardless of the treated condition, VLU and/or limb oedema. CONCLUSION Real-life data documented in this large observational study of non-selected patients receiving compression therapy in daily practice confirm the benefits and safety profile of the evaluated compression system. This study also confirms the high-level of performance and acceptability of the system, regardless of the characteristics of the wounds or patients at initiation of the treatment. The data support the use of this multicomponent compression system as one first-line intervention in patients with symptoms caused by CVI.
Collapse
Affiliation(s)
- Markus Stücker
- Vein Centre of the Dermatology and Vascular Surgery Clinics, Hospital of Ruhr-University Bochum, St. Maria-Hilf Hospital, Venenzentrum, Bochum, Germany
| | | | - Cornelia Erfurt-Berge
- Department of Dermatology, Venereology, and Allergology, University Hospital Erlangen, Erlangen, Germany
| | | | - Stephan Eder
- Department of Vascular Surgery and Vascular Medicine, Schwarzwald-Baar Hospital Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Udo Möller
- Medical Affairs and Clinical Research Department, URGO GmbH, Sulzbach, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| |
Collapse
|
13
|
Garrigues-Ramón M, Julián M, Zaragoza C, Barrios C. Inability of Laplace's law to estimate sub-bandage pressures after applying a compressive bandage: a clinical study. J Wound Care 2021; 30:276-282. [PMID: 33856905 DOI: 10.12968/jowc.2021.30.4.276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the current study was to compare pressures exerted on the lower limb by a high compression bandage as recorded by sub-bandage sensors and those estimated by Laplace's law. The correlation between pressures obtained in each anatomical zone and the corresponding limb perimeters were explored. METHOD For the measurement of sub-bandage pressures, four anatomical zones in the lower right limb were determined. Pressures were recorded by nine pneumatic sensors and a PicoPress transducer. A two-layer compression bandage system (UrgoK2, Urgo Group, France) was used for the dressing. Pressures were registered in supine position. Sensor pressures were compared with those estimated by a modified Laplace's equation. RESULTS A total of 47 female volunteers were recruited (mean age: 21.9±2.3 years) to the study. In the four anatomical segments studied, pressures obtained by the sensors were lower than would be expected by applying Laplace's law (p<0.05). The biggest difference between the two methods was found at the supramalleolar level (42.1% lower by sensors compared with Laplace's equation). The correlation coefficient between pressure recorded by the sensors and that calculated at the perimeters was very weak, ranging from 0.5233 to 0.9634. CONCLUSION Laplace's law, used to predict the sub-bandage pressure after applying a compressive bandage in the lower limb, was not useful, providing significantly higher pressures than those obtained by pneumatic sensors. Laplace's law underestimates the variable musculoskeletal components at the different segments of lower limb that act as compression damping forces.
Collapse
Affiliation(s)
- Marta Garrigues-Ramón
- School of Doctorate, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| | - Mariano Julián
- School of Nursing and Podiatry, University of Valencia, Valencia, Spain
| | - Cristóbal Zaragoza
- Department of Surgery, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| |
Collapse
|
14
|
Scientific and Clinical Abstracts From WOCNext® 2021: An Online Event ♦ June 24-26, 2021. J Wound Ostomy Continence Nurs 2021; 48:S1-S49. [PMID: 37632236 DOI: 10.1097/won.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
15
|
Protz K, Dissemond J, Karbe D, Augustin M, Klein TM. Increasing competence in compression therapy for venous leg ulcers through training and exercise measured by a newly developed score-Results of a randomised controlled intervention study. Wound Repair Regen 2021; 29:261-269. [PMID: 33598997 DOI: 10.1111/wrr.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/16/2020] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
Compression therapy with short-stretch bandages is the most common treating option for patients with venous leg ulcers in the decongestion phase in Germany. This randomised controlled intervention study examined whether a training is suitable to sustainably improve the skills of health care professionals. Altogether 55 nurses from hospitals and outpatient care participated. They were randomly assigned to case and control groups. Participants' abilities to properly apply a compression bandaging were assessed before and after a training session as well as after 1 and 3 months using a newly developed score (CCB score) based on six control parameters (CPs): padding, starting point, heel inclusion, heart direction, pressure at forefoot (A) and calf base (B1). After training, a significant increase in competence was observed, which only decreased non-significantly over the observation period: The average CCB score was 2.796 at V0, 4.89 at V1, 4.88 at V2, and 4.66 at V3. The CPs for pressure at A and B1 were met by a maximum of 42.6 and 43.6%, respectively, at all timepoints. The CP starting point was fulfilled by at least 61.7% after training, the CPs heart direction, heel and underpadding by at least 89.4, 96.4, and 97.9%, respectively. As a result of our study, it can be concluded that training improves the ability of users to apply compression bandagings, but one-off training does not appear to be suitable to improve the ability to apply compression bandagings with a therapy-relevant pressure. Therefor more training especially with pressure measuring devices would be necessary.
