Compression Bandage Systems Research Articles

Comparing the Energy-Stretch Properties of Two Compression Bandage Systems in a Laboratory-Based Test under Controlled Conditions.

ABSTRACTOBJECTIVETo 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.METHODSThe 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.RESULTSThe 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.CONCLUSIONSThe 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.

A dual pressure indicator, two-layer compression system for treatment of venous leg ulcers: a review.

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. 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. 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. 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.

Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial.

Lymphedema is a prevalent long-term effect of breast cancer treatment associated with reduced quality of life. This study examined the efficacy of nighttime compression as a self-management strategy for women with chronic breast cancer-related lymphedema. Th authors conducted a parallel 3-arm, multicenter, randomized trial. Women were recruited from 3 centers in Canada and randomized to group 1 (daytime compression garment alone [standard care]), group 2 (daytime compression garment plus nighttime compression bandaging), or group 3 (daytime compression garment plus the use of a nighttime compression system garment). The primary outcome was the change in excess arm volume from the baseline to 12weeks. Participants from all groups used a nighttime compression system garment from weeks 13 to 24. One hundred twenty women were enrolled, 118 completed the randomized trial, and 114 completed the 24-week follow-up. The rates of adherence to nighttime compression were 95%±15% and 96%±11% in the compression bandaging and nighttime compression system groups, respectively. After the intervention, the addition of nighttime compression was found to be superior to standard care for both absolute milliliter reductions (P=.006) and percentage reductions (P=.002) in excess arm lymphedema volume. Significant within-group changes were seen for quality of life across all groups; however, no between-group differences were found (P>.05). The trial demonstrated a significant improvement in arm lymphedema volume from the addition of nighttime compression whether through the application of compression bandaging or through the use of a nighttime compression system garment. Lymphedema is swelling that occurs in the arm on the side of the surgery for breast cancer. Lymphedema occurs in approximately 21% of women. Lymphedema tends to worsen over time and can result in recurrent infections in the arm, functional impairment, and pain. Currently, treatment consists of intensive treatments to reduce the swelling followed by regular use of a compression sleeve during the day. This study examined and found a benefit from the addition of nighttime compression (whether through self-applied compression bandaging or through the use of a nighttime compression system garment) to the use of a daytime compression sleeve.

Inability of Laplace's law to estimate sub-bandage pressures after applying a compressive bandage: a clinical study.

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. 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. 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. 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.

Two-layer reduced compression system for lower limb wounds: a non-comparative evaluation.

Leg ulceration is a debilitating condition in which various factors play a role in determining patients' quality of life (QoL), and compression therapy has been shown to improve QoL. The 3M Coban 2 Lite Compression System provides reduced compression (25-30 mmHg) ideal for patients with painful venous leg ulcers (VLU) who are unable to tolerate high-strength compression or those with mixed-aetiology leg ulcers (MLU) who have an ankle-brachial pressure index (ABPI)≥0.5. This non-comparative evaluation aims to report the initial clinical experiences with 3M Coban 2 Lite and evaluate the performance of this two-layer reduced compression bandage system in treating chronic VLUs and MLUs. In total, 30 patients (12 men (40%); mean age=68.5 years) were enroled for evaluation. The duration of the chronic wounds was 28 months (range=1.5-144 months); 16 patients had VLUs, while 14 had MLUs. Complete healing was achieved in 6 (20%) patients, and an overall mean reduction in wound surface area (4.11 cm2) was observed between the baseline and study endpoint (16 weeks). Thus, 3M Coban 2 Lite seems safe and effective for treating painful VLUs and MLUs in patients unable to tolerate high-strength compression.

Safety of a compression stocking for patients with chronic venous insufficiency (CVI) and peripheral artery disease (PAD).

