Inelastic Bandages Research Articles

Pressure and stiffness of a new air-inflated compression wrap.

To report pressure and stiffness, in healthy volunteers, of a new compression device with an air bladder inflated by a pump to regulate pressure. The device was applied to 60 legs of 30 volunteers and set to exert different pressures of 20-50mmHg. The exerted pressure was measured in supine and standing positions and during simple physical exercises; static stiffness index, dynamic stiffness index, and walking pressure amplitudes were calculated. The exerted pressure showed a good correlation with the expected pressure at each pressure range. The stiffness indices were >10mmHg in the range of inelastic materials. The device was considered very easy to apply and use by the testing researchers. The device stiffness is in the same range as the inelastic bandages. Consequently, similar hemodynamic effectiveness could be expected but must be proved. Unlike inelastic bandages, this device was easy to apply and use.

Relative cost-effectiveness of three compression bandages in treating newly diagnosed venous leg ulcers in the UK

To assess the clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2, 3M, US) compared with a two-layer compression system (TLCS; KTwo, Urgo, France) and a cohesive inelastic bandage system (CIBR; Actico, L&R, Germany) in treating newly diagnosed venous leg ulcers (VLUs) in clinical practice, from the perspective of the UK's National Health Service (NHS). This was a modelling study based on a retrospective cohort analysis of the case records of patients with a newly diagnosed VLU randomly extracted from the The Health Improvement Network (THIN) database who were treated with TLCCB, TLCS or CIBR. No significant differences were detected between the groups. Nevertheless, analysis of covariance was performed to enable differences in patients' outcomes between the groups to be adjusted for any heterogeneity in baseline covariates. Clinical outcomes and cost-effectiveness of the alternative compression systems were estimated over 12 months after starting treatment. There were 250 patients in each group. Time from wound onset to starting compression was a mean of two months. The healing distribution of the TLCCB-treated patients was significantly different from that of the other two cohorts (p=0.003); the probability of healing at 12 months was 0.62, 0.51 and 0.49 in the TLCCB, TLCS and CIBR groups, respectively. Patients treated with TLCCB experienced better health-related quality of life (HRQoL) over 12 months (0.86 quality-adjusted life years (QALYs) per patient), compared with those treated with TLCS and CIBR (0.83 and 0.82 QALYs per patient, respectively). The 12-month NHS wound management cost was £3693, £4451 and £4399 per patient in the TLCCB, TLCS and CIBR groups, respectively. Within the model's limitations, treating newly diagnosed VLUs with TLCCB instead of the other two compression systems appears to afford a more cost-effective use of NHS-funded resources in clinical practice, since it is expected to result in increased healing, better HRQoL and a lower wound management cost for the NHS.

Соmplex Medical Rehabilitation for Cancer-related Lower Limbs Lymphedema: a Prospective Comparative Randomized Study of 60 Patients