Collapse
Affiliation(s)
- Kerstin Protz
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Toni Maria Klein
- Institute for Health Services Research in Dermatology and Nursing (IVDP), CWC - Comprehensive Wound Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
16
|
[Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC) : S2k guideline of the German Phlebology Society (DGP) in cooperation with the following professional associations: DDG, DGA, DGG, GDL, DGL, BVP. German version]. Hautarzt 2021; 72:137-152. [PMID: 33301064 DOI: 10.1007/s00105-020-04734-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
17
|
Rabe E, Földi E, Gerlach H, Jünger M, Lulay G, Miller A, Protz K, Reich-Schupke S, Schwarz T, Stücker M, Valesky E, Pannier F. Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC) : S2k guideline of the German Phlebology Society (DGP) in cooperation with the following professional associations: DDG, DGA, DGG, GDL, DGL, BVP. Hautarzt 2021; 72:37-50. [PMID: 33386416 PMCID: PMC8692288 DOI: 10.1007/s00105-020-04706-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Affiliation(s)
- E Rabe
- Emeritus Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Germany.
| | - E Földi
- Földiklinik, Rösslehofweg 2-6, 79856, Hinterzarten, Germany
| | - H Gerlach
- , Zehntstr. 25, 68519, Viernheim, Germany
| | - M Jünger
- Klinik und Poliklinik f. Hautkrankheiten, Universitätsmedizin, Ferdinand Sauerbruchstraße, 17475, Greifswald, Germany
| | - G Lulay
- Klinik für Gefäß- u. Endovaskularchirurgie, Phlebologie-Lymphologie, Frankenburgstr. 31, 48431, Rheine, Germany
| | - A Miller
- Dermatologische Praxis, Wilmersdorfer Str. 62, 10627, Berlin, Germany
| | - K Protz
- Wundforschung, Universitätsklinikum Hamburg-Eppendorf, Bachstr. 75, 22083, Hamburg, Germany
| | - S Reich-Schupke
- Privatpraxis für Haut- und Gefäßmedizin, Wundtherapie, Hertener Str. 27, 45657, Recklinghausen, Germany
| | - T Schwarz
- Praxis für Gefäßmedizin, Konrad Goldmann Str. 5b, 79100, Freiburg, Germany
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - F Pannier
- Praxis für Dermatologie & Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany
- Dermatologische Universitätsklinik Köln, Cologne, Germany
| |
Collapse
|
18
|
Conde-Montero E, Bohbot S, Grado Sanz R, Peral Vázquez A, Recarte-Marín L, Pérez-Jerónimo L, Galán Sánchez JL, de la Cueva Dobao P. Association of autologous punch grafting, TLC-NOSF dressing and multitype compression therapy to rapidly achieve wound closure in hard-to-heal venous leg ulcers. JOURNAL DE MEDECINE VASCULAIRE 2020; 45:316-325. [PMID: 33248534 DOI: 10.1016/j.jdmv.2020.10.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To document the efficacy of a combined therapeutic strategy in achieving rapid wound healing in patients with long-standing ulcers. MATERIALS AND METHODS Outpatients with hard-to-heal venous leg ulcers were included in an interventional, prospective, single-arm, mono-centre study and treated with autologous punch grafting, TLC-NOSF dressing and multi-type compression therapy. The primary outcome was the percentage of healed wounds by week 12. Secondary outcomes included time-to-reach wound closure, wound area reduction, treatment acceptability and safety. RESULTS From November 2018 to October 2019, 42 patients with 51 ulcers were included (23 males, 70.6±40.8 years old, with multiple comorbidities). Despite poor wound healing prognosis at baseline (47% of recurrent ulcers, with a mean duration of 15 months and a mean area of 12.6cm2), wound healing was achieved in 47 ulcers (92%) after a mean period of treatment of 25±13 days. A relative wound area reduction>75% was also reached in three additional ulcers by the last evaluation visit. No adverse event related to the procedure was reported throughout the study period. The associated treatment were very well tolerated and accepted by the patients. CONCLUSIONS The evaluated procedure induced fast re-epithelisation of the treated ulcers. Based on our experience, this simple and successful reparative strategy may be considered as an interesting option in the treatment of venous leg ulcers of poor prognosis.