With increasing age, it is increasingly common for patients to develop both chronic venous insufficiency (CVI) and peripheral artery disease (PAD). While there are special compression bandage systems commercially available for individuals thus affected, appropriate compression stockings have previously not been available. In the present study, we investigated the safety and effectiveness of a type of compression stocking specifically designed for this patient group (VenoTrain® angioflow, Bauerfeind Germany, German compression class 1 with high stiffness). In a prospective case series, we included patients with both CVI (C3-C5 disease according to CEAP classification) and PAD (ankle-brachial index of <0.9 and >0.5; absolute ankle systolic pressure of >60mmHg). Primary outcome measures consisted of 1) safety in terms of PAD, as determined by measuring acral pressure using acral photoplethysmography (APPG), and 2) effectiveness in terms of CVI symptoms, as assessed by using a suitable questionnaire (VVSymQ). Fifty patients were evaluated (mean age: 67.1; mean ankle-brachial index: 0.75 ±0.77). Fifteen patients had stage IIa PAD (according to Fontaine); 15, stageIIb; the remainder, stage I disease. Thirty-one patients had stage C3 CVI (according to CEAP classification); 16 patients, stage C4; and three patients, stage C5 disease. Immediately after donning the medical compression stocking, systolic arterial pressure in the big toe increased significantly (from 83.3mmHg ±27.6mmHg to 90.8mmHg ±24.1mmHg) (p=0.026). The VVSymQ score dropped significantly from 5.0 ±4.95 points to 1.4 ±2.26 points (p<0.001), thus reflecting an improvement in CVI symptoms. The compression stocking tested herein is safe for individuals with an ankle brachial index ≥0.5. Skin damage was not observed.

Compression therapy for chronic oedema and venous leg ulcers: CoFlex TLC Calamine.

The prevalence of venous leg ulcers and chronic oedema is increasing because of the rise in the older population who have comorbidities. Managing and living with these conditions is extremely costly in resource and human terms and there is often a cyclical process of ulceration, healing and recurrence, resulting in significant physical and psychosocial morbidity. Identifying those at risk and advising on lifestyle changes to prevent progression of these conditions will help in avoiding high wound management and compression costs, nursing input and associated patient morbidity. Compression bandaging is the linchpin in managing these conditions and it must be started as early as possible. However, many patients find it difficult to tolerate bandaging because of issues such as pain, the inability to wear shoes and itch. Therefore, if compliance is to be achieved, it is important to select a compression bandaging system that addresses the issues that patients have difficulty with. AndoFlex TLC Calamine is a compression bandaging system that deals with many of these problems, and is easy to apply and remove. Testimonials by practitioners treating patients with chronic oedema, ulceration and/or skin problems will demonstrate the benefits and effectiveness of AndoFlex TLC Calamine.

Knee Replacement Bandaging Study (KReBS) evaluating the effect of a two-layer compression bandage system on knee function following total knee arthroplasty: study protocol for a randomised controlled trial

BackgroundData from a feasibility study suggest that the use of an inelastic, short-stretch compression bandage following total knee arthroplasty is a safe technique that may improve patient-reported health outcomes, and that it is feasible to recruit to a full-scale study.MethodsWe will conduct a randomised controlled trial (RCT) of 2600 adult patients, which has 80% power to detect a 1 point difference in the Oxford Knee Score (a patient self-reported assessment of knee pain and function) at 52 weeks. Short stretch compression bandaging will be compared with standard wool and crepe bandaging following total knee arthroplasty. Recruitment will take place in orthopaedic units across the United Kingdom. Secondary outcomes include the EuroQol 5 Dimensions (EQ-5D)-5 L and EQ-5D-3 L scores, pain, length of hospital stay, and complications.DiscussionThe Knee Replacement Bandaging Study (KReBS) is a large study which aims to contribute to the evidence base for informing clinical decisions for the use of compression bandaging following knee arthroplasty.Trial registrationInternational Standard Randomised Controlled Trial Register, ISRCTN 87127065. Registered on 20 February 2017.