INTRODUCTION. The management of patients with secondary lymphedema of the lower extremities associated with radical treatment of pelvic cancer (Cancer Related Lymphedema) is extremely problematic due to persistent impairment of the draining function of regional lymph nodes due to intraoperative dissection and subsequent radiation therapy. AIM. To compare the effectiveness of complex medical rehabilitation using the kinesio taping method and innovative non-stretchable compression bandages in patients with secondary lymphedema of the lower extremities associated with radical treatment of pelvic cancer. MATERIAL AND METHODS. The study involved 60 patients with stages I-III Cancer Related Lymphedema (according to the classification of Savchenko T.V., Pokrovsky A.V., 2004) who underwent radical treatment for various forms of pelvic cancer (gynecological cancer in women and prostate cancer in men), randomized into 2 groups (30 people each). A comprehensive rehabilitation was carried out in the main group (n=30), including sequential manual lymphatic drainage, skin care, kinesio taping, therapeutic gymnastics in the gym; Adjustable Non-stretchable Compression Bandages (circaid juxtafit, Germany). Meanwhile, a Complex Decongestive Therapy was performed in the comparison group (n=30), which is considered as the gold standard of conservative treatment of lymphedema of the lower extremities, including manual lymphatic drainage, skin care, Multi-layered limb banding using Inelastic compression Bandages. In order to evaluate the anti-edematous effect the dynamics of the circumferences of the lower extremities, waist circumference and hip circumference, the Ankle Range of Motion were examined using goniometry, bio-impedancemetry. Laser Doppler Flowmetry was used to evaluate microcirculatory parameters. RESULTS AND DISCUSSION. There was a decrease in swelling and thickening of the skin in the thigh, a decrease the external genitalia edema in patients with Cancer Related Lymphedema in both groups after a course of rehabilitation. There was a regression of swelling of the feet and lower legs in patients of both groups (p<0.05) after treatment, which was confirmed by a decrease in the circumferences of the lower limbs. There was an increase in the Ankle Range of Motion (dorsiflexion) from 17.50±1.26° to 19.25±1.52° (p<0.05) in the main group and from 17.90±1.44° to 18.59±1.10° (p<0.05) in the comparison group. According to the bio-impedancemetry data, there was a decrease in the extracellular fluid content both in the main group and the comparison group by 2.64% and 2.83%, (p<0.05) respectively. There was also a comparable decrease in the total fluid content by 2.67% in the main group and 1.90% (p<0.05) in the comparison group. There were a decrease in body weight by 2.49% and 1.52% (p<0.001), a decrease in fat mass by 2.62% and 4.01% (p<0.05) in both groups respectively after the course of treatment. According to the Laser Doppler Flowmetry data, there were an improvement in the indicators of myogenic tone of arterioles and secretory activity of the endothelium, as well as elimination of venular congestion in patients of both groups (p<0.05). CONCLUSION. Regression of edema in Cancer Related Lymphedema can be achieved as a result of the use of manual lymphatic drainage which stimulates the outflow of lymph through lymphatic watersheds into adjacent lymphatic territories with intact regional lymph nodes, which was achieved in both groups. The lymphatic drainage effect of manual lymphatic drainage was supported by the daily compression profile of bandages (Multi-layered Inelastic Bandages and Adjustable Non-stretchable Compression Bandages) in patients of both groups. Our study showed that the use of kinesio tapes leveled the difference in compression of approximately 10-15 mmHg between the bandages used (50 mmHg/~60 mmHg).

Experience of using an adjustable inextensible compression bandage in a patient with secondary lymphedema of the right upper limb

Introduction. Secondary upper-extremity lymphedema is most commonly caused by lymphadenectomy and radiotherapy (RT) of regional lymph nodes. Lymphatic edema differ in the fact that they lead to fibrotic changes in tissues, as the lymph contains up to 2–4% of protein, which causes a specific histopathological response. Proteins, as well as tissue protein-polysaccharide complexes, undergo transformations leading to pathological collagenization, and then to hyalinization and sclerosis. A vicious circle of pathological processes stemming from biophysical and chemical changes in proteins and polysaccharides with metabolic disorders occurs. Compression therapy is the most important component of the fight against both upper- and lower-extremity edema of various origins at any stage of the disease.The aim is to assess the postoperative stabilization of the upper-extremity edema state due to the patient’s self-bandaging using inelastic bandages and the possibility of personalized adjustment of pressure to be applied at the required level. The article provides indications for the use of an adjustable inelastic compression bandage to stabilize edema, and reviews a clinical example of its postoperative use in a patient with grade 4 secondary right upper-extremity lymphedema. Particular emphasis is placed on the versatility of adjustable inelastic compression bandage and the expediency of its widespread use in clinical practice.Conclusion. Simplicity and ease of use with an option to self-adjust and maintain the stable level of therapeutic pressure throughout the entire period of medical rehabilitation, as well as minimization of doctor’s involvement, allow us to recommend the adjustable inelastic compression bandage for effective use in wide clinical practice.

Ex vivo comparison of the bursting strength of an equine ventral midline celiotomy covered by two standard abdominal bandages

To determine the compressive effect of abdominal bandages after ventral midline celiotomy closure in horses. Ex vivo, experimental study. Equine cadavers (n = 18), six per group. A 20-cm ventral midline celiotomy was created in each of 18 equine cadavers. A 200-L inflatable bladder was placed in the abdomen, and the linea alba was apposed. Horses were randomly assigned to no bandage (C), elastic (E), or Velcro inelastic (I) bandage groups for testing. Circumferential bandages were placed with a subbandage pressure monitoring system over the incision. The bladder was insufflated until construct failure, which was determined by a decrease in pressure reading. Bursting pressure, location of body wall or bandage failure, and subbandage pressures were recorded. Maximum bursting pressure was different between groups E and C (P = .004), with no difference between groups E and I (P = .146) or I and C (P = .085). Group I achieved higher subbandage pressure compared with group E (P = .036). Abdominal compliance was not different between groups (P = .099). Location of failure differed between groups (P = .011), with failure at the diaphragm more common in group I (6/6, 100%) compared with groups E (3/6 [50%]) and C (1/6 [16.7%]). Elastic abdominal bandages had higher abdominal bursting pressures compared with unbandaged incisions.