Collapse
Affiliation(s)
- E Conde-Montero
- Department of dermatology, Hospital Universitario Infanta Leonor and Hospital Virgen-de-la-Torre, avenida Gran Via de Este 80, 28031 Madrid, Spain.
| | - S Bohbot
- Medical affairs department, Laboratoires URGO Medical, 15, avenue de Iena, 75116 Paris, France
| | - R Grado Sanz
- Centro de salud cervantes, Hospital Universitario de Guadalajara, calle Miguel-Cervantes, 16, 19001 Guadalajara, Spain
| | - A Peral Vázquez
- Centro de especialidades Vicente-Soldevilla, calle Sierra-de-Alquife, 8, 28053 Madrid, Spain
| | - L Recarte-Marín
- Centro de especialidades Vicente-Soldevilla, calle Sierra-de-Alquife, 8, 28053 Madrid, Spain
| | - L Pérez-Jerónimo
- Centro de especialidades Vicente-Soldevilla, calle Sierra-de-Alquife, 8, 28053 Madrid, Spain
| | - J-L Galán Sánchez
- Department of dermatology, Hospital Universitario Infanta Leonor and Hospital Virgen-de-la-Torre, avenida Gran Via de Este 80, 28031 Madrid, Spain
| | - P de la Cueva Dobao
- Department of dermatology, Hospital Universitario Infanta Leonor and Hospital Virgen-de-la-Torre, avenida Gran Via de Este 80, 28031 Madrid, Spain
| |
Collapse
|
19
|
Folguera-Álvarez C, Garrido-Elustondo S, Rico-Blázquez MM, Esparza-Garrido MI, Verdú-Soriano J. [Effectiveness of double-layered compression therapy against crepe bandage for healing venous ulcers in primary care. Randomized clinical trial]. Aten Primaria 2020; 52:712-721. [PMID: 32278578 PMCID: PMC8054279 DOI: 10.1016/j.aprim.2020.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate if the two-layer bandage is more effective than the crepe bandage in the healing of venous ulcers after 12 weeks of follow-up. DESIGN Randomized multicentre controlled clinical trial. LOCATION 22 Primary Health Centers of Madrid. PARTICIPANTS Over 18 years old, with diagnosis of venous ulcers. 93 patients were randomized, 56 in the double layer group and 37 in the crepe group. Withdrawals: 16 in double layer group, 7 in crepe group. INTERVENTIONS Control group: usual clinical practice: treatment of the wound and bandage with crepe. Experimental group: same usual clinical practice for wound treatment and bandage with double layer. MAIN MEASUREMENTS Primary outcome: complete healing at 12 weeks. SECONDARY OUTCOMES severity of ulceration, health-related quality of life, adverse events. Blind evaluation of the response variable. RESULTS Complete healing: in crepe group, 25, 67.5% (95% CI 50.2-81.9) and in double layer group, 32, 57.1% (95% CI 43.2-70.3). No evidence of a difference in both groups, RR=1.10 (95% CI 0.864-1.424). The basal severity of the ulcers is associated with the healing time. HR=0.86 (95% CI 0.78-0.94). Our data showed a significant improvement in health-related quality of life, total and in the of cosmesis and emotional dimensions. No evidence of a difference in both groups. We didn't find serious adverse events in any of the groups. CONCLUSIONS We didn't find significant differences in the healing between the two bandages evaluated. Both are appropriate for ulcer healing and to improve the health-related quality of life.