Survey of registered nurses’ selection of compression systems for the treatment of venous leg ulcers in the UK

BackgroundVenous leg ulceration is common in older adults in the United Kingdom. The gold-standard treatment is compression therapy. There are several compression bandage and hosiery systems that can be prescribed or purchased, but it was unclear what types of compression systems are currently being used to treat venous leg ulceration within the UK. This online scoping survey of registered nurses sought to (1) to identify what compression systems are available across the UK, (2) how frequently these are in use and (3) if there are any restrictions on their use. ResultsThe results showed that registered nurses who treat patients with venous leg ulceration use a wide range of compression systems. The most frequently used systems are the ‘less bulky’ two-layer elastic and inelastic compression bandaging systems whilst two-layer hosiery was used less frequently and four-layer bandaging used infrequently. Nurses report that certain compression systems are less accessible through the usual procurement routes but this appears to be related to concerns about competency in application techniques. ConclusionsThe data in this survey provides some important insights into the issues around the use of compression therapy for venous leg ulceration in the UK. Limiting access to certain types of compression may promote patient safety but limit patient choice. There may be underuse of the types of compression that promote patient independence, such as hosiery, and over-use of potentially sub-therapeutic therapy such as ‘reduced compression’. Overall, this study suggests that further consideration is needed about the provision of compression therapy to UK patients with venous leg ulceration to optimise care and patient choice.

Economic Benefit of a Novel Dual Mode Ambulatory Compression Device for Treatment of Chronic Venous Leg Ulcers

Compression is critical to heal chronic venous leg ulcers (VLUs). A novel dual mode ambulatory pneumatic compression (APC) device was tested in comparison to multilayered compression bandaging systems for the treatment of nonhealing VLUs in a prospective randomized clinical trial (RCT). Patients with VLUs measuring between 2 and 50 cm2 present for 1 to 12 months were randomized to treatment with the APC device (ACT group; Actitouch; Tactile Medical, Minneapolis, Minn] or multilayered compression bandaging (MLB) with either Profore (Smith & Nephew, Memphis, Tenn) or Coban 2 (3M Health Care, St. Paul, Minn) compression systems. Patients in the ACT group were asked to wear the device for sustained or intermittent compression throughout the day and to wear a light compression stocking at night. The ACT group patients were seen every 2 to 3 weeks for follow-up to 16 weeks, allowing more in-home care. The MLB group was seen in the outpatient clinic weekly. Other aspects of VLU care were standardized between the two groups. The primary study objective was to compare wound size reduction at 16 weeks between the two groups in a noninferiority RCT. Secondary objectives assessed the effect of each therapy on medical resource utilization and the direct cost of care. There were 58 patients who were randomized to treatment with either MLB (n = 30) or ACT (n=28). Both groups experienced similar rates of wound healing during the 16-week follow-up period, with ACT group patients decreasing from 4.01 ± 2.4 cm2 to 1.21 ± 2.5 cm2 and MLB-treated wounds decreasing from 7.6 ± 7.9 cm2 to 2.5 ± 6.1 cm2. There was no significant difference between groups in percentage of wound closure, incidence of complete wound healing, or improvement in Venous Clinical Severity Score. ACT-treated wounds had lower utilization of non-study-related clinic visits compared with the MLB cohort (50.0% vs 63.3%, respectively). In addition, there were fewer ACT-scheduled patient visits without any associated complications, resulting in lower direct medical costs compared with the MLB cohort (− difference [−$2733; P = .06]). The trial was halted before full randomization to make improvements to the ACT device to increase the patient’s comfort and usability, as suggested by both participating physicians and patients. In this preliminary RCT, a novel APC device achieved similar VLU wound healing results in comparison to MLB but with lower direct costs. The study has led to important changes in device design that will allow confirmation of these findings in a larger RCT.

Venous Ulcer: Could Endovenous Radiofrequency Ablation Improve Ulcer Healing? Preliminary Results of a Randomized Controlled Trial