Influence of Inelastic Bandage on Ankle Range of Motion and Calf Muscle Pump Dysfunction in Patients with Lower Limb Lymphedema

<h3></h3> Ограничение диапазона движений в голеностопном суставе (Ankle Range of Motion — AROM) приводит к дисфункции мышечно-венозной помпы (МВП) голени. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Провести сравнительный анализ воздействия многослойного низкоэластичного бандажа (МНБ) и регулируемых нерастяжимых компрессионных бандажей (РНКБ) на работу МВП голени, а также на показатели AROM у больных лимфедемой нижних конечностей. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В пилотный проект включены 10 больных лимфедемой нижних конечностей I—III стадий, средний возраст — 62 года. Проводили гониометрию с измерением AROM дорсифлексии в градусах и изокинетическую динамометрию мышц нижних конечностей на роботизированном биомеханическом комплексе. <h3>РЕЗУЛЬТАТЫ</h3> Выявили снижение показателей AROM дорсифлексии на 30% и AROM подошвенного сгибания на 20,2%, что свидетельствует о функциональном ограничении движений в голеностопном суставе, лимитирующем полноценную работу мышечно-венозных насосов. У больных лимфедемой зарегистрировано снижение показателей изокинетической динамометрии: максимальной силы разгибания — на 26,5%, средней силы разгибания — на 35,7%, общей работы — на 29,8%. Применение МНБ, рекомендуемых в 1-ю фазу компрессионной терапии, приводит наряду с противоотечным действием к повышению эффективности мышечной помпы голени, что подтверждается увеличением средней и максимальной силы разгибания, но ограничивает AROM дорсифлексии на 47% от исходного показателя. Применение альтернативного противоотечного метода компрессии, РНКБ, также повышает производительность мышечной помпы: увеличивает среднюю и максимальную силу разгибания, при этом ограничение AROM происходит только на 20%. <h3>ЗАКЛЮЧЕНИЕ</h3> РНКБ не уступает многослойному бандажу не только в противоотечном действии, но и в повышении производительности мышечной помпы.

Evidence Summary: Venous leg ulcers: Compression with short stretch (inelastic) bandages

Venous leg ulcers (VLUs) are chronic wounds that occur on the lower leg as a result of venous disease. Compression therapy is recognized as gold standard treatment for promoting healing of VLUs. The best available evidence on SSBs indicates that this form of compression therapy is effective in promoting VLU healing, although other forms of compression (e.g. compression stockings or 4-layer bandaging) appear to achieve superior healing outcomes and might heal VLUs slightly faster (Level 1).

Adjustable compression wrap devices are cheaper and more effective than inelastic bandages for venous leg ulcer healing. A Multicentric Italian Randomized Clinical Experience.

IntroductionCompression therapy by inelastic bandages is highly effective in achieving venous leg ulcer healing. Inelastic bandages may be expensive as they need to be changed and discarded at every dressing change. In addition, correct application is difficult in the clinical practice, even by expert healthcare personnel. The aim of our work was to assess whether adjustable compression wraps are more cost effective and more effective than inelastic bandage to achieve venous leg ulcer healing.MethodsSixty-six venous leg ulcer patients were randomized to be treated by adjustable compression wrap (CircAid® JuxtaCure®) ( n = 33) and inelastic bandage (Coban 2 Layer®) ( n = 33). Study duration was 12 weeks. During weekly visits, the ulcers were cleansed and dressed with the same products, and the only variable was the compression device. Ulcer size, ulcer pain, patient’s perception of compression systems, and compression pressure were assessed during the visits, and the material cost was evaluated at the 12th week.ResultsAdjustable compression wraps were significantly cheaper than bandages (p &lt; 0.0001) and were also more effective (not significantly) in achieving ulcer healing. To heal one ulcer patient, €228 had to be spent when applying an adjustable compression wrap and €381 if inelastic bandages were used. About 26/33 (78.8%) patients in the adjustable compression wrap group were healed after 12 weeks versus 23/33 (69.7%) in the inelastic bandage group (n.s.). Ulcer pain was reduced by both compression devices. Patient perception of compression pressure was similar with both compression devices. Compression pressure was similar at application but better maintained by adjustable compression wrap over time.ConclusionsAdjustable compression wraps are significantly cheaper and more effective (not significantly) in achieving venous leg ulcer healing. Self-applicable, adjustable compression wraps are therefore a powerful, cost-effective alternative to inelastic bandages in treating venous leg ulcer.