Collapse
Affiliation(s)
- Carmen Folguera-Álvarez
- Centro de Salud La Paz, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España; Facultad de Enfermería, Universidad Complutense, Madrid, España.
| | - Sofía Garrido-Elustondo
- REDISECC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas; Unidad Docente Multiprofesional Sureste, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España
| | - Mili Milagros Rico-Blázquez
- REDISECC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas; Unidad de Investigación, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España; Facultad de Enfermería, Universidad Complutense, Madrid, España
| | | | - José Verdú-Soriano
- Departamento de Enfermería Comunitaria, Medicina Preventiva, Salud Pública e Historia de la Ciencia, Facultad de Ciencias de la Salud, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
| |
Collapse
|
20
|
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
|
21
|
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]
|
22
|
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
|
23
|
Protz K, Reich-Schupke S, Klose K, Augustin M, Heyer K. [Compression devices for decongestion therapy : A cross-sectional observational survey of handling, pressure, and comfort]. Hautarzt 2019; 69:232-241. [PMID: 29184983 DOI: 10.1007/s00105-017-4084-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND If compression bandaging is not performed in a professional manner, the objectives of the therapy may not be achieved and side effects or complications may result. OBJECTIVES This cross-sectional observational survey examines the handling of the treatment options: short-stretch bandages with padding, multicomponent compression systems, and adaptive compression bandages. PARTICIPANTS AND METHODS During several training sessions on the topic of compression therapy, 137 participants performed compression bandagings on each other. In this regard, they were asked to achieve a predetermined pressure range (short-stretch bandages: 50-60 mm Hg, multicomponent compression systems: 40-50 mm Hg, adaptive compression bandage: 35-45 mm Hg). To evaluate the efficiency, the time used for application, the achieved pressure value, and the comfort were determined. RESULTS Of the 302 bandagings (n = 137 participants), 28.4% lay within the given target pressure value range. This included 11.2% of performed short-stretch bandages, 35.2% of multicomponent compression systems, and 85.0% of adaptive compression bandages. Significant differences in the mean deviations are found between the treatment options. The bandage was described as being comfortable by 37.7% of users of short-stretch bandages with padding, by 65.0% of those wearing a multicomponent compression system, and by 94.6% of participants with an adaptive compression bandage. CONCLUSIONS In practice, short-stretch bandages are still the most frequently used care option for the creation of a phlebological compression bandage. In this survey, they proved to be unsafe, time-consuming, and uncomfortable in relation to other treatment options. Multicomponent compression systems and adaptive compression bandages are treatment options that may be a contemporary alternative which also bares more comfort for the patient.
Collapse
Affiliation(s)
- K Protz
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, Bethanien-Höfe Eppendorf, 20246, Hamburg, Deutschland.
| | - S Reich-Schupke
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Ruhr-Universität Bochum, Bochum, Deutschland
| | - K Klose
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, Bethanien-Höfe Eppendorf, 20246, Hamburg, Deutschland
| | - M Augustin
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, Bethanien-Höfe Eppendorf, 20246, Hamburg, Deutschland
| | - K Heyer
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, Bethanien-Höfe Eppendorf, 20246, Hamburg, Deutschland
| |
Collapse
|
24
|
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
|
25
|
Heyer K, Protz K, Augustin M. Compression therapy - cross-sectional observational survey about knowledge and practical treatment of specialised and non-specialised nurses and therapists. Int Wound J 2017; 14:1148-1153. [PMID: 28744967 DOI: 10.1111/iwj.12773] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/04/2017] [Accepted: 05/13/2017] [Indexed: 11/30/2022] Open
Abstract
Knowledge about methods and materials and their correct usage is the basis for compression therapy. This study compares knowledge and practical skills of participants with further training with those who had no training. This comparison provides information on whether further qualifications have an impact on knowledge and practical skills. In seminars for compression therapy, data on specific and non-specific expertise were acquired. A practical test determined the participants' skills for creating a compression bandage in a pressure value range of 50-60 mmHg. In total, 1338 participants with specific expertise and 138 participants with non-specific expertise took part. Knowledge evaluation showed that 7·9% of the specific expertise group had knowledge regarding padding, 10% regarding multi-component systems and 13·6% regarding ulcer stocking systems. In the practical test, 12·3% of all participants achieved the target range. The majority of users in both groups is not familiar with the different compression materials or their appropriate usage. In the non-specific expertise group, knowledge concerning up-to-date materials and methods is one-third lower. The practical test showed major deficits on both sides. Appropriate exercises, for example, with pressure-measuring devices, should be mandatory for all professional groups who perform compression bandaging.
