373 Efficacy of Pressure Garment Therapy at Reduced Lengths of Daily Wear

Abstract

Patient compliance is a major challenge associated with pressure garment therapy with studies reporting compliances as low as 40%. . We hypothesize that if patients were able to wear the garments for less time per day, the discomforts associated with garment use would be reduced and patient compliance may improve. To examine the effect of duration of daily wear on outcomes, we assessed scar development and maturation in autografted burns treated with pressure garment therapy for 8, 16 and 24 hours/day in a porcine model. Full-thickness burns (1 x 1 in) were created on red Duroc pigs (8 burns/pig), then were excised and autografted with split-thickness skin. Custom, adjustable pressure garments were applied 1 week after grafting and maintained at 20 ± 2 mmHg. Garments were worn for 8, 16, or 24 hours a day for 15 weeks; control scars did not receive any pressure treatment (n=16/group). Scar properties monitored over time included contraction, scar height, erythema, surface roughness, tissue biomechanics, scar anatomy and extracellular matrix organization/composition. After only 8 weeks of pressure garment therapy, scars in the 24 hour/day group were approximately 49% less contracted than controls and 20% less contracted than the 8 and 16 hour/day groups. This difference persisted throughout the study (p < 0.05). At the end of the study, all treatment conditions significantly reduced scar thickness vs. controls. Scar stiffness and pliability were significantly improved over controls with just 8 hours/day of wear; however, applying pressure 24 hours a day enhanced these effects and also improved skin elasticity. No difference in erythema between pressure treated and control scars was observed. Pressure garments worn for at least 8 hours/day are effective at reducing contraction and scar thickness and also improving elasticity versus controls; however, the greatest benefits in scar properties was observed with continuous use (24 hours/day). The current practice of prescribing 23 hour/day use of compression garments is warranted as outcomes are greatest when therapy is maintained. Reduced use (8–16 hours per day) provides modest improvements to some scar properties. However, patients should continue to be encouraged to comply with current therapy regimens to achieve maximum benefit.