Several practical aspects of the use of adjustable inelastic compression bandages (AICB)

In the review article various indications for the use of adjustable inelastic compression bandage circaid are considered, and an actual clinical example of its successful application is given. The authors draw a conclusion about the universality of circaid bandage and the expediency of its wide use in real clinical practice.

Compression systems used in lymphoedema management.

British Journal of NursingVol. 27, No. 20 FocusCompression systems used in lymphoedema managementTracy GreenTracy GreenSearch for more papers by this authorTracy GreenPublished Online:12 Nov 2018https://doi.org/10.12968/bjon.2018.27.20.1150AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Hobday A. Use of compression therapy in patients with lymphoedema. Nurs Stand. 2016; 30(27):50–58. https://doi.org/10.7748/ns.30.27.50.s46 Crossref, Medline, Google ScholarInternational Lymphoedema Framework. Best practice for the management of lymphoedema. 2006. https://tinyurl.com/y8hhd66c (accessed 22 October 2018) Google ScholarMoffatt CJ, Keeley V, Franks PJ, Rich A, Pinnington LL. Chronic oedema: a prevalent health care problem for UK health services. Int Wound J. 2017; 14(5):772–781. https://doi.org/10.1111/iwj.12694 Crossref, Medline, Google ScholarMosti G, Cavezzi A, Partsch H, Urso S, Campana F. Adjustable Velcro compression devices are more effective than inelastic bandages in reducing venous edema in the initial treatment phase: a randomized controlled trial. Eur J Vasc Endovasc Surg. 2015; 50(3):368–374. https://doi.org/10.1016/j.ejvs.2015.05.014 Crossref, Medline, Google ScholarPartsch H, Moffatt C. An overview of the science behind compression bandaging for lymphoedema and chronic oedema. In International Lymphoedema Framework. Compression therapy: a position document on compression bandaging. Best practice for the management of lymphoedema. 2nd edn. 2012. https://tinyurl.com/ycxxbufj (accessed 22 October 2018) Google Scholar FiguresReferencesRelatedDetailsCited byCase study: night compression use in a patient with Milroy's diseaseAmbreen Chohan, Simon Sumner, Mairi Olivier, Justine Whitaker23 June 2022 | British Journal of Nursing, Vol. 31, No. 12Examination of the effects of a new compression garment on skin tissue oxygenation in healthy volunteersAmbreen Chohan, Lauren Haworth, Simon Sumner, Mairi Olivier, Daniel Birdsall, Justine Whitaker11 July 2019 | Journal of Wound Care, Vol. 28, No. 7Leg care: improving assessment and adherenceDrew Payne13 June 2019 | Nursing and Residential Care, Vol. 21, No. 7 8 November 2018Volume 27Issue 20ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 12 November 2018 Published in print 8 November 2018 Information© MA Healthcare LimitedPDF download

A Meta-analysis to Compare Four-layer to Short-stretch Compression Bandaging for Venous Leg Ulcer Healing