Collapse
Affiliation(s)
- Kristina Heyer
- Comprehensive Wound Center (CWC), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kerstin Protz
- Comprehensive Wound Center (CWC), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Comprehensive Wound Center (CWC), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
26
|
Welsh L. What is the existing evidence supporting the efficacy of compression bandage systems containing both elastic and inelastic components (mixed-component systems)? A systematic review. J Clin Nurs 2017; 26:1189-1203. [PMID: 27706876 DOI: 10.1111/jocn.13611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2016] [Indexed: 01/20/2023]
Abstract
AIMS AND OBJECTIVES To analyse current evidence on the efficacy of bandage systems containing both elastic and inelastic components (mixed-component systems). BACKGROUND International consensus on the efficacy of types of compression systems is difficult to achieve; however, mixed-component systems are being promoted as combining the best properties of both elastic and inelastic bandage systems and increasingly being used to treat venous leg ulcers in practice. DESIGN A systematic literature review. METHODS Search terms such as venous leg ulcer, varicose ulcer, leg ulcer, compression, bandage, elastic, inelastic, short stretch, healing rate, interface pressure, mixed component, two-layer, four-layer and multi-layer were used in database and hand searches in several combinations. Limits were set for years 2005-March 2015 and English-language publications. RESULTS A total of 475 studies were identified at initial search, and following elimination from abstract and title, this was reduced to 7. A further study was identified on Google Scholar, bringing the final number of studies fitting inclusion criteria to 8. The following subgroups relating to outcomes of efficacy were identified: ulcer healing, maintenance of interface pressure, slippage, ease of application and patient quality of life. CONCLUSIONS Mixed-component systems were found to have comparable ulcer healing rates to alternative compression systems and be easy to apply; have similar abilities to maintain pressure as four-layer bandages and better abilities than short-stretch bandages; have less slippage than alternative systems; and to be significantly associated with several favourable quality of life outcomes. Clinician skill in bandage application was an uncontrolled variable in all eight papers included in the review, which may limit reliability of findings. RELEVANCE TO CLINICAL PRACTICE This review synthesises existing evidence on the efficacy of mixed-component systems and encourages clinicians to regard them as an effective alternative to purely elastic or inelastic compression systems. Additionally, it highlights the importance of clinician skill in bandage application as a crucial determinant of effective compression.