Venous leg ulcers can take several weeks or months to heal and typically present with repeated cycles of ulceration, healing, and recurrence that result in high treatment costs and have a negative impact on patients’ quality of life. The multicomponent compression bandage system is still regarded as the “gold standard” to treat venous ulceration since previous randomized controlled trials failed to show improvement in ulcer healing rates by venous insufficiency surgical treatment despite decrease of ulcer recurrence risk. The current study was designed to investigate whether radiofrequency endovenous ablation of saphenous and perforating insufficient veins could increase venous ulcer healing rates. We did a prospective, controlled, randomized, open-label trial at a single center in Brazil. Participants had venous leg ulcer related to saphenous and perforating vein insufficiency with no sign of current or previous deep venous thrombosis. We randomly assigned participants to receive a weekly-changed two-layer compression bandage system alone or surgical radiofrequency ablation of insufficient saphenous and perforating veins before starting to receive the same compression system. Participants were stratified by ulcer duration (>6 months or <6 months) and ulcer area (>5 cm2 or <5 cm2). The primary end points were ulcer healing rates 6, 12, and 24 weeks after start of treatment. From January 2015 to August 2017, there were 77 patients considered eligible for the study, but 21 participants were excluded before randomization because of treatment abandonment, pretreatment wound healing, ultrasound evidence of previous unknown deep venous thrombosis, and clinical deterioration. The 56 remaining patients were randomly allocated to two treatment groups: 29 to multicomponent compression bandage alone and 27 to combined surgical and compressive treatment. The study is still ongoing, and 24 patients have been under intervention. We have therefore considered for analysis 15 participants from the surgical group and 17 participants from the isolated compressive treatment group. There are no statistically significant differences between groups in ulcer healing rates after 6 weeks. However, after 12 weeks, 73% of surgically treated patients have their ulcers healed vs 65% of compression alone-treated patients (hazard ratio, 4.968; 95% confidence interval, 1.053-23.42; P = .043). After 24 weeks, ulcer healing rate differences are even more evident (100% vs 76%), with the chance of healing greater for the surgical group (hazard ratio, 6.278; 95% confidence interval, 1.693-23.28; P = .006). Until now, 12- and 24-week venous ulcer healing rates were significantly greater in participants treated by endovenous radiofrequency ablation of saphenous and perforating veins plus two-layer compressive bandages than in patients who were treated with compression alone. We expect this difference to be maintained until the end of the study.

Treatment in the home setting with intermittent pneumatic compression for a woman with chronic leg ulcers: a case report

BackgroundIntermittent Pneumatic Compression (IPC) is shown to improve the healing rate of Venous Leg Ulcers (VLU) in the hospital setting. The current Australian “Gold Standard” treatment according to the Australian and New Zealand Wound Management Associations’ (AWMA) Prevention & Management of Venous Leg Ulcer guidelines is compression, generally in the form of bandaging then progressing to hosiery once wounds are healed to prevent recurrence. This is recommended in conjunction with other standards of wound management including; nutrition, exercise, client education and addressing underlying pathophysiology and psychosocial factors. Compression bandaging is predominantly attended by community nurses in the clients’ home. Barriers to delivery of this treatment include; client concordance and or suitability for bandaging including client habitus, (shape of legs), client lifestyle, clinician knowledge and clinicians physical ability to attend bandaging, in particular for obese clients with limited mobility who pose a manual handling risk to the clinician themselves. The use of IPC may assist in mitigating some of these concerns, therefore it would seem wise to explore the use of IPC within the home setting.Case presentationThis paper will present an original case report on the successful treatment of a woman living with chronic bilateral lower leg ulcers using IPC as an adjunct treatment in her home. This paper supports recommendations to explore the use of IPC therapy in the home setting, for treatment of chronic leg ulcers requiring compression.ConclusionUse of IPC in the home is anticipated to improve client involvement, concordance, client outcomes and reduce risk to staff applying conventional compression bandaging systems, particularly for obese clients with limited mobility.

First principle study: parametric investigation of the mechanics of elastic and inelastic textile materials for the determination of compression therapy efficacy

Vascular diseases are among the most common diseases in the world. Whether acute or chronic cases, compression therapy by bandaging is a well-known treatment for the majority of these diseases. In the textile processing of bandages, the influence of material chemistry (e.g. viscosity), the laws of physics (e.g. resiliency), and the medical requirements in the therapy must be taken into account. Furthermore, knowledge of the textile material helps us to understand why bandages do or do not have the desired effect. This paper provides a study of the Dynamic Hysteresis Coefficient (DHC) and lengthening, allowing the examination of compression bandage systems used in phlebology and lymphology using a novel measurement parameter. Compression bandage systems were subjected to a dynamic hysteresis test on a dynamometer, enabling estimation of the DHC and the lengthening (Δ L2) after five consecutive cycles. Evaluation of the findings indicates that the therapeutical stiffness index of the compression bandages can be reliably estimated using this new method. These findings show that inelastic compression bandage systems with elastomers can achieve a sustainable compression therapy over several days. DHC and Δ L2 are proven to be highly reliable parameters for comparing different compression bandage systems.