Compression therapy is the standard of care for venous leg ulcers (VLUs), and some evidence suggests 4-layer compression is more effective than short-stretch bandages. A meta-analysis was conducted to compare the effectiveness of these 2 compression bandages for venous ulcer healing. In March 2016, a systematic review of the literature was conducted to identify randomized controlled trials. Databases used included Pubmed/MEDLINE, EMBASE, Cochrane Central, the Cumulative Index of Nursing and Allied Health Literature, and the Latin American and Caribbean of Health Sciences Information System. Search terms were varicose ulcer, venous leg ulcer, venous ulceration, leg ulcer, compression bandages, compressive therapy, multilayer system, four-layer system, elastic bandages, short-stretch bandage, short-stretch system, and inelastic bandage. No publication time or language restrictions were imposed, but findings subjected to analysis were limited to results of research that reported healing and healing time using 4-layer and short-stretch compression only. The quality of the studies was assessed using the Jadad scale. Data extracted included study design, country, target population demographics, VLU clinical aspects at baseline, sample size, interventions applied, follow-up period, complete healing, and healing time as outcomes. Relative risk was calculated considering a 95% confidence interval for dichotomous variables (complete healing), and heterogeneity was statistically assessed among the studies using the chi-squared test assuming random effect when I2 ≥50%. The search yielded 557 papers; 21 met the study criteria for full-text analysis, and 7 met the meta-analysis inclusion criteria. The studies included 1437 patients, average age 70 (range 23-97) years with 1446 venous leg ulcers. Most (5) studies were classified as being at low risk of bias. At 12 and 16 weeks, 259 ulcers (51.08%) healed completely in the 4-layer and 234 (46.34%) in the short-stretch bandage groups, respectively (P = .41). At 24 weeks, 268 ulcers (69.07%) in the 4-layer and 257 (62.23%) in the short-stretch bandage groups, respectively, had healed (P = .16). The 2 bandage systems evaluated were similar in achieving complete healing at their respective study endpoints. The average time for healing was 73.6 ± 14.64 days in the 4-layer and 83.8 ± 24.89 days in the short-stretch bandage groups; no meta-analysis was done for this outcome due the inability to retrieve all the individual patient data for each study. The choice of compression system remains at the discretion of the clinicians based on evidence of effectiveness, patient tolerability, and preference. Additional randomized controlled trials to compare various wound and patient outcomes between different compression systems are warranted.

Venous ulcer treatment requires inelastic compression

SummaryLeg ulcers have a venous pathophysiology in the vast majority of cases (1–4). Superficial or deep venous insufficiency and deep vein obstruction produce ambulatory venous hypertension due to venous reflux and venous pumping function impairment. The impaired venous hemodynamics is the key pathophysiologic mechanism leading to skin damage through several intermediate steps. Fibrin cuff formation around the microvessels, impairing gases (O2, CO2) exchange (5), white cells entrapment (6) causing skin necrosis, growth factors inhibition (7) producing a stagnation of the healing process have been considered involved in ulcer onset and maintenance. The treatment of venous leg ulcers (VLU) must be based on the correction of the hemodynamic impairment which can be achieved conservatively by means of compression therapy, walking and leg elevation or by means of invasive procedures (open surgery, endovascular procedures as endovenous Laser ablation, radiofrequency, foam sclerotherapy, conservative hemodynamic treatment). Compression therapy is frequently considered the first treatment option and it is the only therapeutical procedure which achieved the grade 1A in most recent guidelines or consensus documents (8–10). The crucial point is choosing the most effective compression modality. There are clear evidences that inelastic is more effective than elastic material in counteracting the venous hemodynamic impairment (11–14) that should „ensure” a superior effectiveness in promoting a higher healing rate of VLU, which are due to venous hemodynamic impairment. When looking at evidences we have some data showing that the higher the compression pressure the higher the healing rate (9, 15–17) and this is clearly in favors of inelastic bandages which exert a much higher pressure that elastic materials. On the other side we have many papers claiming a greater effectiveness of elastic stockings or elastic bandaged compared with inelastic material (18–30). Nevertheless studies comparing elastic and inelastic devices have so many flaws that their conclusions are hard to trust (31). Aim of this work is providing updated information about compression therapy effects on venous hemodynamic and the most effective compression modality to achieve the best outcome in VLU treatment.

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.

STICKS study \u2013 Short-sTretch Inelastic Compression bandage in Knee Swelling following total knee arthroplasty \u2013 a feasibility study