Collapse
Affiliation(s)
- Lynn Welsh
- University of the West of Scotland, Paisley, UK
| |
Collapse
|
27
|
Folguera-Álvarez C, Garrido-Elustondo S, Verdú-Soriano J, García-García-Alcalá D, Sánchez-Hernández M, Torres-de Castro OG, Barceló-Fidalgo ML, Martínez-González O, Ardiaca-Burgués L, Solano-Villarrubia C, Lebracón-Cortés PR, Molins-Santos C, Fresno-Flores M, Cánovas-Lago MC, Benito-Herranz LF, García-Sánchez MT, Castillo-Pla O, Morcillo-San Juan MS, Ayuso-de la Torre MB, Burgos-Quintana P, López-Torres-Escudero A, Ballesteros-García G, García-Cabeza P, de Francisco-Casado MÁ, Rico-Blázquez M. ECAMulticapa: Effectiveness of double-layered compression therapy for healing venous ulcers in primary care: a Study Protocol. BMC Nurs 2016; 15:58. [PMID: 27752238 PMCID: PMC5059975 DOI: 10.1186/s12912-016-0179-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic venous insufficiency, in its final stage can cause venous ulcers. Venous ulcers have a prevalence of 0.5 % to 0.8 % in the general population, and increases starting at 60 years of age. This condition often causes increased dependency in affected individuals, as well as a perceived reduced quality of life and family overload. Local Treating chronic venous ulcers has 2 components: topically healing the ulcer and controlling the venous insufficiency. There is evidence that compressive therapy favours the healing process of venous ulcers. The studies we have found suggest that the use of multilayer bandage systems is more effective than the use of bandages with a single component, these are mostly using in Spain. Multilayer compression bandages with 2 layers are equally effective in the healing process of chronic venous ulcers as 4-layer bandages and are better tolerated and preferenced by patients. More studies are needed to specifically compare the 2-layer bandages systems in the settings where these patients are usually treated. METHOD/DESIGN Randomised, controlled, parallel, multicentre clinical trial, with 12 weeks of follow-up and blind evaluation of the response variable. The objective is to assess the efficacy of multilayer compression bandages (2 layers) compared with crepe bandages, based on the incidence of healed venous ulcers in individuals treated in primary care nursing consultations, at 12 weeks of follow-up. The study will include 216 individuals (108 per branch) with venous ulcers treated in primary care nursing consultations. The primary endpoint is complete healing at 12 weeks of follow-up. The secondary endpoints are the degree of healing (Resvech.2), quality of life (CCVUQ-e), adverse reactions related to the healing process. Prognosis and demographic variables are also recorder. Effectiveness analysis using Kaplan-Meier curves, a log-rank test and a Cox regression analysis. The analysis was performed by intention to treat. DISCUSSION The study results can contribute to improving the care and quality of life of patients with venous ulcers, decreasing healing times and healthcare expenditure and contributing to the consistent treatment of these lesions. TRIAL REGISTRATION This study has been recorded in the Clinical Trials.gov site with the code NCT02364921. 17 February 2015.
Collapse
Affiliation(s)
- Carmen Folguera-Álvarez
- Centro de Salud La Paz, Atención Primaria, Servicio madrileño de Salud, Avenida Parque de Asturias s/n, Rivas-Vaciamadrid, 28523 Madrid Spain
| | - Sofia Garrido-Elustondo
- Red de investigación en Servicios de salud en enfermedades crónicas (REDISECC), Unidad de Apoyo a la Investigación, Gerencia de Atención Primaria Madrid, Calle Hacienda de Pavones, 271-28030 Madrid, Spain
| | - José Verdú-Soriano
- Facultad de Ciencias de la Salud, Departamento de Enfermería Comunitaria, Medicina Preventiva, Salud Pública e Historia de la Ciencia, Universidad de Alicante, Campus de San Vicente del Raspeig, AP 99, San Vicente del Raspeig, 03080 Alicante Spain
| | - Diana García-García-Alcalá
- Centro de Salud Villa de Vallecas, Atención Primaria. Servicio madrileño de Salud, Calle Fuentidueña, 12 28031 Madrid, Spain
| | - Mónica Sánchez-Hernández
- Hospital Puerta de Hierro Majadahonda, Servicio madrileño de Salud, Calle Joaquín Rodrigo 2, Majadahonda, 28222 Madrid Spain
| | - Oscar German Torres-de Castro
- Centro de Salud Federica Montseny, Atención Primaria, Servicio madrileño de Salud, Avenida de la Albufera, 285-28038 Madrid, Spain
| | - Maria Luisa Barceló-Fidalgo
- Centro de Salud Rafael Alberti, Atención Primaria, Servicio madrileño de Salud, Calle San Claudio 154 c/v León Felipe, 28038 Madrid, Spain
| | - Olga Martínez-González
- Centro de Salud Pavones, Atención Primaria, Servicio madrileño de Salud, Calle Hacienda de Pavones, 271-28030 Madrid, Spain
| | - Lidia Ardiaca-Burgués
- Centro de Salud La Paz, Atención Primaria, Servicio madrileño de Salud, Avenida Parque de Asturias s/n, Rivas-Vaciamadrid, 28523 Madrid Spain
| | - Carmen Solano-Villarrubia
- Dirección Asistencial Sureste, Atención Primaria, Servicio madrileño de Salud, Avenida de la Albufera, 285-28038 Madrid, Spain