What is the existing evidence supporting the efficacy of compression bandage systems containing both elastic and inelastic components (mixed-component systems)? A systematic review.

To analyse current evidence on the efficacy of bandage systems containing both elastic and inelastic components (mixed-component systems). 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. A systematic literature review. 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. 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. 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. 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.

Liquid transmission characteristics of padding bandages under pressure.

Padding is an essential component in a multilayer compression bandaging system, used inside the compression bandage through which substantial amount of pressure is exerted on the limb of patient for treatment of venous leg ulcers. As a result, the liquid transmission behavior of padding is also critical in managing body fluids or sweat exuded from the affected limb, reducing the excessive moisture build-up around the wound and thereby ensuring comfort to and hence a better compliance from the patients. This study investigates the in-plane fluid transport characteristics of needle-punched nonwoven padding bandages. It first reviewed the existing studies related to the problems, and discussed their limits and possible improvements in dealing with complex fluid transport issues in textile porous media. The measurement of fluid transport under different pressure levels was then done using a newly designed apparatus capable of simultaneously tracing the liquid in-plane spreading along different directions, and obtaining several transport characteristics of a testing sample, e.g. the liquid flow anisotropy, the rate of movement, the area of wet surface with time, etc. Also the effects of several important factors, such as the levels of pressure applied, the specimen bulk density, and needling density of the padding products, have been experimentally investigated. In addition, based on an extended Lucas-Washburn theory, we calculated the liquid flow distance, both instantaneous speed and a more useful time-averaged speed v(av) at any given direction, and also defined a flow anisotropy index I(A) as a convenient parameter to represent the material flow anisotropy. The applications of v(av) and I(A) to actual samples have demonstrated the usefulness of these parameters in characterizing the flow nature and behavior of the materials.

Loss of Interface Pressure in Various Compression Bandage Systems over Seven Days

Background: Manufacturers' instructions of multi-component compression bandage systems inform that these products can remain up to 7 days during the therapy of venous leg ulcer. This implies that the pressure needed will be sustained during this time. Objective: The present research investigated the persistence of pressure of compression systems over 7 days. Methods: All 6 compression systems available in Germany at the time of the trial were tested on 35 volunteering persons without signs of venous leg disease. Bandaging with short-stretch bandages was included for comparison. Pressure was measured by using PicoPress®. Results: Initially, all products showed sufficient resting pressure of 40 mm Hg checked with a pressure monitor, except for one system in which the pressure fell by at least 23.8%, the maximum being 47.5% over a period of 7 days. Conclusion: The currently available compression systems are not fit to keep the required pressure. Optimized products need to be developed.

In vitro measurements of compression bandages and bandage systems: a review of existing methods and recommendations for improvement

In this article an overview is presented of identified devices that are or can be used for in vitro pressure and stiffness measurements of compression bandages and bandage systems. The performance of these devices has been evaluated on several parameters as well as the clinical relevance of the findings. In addition, recommendations for improvement and standardization of future measurements from the International Compression Club (ICC) working group compression bandages are presented.