BackgroundPostoperative knee swelling is common and impairs early postoperative function following total knee arthroplasty. It was hypothesised that the use of a short-stretch, inelastic compression bandage would reduce knee swelling and improve pain and early function. The aim of this study was to provide preliminary data and test feasibility with a view to informing a larger, future trial.MethodsFifty consecutive patients selected for primary total knee arthroplasty underwent distance randomisation to receive a short-stretch, inelastic compression bandage or a standard wool and crepe bandage for the first 24 h postoperatively. Study feasibility including recruitment rates, retention rates and complications were analysed. The Oxford Knee Score, the EQ-5D-3L index score, knee swelling, knee range of motion, visual analogue pain score and length of stay were compared between groups. Analysis of covariance (ANCOVA) was performed adjusting for the preoperative measurement.ResultsSixty-eight percent of eligible patients were recruited into the trial. The retention rate was 88%. There were no complications regarding compression bandage use. There was a greater mean but non-significant improvement in Oxford Knee Score (p = 0.580; point estimate = 2.1; 95% CI −3.288 to 7.449) and EQ-5D-3L index score (p = 0.057; point estimate = 0.147; 95% CI −0.328 to 0.005) in the compression bandage group at 6 months. There was no significant difference between groups regarding knee swelling, knee range of motion, visual analogue pain score, complications and length of stay.ConclusionPreliminary data suggests that the use of an inelastic, short-stretch compression bandage following total knee arthroplasty is a safe technique that is acceptable to patients. A larger, multicentre trial is required to determine its effect postoperatively.Trial registrationThe study was registered with Current Controlled Trials, identifier: ISRCTN86903140. Registered on 30 May 2013.

New aspects of compression therapy

In this review article the mechanisms of action of compression therapy are summarized and asurvey of materials is presented together with some practical advice how and when these different devices should be applied. Some new experimental findings regarding the optimal dosage (= compression pressure) concerning an improvement of venous hemodynamics and areduction of oedema are discussed. It is shown, that stiff, non-yielding material applied with adequate pressure provides hemodynamically superior effects compared to elastic material and that relatively low pressures reduce oedema. Compression over the calf is more important to increase the calf pump function compared to graduated compression. In patients with mixed, arterial-venous ulcers and an ABPI over 0.6 inelastic bandages not exceeding asub-bandage pressure of 40mmHg may increase the arterial flow and improve venous pumping function.

Adjustable Velcro® Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial

The objective of this study was to compare the efficacy and comfort of inelastic bandages (IBs) and adjustable Velcro® compression devices (AVCDs) in reducing venous leg edema in the initial treatment phase. Forty legs from 36 patients with untreated venous edema (C3EpsAsdPr) were randomized to two groups. Patients in the first group received IBs (n = 20) and those in the second AVCDs (n = 20). Both compression devices were left on the leg day and night, and were renewed after 1 day. Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose. Leg volume was calculated using the truncated cone formula at baseline (T0), after 1 day (T1) and after 7 days (T7). The interface pressure of the two compression devices was measured by an air filled probe, and the static stiffness index calculated after applying compression at T0 and T1, and just before removal of compression on T1 and T7. Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale. At T1, the median percent volume reduction was 13% for the IB group vs 19% for the AVCD group; at T7 it was 19% vs 26%, respectively (P < .001). The pressure of the IBs was significantly higher compared with the AVCDs at T0 (63 vs 43 mmHg) but dropped by >50% over time, while it remained unchanged with AVCDs owing to the periodic readjustment by the patient. Comfort was reported to be similar with the two compression devices. Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema.

Commentary on ‘Adjustable Velcro Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial’

Mosti et al. have compared the use of inelastic bandages (IBs) with an adjustable Velcro compression device (AVCD) (Circaid Juxtafit; Medi GmbH, Bayreuth, Germany) applied to the legs of patients with edema. This is a very important study demonstrating the effectiveness of an AVCD in the management of leg edema. The ability of the patient to adjust the AVCD as leg swelling abates is critical to the success of the Velcro method. It is not feasible to rewrap inelastic bandages daily, and the importance of having the patient participate in their treatment is key to long-term success. Owing to the excellent static stiffness achieved with the Velcro wraps, the inelastic properties of the AVCD are ideal in reducing swelling. The static stiffness index may be defined as the difference in sub-bandage or wrap pressure from the lying to the standing position. A rise of 10 mmHg or more is considered a good value to increase the flow of blood out of the leg. Stockings, however, show little or no increase in pressure when comparing the lying with the standing position, and these properties help explain why many patients with significant leg swelling are not helped by the stockings. Another group of patients with swelling are candidates for the AVCD as they have serious donning and/or doffing difficulties. This is especially true in the elderly population, where lack of strength in the hands and/ or arthritic changes impede the ability to use stockings. Another important use of AVCDs is after knee replacement or other orthopedic procedures where swelling may be commonly encountered. The ease of application and the ability to increase blood flow out of the leg limiting edema may also have benefit as an adjunctive method for thrombosis prophylaxis. This is especially true in those who have leg swelling preoperatively.

