99 Are Custom Fabricated Pressure Garments Applying Adequate Pressure?

Abstract

Custom fabricated pressure garments (PGs) are commonly used to treat hypertrophic scars (HSc) after a burn injury. However, there is minimal scientific evidence quantifying the pressure applied after standard measurement and fitting techniques. In addition, the pressure likely decreases with time as the PGs are worn, but this has not been systematically documented. A pressure-sensing device validated specifically for this type of evaluation is now available. The aim of this study was to quantify the pressure applied to HSc and normal skin (NS) by custom fabricated PGs and the extent to which the pressure varies with time. Burn survivors whose HSc (diagnosed using the Cutometer and high-frequency ultrasound) was treated with custom fabricated PGs were recruited after signing an informed consent. A trained fitter, blinded to the study locations and results, took the garment measures. Once the PGs arrived and were fitted, baseline measures of the applied pressure, at standardized HSc and NS sites, were determined. Pressure readings were repeated at 1, 2 and 3 months to determine the applied pressure at the specific study locations. Participants also maintained treatment diaries during the study period. The mean mmHg pressure applied at baseline was 15.3 (SD 10.4) at the HSc and 13.4 (SD 11.9) at the NS sites. Wilcoxon Signed Rank Test revealed a significant reduction in pressure during the first month at both sites (p<0.001 HSc; p<0.001 NS). A multivariable linear regression model, adjusting for garment type and repeated measures, revealed further reduction at the HSc site between 1 and 2 months (p=0.047). By 3 months, the mean pressure had reduced to 9.9 (SD 6.7) and 9.2 (SD 7.2) mmHg at the HSc and NS sites respectively. At each time point the mean pressure applied was higher at the HSc compared to NS but was significantly different only at 1 month (p=0.005). PGs were worn on average 16.3 hrs/day 3.8 days/week (per garment). A systematic review and meta-analysis determined that PGs applying 15–25 mmHg pressure showed significant HSc improvement when compared to low/no pressure. However, immediately after fitting, the average pressure of newly fabricated custom PGs was at the bottom of the recommended range and by 1 month was significantly below. Clinicians are likely underestimating the therapeutic pressure dosage that is required for custom fabricated PGs and need to be aware that there is significant pressure loss within the first 2 months. To optimize PG prescription, reliable pressure assessment is recommended.