Effect of Multi-layer Compression Bandage Systems on Leg Ulcers Associated with Chronic Venous Insufficiency

Giriş: Kronik venöz yetmezliğe bağlı bacak ülserleri yüksek prevalans ve tedavi için yüksek maliyet açısından çok önemli bir sağlık problemidir. Venöz bacak ülserlerinin tedavisinde çok katlı kompresyon bandaj sistemleri altın standarttır. Çalışmamızın amacı çok katlı kompresyon bandaj sistemin kronik venöz yetmezliğe bağlı oluşan venöz bacak ülserlerinin tedavisinde etkinliğini araştırmaktır. Hastalar ve Yöntem: Kliniğimize başvuran bacak ülserli ardışık 19 hasta değerlendirildi ve dört hasta periferik arter hastalığı nedeniyle çalışmadan çıkarıldı. Toplam 15 hasta çalışmaya dahil edildi. Hastaların CEAP sınıflandırmaları yapıldı ve tüm hastalar aynı CEAP sınıfına dahildi. Hastalara Betaven® çok katlı kompresyon bandajı uygulandı. Hastalar yara iyileşmeleri açısından takip edildi. Hastaların ülser boyutları planimetrik olarak ölçülerek değerlendirildi. Takip kriteri olarak yara iyileşmesi, yara alanında azalma esas alındı. Bulgular: Kliniğimizde toplam 12 erkek ve üç kadın hastaya çok katlı bandaj sistemi uygulandı. Hastaların yaş ortalaması 38.2 ± 4.2 idi. Hastaların ülser boyutları planimetrik olarak ölçüldü. Ülser boyutlar 4-10 cm² idi. Hastaların ülserleri yedi hastada medial malleol ayak bileği seviyesinde, üç tanesi lateral malleol düzeyinde, dört tanesi bacak ön yüzde bir tanesi bacak lateral yüzeydeydi. Hastalarda ortalama 5.1 ± 2.1 yıldır kronik venöz yetmezlik bulunmaktaydı. Hastaların CEAP sınıflaması C6, Ep, As2,3-p18, Pr2,3, 18 şeklindeydi. Ortalama tedavi süresi 6 ± 2 hafta olarak gerçekleşti ve bir hasta dışında tüm hastalarda tam iyileşme sağlandı. Bu hasta da rekonstrüksiyon amacıyla plastik cerrahi kliniğine yönlendirildi. Sonuç: Çok katlı kompresyon bandaj sistemleri intersisyel doku basıncını artırarak venöz dönüşü artırır ve venöz hipertansiyonu azaltarak kronik venöz yetmezliğe bağlı oluşan venöz bacak ülserlerinin tedavisinde etkili olur. Bu etkisi kısa sürede ortaya çıkmakta hem düşük maliyetle tedavi edilmekte hem de işgücü kaybının önüne geçilmektedir

Compression for venous leg ulcers.

Compression for venous leg ulcers.

Analysis of sub-bandage pressure of compression bandages during exercise

The sub-bandage pressure produced by any compression bandaging system is likely to vary during the physical activities taken by the patient. It is of significant importance to understand the variation of sub-bandage pressure during the exercise of calf muscle pump. The present paper aims to analyse the dominating factors and their interactions on the sub-bandage pressure during exercise. In this work the circumferential change of the leg because of the exercise of the calf muscle pump (expansion or contraction) is simulated using expansion or contraction actions of an air bladder placed on a mannequin. The study has been carried out using an indigenously developed prototype by pumping or squeezing of air in air bladder using cylinder–piston arrangement. A series of commercially available bandages were studied and the impact of the major factors, namely bandage extensibility (E), bandage tension (T) and the amount of bladder expansion or contraction (A) on the sub-bandage pressure during one cycle of expansion or contraction of air bladder have been analysed. Different levels of the factors have been chosen and a complete factorial design was prepared to obtain the sub-bandage pressure at all combination of the levels of the factors. The results showed that the sub-bandage pressure variations were higher for short-stretch bandage under dynamic mode (p value < 0.05). The variation in sub-bandage pressure were increased by increasing the amount of expansion or contraction of the air bladder and also increased when the bandage was wrapped at higher tension level (p-value < 0.05). N-way ANOVA results showed that some of the interactions effects of these above factors (EA and AT) also significantly affecting the sub-bandage pressure variations (p-value < 0.05). The prototype provides a simpler method to assess the bandage behaviour under different conditions without doing in vivo sub-bandage pressure measurement, and hence could be used to evaluate and compare the effectiveness of different compression bandage under different conditions, prior to their application on the wounded leg.