| | - Pilar Raquel Lebracón-Cortés
- Centro de Salud Paracuellos del Jarama, Atención Primaria, Servicio madrileño de Salud, Calle Chorrillo Alta, 26-28860 Paracuellos del Jarama, Madrid Spain
| | - Carmen Molins-Santos
- Centro de Salud Buenos Aires, Atención Primaria, Servicio madrileño de Salud, Calle Pio Felipe, c/v Boada, c/v José Paulette, 28038 Madrid, Spain
| | - Mar Fresno-Flores
- Residencia San Fernando, Consejería de Bienestar Social, Calle Ventura de Argumosa 4, 28830 San Fernando de Henares, Madrid Spain
| | | | - Luisa Fernanda Benito-Herranz
- Centro de Salud Arganda, Atención Primaria, Servicio madrileño de Salud, Calle Camino del Molino s/n, 28500 Arganda del Rey, Madrid Spain
| | - Maria Teresa García-Sánchez
- Centro de Salud San Fernando II, Atención Primaria, Servicio madrileño de Salud, Plaza de Ondarreta, 28830 San Fernando de Henares, Madrid Spain
| | - Olga Castillo-Pla
- Centro de Salud Villablanca, Atención Primaria, Servicio madrileño de Salud, Calle Villablanca, 81 28032 Madrid, Spain
| | - María Sol Morcillo-San Juan
- Centro de Salud Villarejo de Salvanés, Atención Primaria, Servicio madrileño de Salud, Calle Hospital, 7-28590 Villarejo de Salvanés, Madrid Spain
| | - Maria Begoña Ayuso-de la Torre
- Centro de Salud Artilleros, Atención Primaria, Servicio madrileño de Salud, Paseo de los Artilleros s/n, 28032 Madrid, Spain
| | - Pilar Burgos-Quintana
- Centro de Salud Villa de Vallecas, Atención Primaria. Servicio madrileño de Salud, Calle Fuentidueña, 12 28031 Madrid, Spain
| | - Ana López-Torres-Escudero
- Centro de Salud Mejorada del Campo, Atención Primaria, Servicio madrileño de Salud, Calle Ciudad de Paris, 22-28840 Mejorada del Campo, Madrid Spain
| | - Gema Ballesteros-García
- Centro de Salud Torito, Atención Primaria, Servicio madrileño de Salud, Calle Camino de Vinateros, 140-28030 Madrid, Spain
| | - Piedad García-Cabeza
- Centro de Salud Jose María Llanos, Atención Primaria, Servicio madrileño de Salud, Calle Cabo Machichaco c/v, Cabo Tarifa, 28018 Madrid Spain
| | | | - Milagros Rico-Blázquez
- Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, Spain
| |
Collapse
|
28
|
Protz K, Heyer K, Dörler M, Stücker M, Hampel-Kalthoff C, Augustin M. Kompressionstherapie - Kenntnisse und Anwendungspraxis. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12405_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kerstin Protz
- Universitätsklinikum Hamburg-Eppendorf; Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen; CWC - Comprehensive Wound Center; Hamburg
| | - Kristina Heyer
- Universitätsklinikum Hamburg-Eppendorf; Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen; CWC - Comprehensive Wound Center; Hamburg
| | - Martin Dörler
- Venenzentrum; Kliniken für Dermatologie und Gefäßchirurgie; Ruhr-Universität Bochum
| | - Markus Stücker
- Venenzentrum; Kliniken für Dermatologie und Gefäßchirurgie; Ruhr-Universität Bochum
| | | | - Matthias Augustin
- Universitätsklinikum Hamburg-Eppendorf; Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen; CWC - Comprehensive Wound Center; Hamburg
| |
Collapse
|
29
|
Protz K, Heyer K, Dörler M, Stücker M, Hampel-Kalthoff C, Augustin M. Compression therapy: scientific background and practical applications. J Dtsch Dermatol Ges 2014; 12:794-801. [PMID: 25134422 DOI: 10.1111/ddg.12405] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/05/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Compression bandaging is the most prevalent form of treatment for venous leg ulcers. Successful treatment requires knowledge of the appropriate materials and the ability to employ them following current guidelines. This study investigates German health-care providers for their knowledge of bandage materials and their practical ability in applying short-stretch compression bandages. PARTICIPANTS AND METHODS Within the framework of nationwide practical education on compression therapy, the participants' knowledge was quantified by asking standardized questions. Furthermore, their practical ability was evaluated by having them apply compression bandages within a pressure range of 50-60 mmHg. Another criterion was the pressure drop after a four-time dorsiflexion. RESULTS Overall, 891 providers (3.3 % physicians, 5.5 % medical assistants, 90.7 % nursing staff) participated. Within the practical test only few (just under 10%) applied the bandages with the intended pressure; 77.0 % applied them below and 13.7 % above the target pressure. After a four-time dorsiflexion there was an average pressure drop of 6.7 mmHg. Surveying the participant's skills revealed that only 11.9 % knew about padding beneath compression bandages, 15.0 % knew of multi-component systems, and 14.8 % were familiar with ulcer stocking systems. CONCLUSIONS Clearly, compression material and its application are unfamiliar to most practice employees. Without question there are deficits in the provision of compression therapy.
Collapse
Affiliation(s)
- Kerstin Protz
- Universitätsklinikum Hamburg-Eppendorf, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, CWC - Comprehensive Wound Center, Hamburg
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
Over the past few decades, there has been a growing appreciation of the impact of leg ulceration on all aspects of a patient's life. Particular issues include uncontrolled pain, lack of sleep, odour, emotional problems and reduced mobility.
Collapse
|
31
|
Benbow M. Safety, tolerability and acceptability of KTwo. J Wound Care 2014; 23:S4-19. [DOI: 10.12968/jowc.2014.23.sup4a.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Part 1 of the KTwo evidence review concerned the efficacy and reproducibility of the bandage system in the management of leg ulceration and lymphoedema. Here, in Part 2, the focus shifts to its tolerability and acceptability to both patients and clinicians. The evidence presented here ranges from a randomised controlled trial to anecdotal reports in conference posters. The aim of this review is to describe the evidence, and not to critique it.
Collapse
Affiliation(s)
- Maureen Benbow
- Senior Lecturer, Health and Social Care, University of Chester
| |
Collapse
|
32
|
Protz K, Heyer K, Verheyen-Cronau I, Augustin M. Loss of Interface Pressure in Various Compression Bandage Systems over Seven Days. Dermatology 2014; 229:343-52. [DOI: 10.1159/000365111] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/06/2014] [Indexed: 11/19/2022] Open
|
33
|
Lazareth I, Moffatt C, Dissemond J, Padieu AL, Truchetet F, Beissert S, Wicks G, Tilbe H, Sauvadet A, Bohbot S, Meaume S. Efficacy of two compression systems in the management of VLUs: results of a European RCT. J Wound Care 2012; 21:553-4, 556, 558 passim. [DOI: 10.12968/jowc.2012.21.11.553] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- I. Lazareth
- Vascular Medicine Unit, Saint-Joseph Hospital, Paris, France
| | | | - J. Dissemond
- Head, Dermatology Department, University Hospital, Essen, Germany
| | | | - F. Truchetet
- Head, Dermatology Department, Beauregard Hospital, Thionville, France
| | - S. Beissert
- Dermatology Department, University Hospital, Münster, Germany
| | - G. Wicks
- Leg Ulcer Clinic, Wrafton House Surgery, Hatfield, UK
| | - H. Tilbe
- Trowbridge Community Hospital, Trowbridge, UK
| | - A. Sauvadet
- R–D Department, Laboratoires URGO, Chenôve, France
| | - S. Bohbot
- R–D Department, Laboratoires URGO, Chenôve, France
| | - S. Meaume
- Head, Geriatric Department, Rothschild Hospital, Paris, France
| |
Collapse
|
34
|
Kumar B, Das A, Alagirusamy R. Analysis of sub-bandage pressure of compression bandages during exercise. J Tissue Viability 2012; 21:115-24. [DOI: 10.1016/j.jtv.2012.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 08/03/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
|