Adjustable Velcro® Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial

The objective of this study was to compare the efficacy and comfort of inelastic bandages (IBs) and adjustable Velcro compression devices (AVCDs) in reducing venous leg edema in the initial treatment phase. Forty legs from 36 patients with untreated venous edema (C3EpsAsdPr) were randomized to two groups. Patients in the first group received IBs (n = 20) and those in the second AVCDs (n = 20). Both compression devices were left on the leg day and night, and were renewed after 1 day. Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose. Leg volume was calculated using the truncated cone formula at baseline (T0), after 1 day (T1) and after 7 days (T7). The interface pressure of the two compression devices was measured by an air filled probe, and the static stiffness index calculated after applying compression at T0 and T1, and just before removal of compression on T1 and T7. Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale. At T1, the median percent volume reduction was 13% for the IB group versus 19% for the AVCD group; at T7 it was 19% versus 26%, respectively (p < .001). The pressure of the IBs was significantly higher compared with the AVCDs at T0 (63 vs. 43 mmHg) but dropped by > 50% over time, while it remained unchanged with AVCDs owing to the periodic readjustment by the patient. Comfort was reported to be similar with the two compression devices. Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema.

Delivery of compression therapy for venous leg ulcers.

Despite the documented effect of compression therapy in clinical studies and its widespread prescription, treatment of venous leg ulcers is often prolonged and recurrence rates high. Data on provided compression therapy are limited. To assess whether home care nurses achieve adequate subbandage pressure when treating patients with venous leg ulcers and the factors that predict the ability to achieve optimal pressure. We performed a cross-sectional study from March 1, 2011, through March 31, 2012, in home care centers in 2 Danish municipalities. Sixty-eight home care nurses who managed wounds in their everyday practice were included. Participant-masked measurements of subbandage pressure achieved with an elastic, long-stretch, single-component bandage; an inelastic, short-stretch, single-component bandage; and a multilayer, 2-component bandage, as well as, association between achievement of optimal pressure and years in the profession, attendance at wound care educational programs, previous work experience, and confidence in bandaging ability. A substantial variation in the exerted pressure was found: subbandage pressures ranged from 11 mm Hg exerted by an inelastic bandage to 80 mm Hg exerted by a 2-component bandage. The optimal subbandage pressure range, defined as 30 to 50 mm Hg, was achieved by 39 of 62 nurses (63%) applying the 2-component bandage, 28 of 68 nurses (41%) applying the elastic bandage, and 27 of 68 nurses (40%) applying the inelastic bandage. More than half the nurses applying the inelastic (38 [56%]) and elastic (36 [53%]) bandages obtained pressures less than 30 mm Hg. At best, only 17 of 62 nurses (27%) using the 2-component bandage achieved subbandage pressure within the range they aimed for. In this study, none of the investigated factors was associated with the ability to apply a bandage with optimal pressure. This study demonstrates the difficulty of achieving the desired subbandage pressure and indicates that a substantial proportion of patients with venous leg ulcers do not receive adequate compression therapy. Training programs that focus on practical bandaging skills should be implemented to improve management of venous leg ulcers.

Progressive or degressive compression pressure profile in patients with chronic venous disorders of the lower limb

Graduated compression devices are considered the standard care for management of venous and lymphatic disorders. Recently compression devices exerting a pressure over the calf higher than over the ankle have been proved to be more effective than traditional graduated devices in increasing the impaired ejection fraction (EF) from the lower leg in patients with venous disease. Aim of this work is presenting an overview of the new concept on progressive compression, its potential benefits and limits. In different series of tests, the EF from the lower leg was assessed in 70 patients with severe reflux in the great saphenous vein (GSV). EF was measured by strain gauge plethysmography, in baseline conditions and after applying graduated compression devices or the new inversely graduated or progressive compression (PC) devices. The interface pressure was recorded, simultaneously with the EF, both in the gaiter area (B1 point) and at the calf (C point) in order to assess the compression pressure profile. EF, severely impaired in patients with GSV reflux, was increased by compression. So called PC devices (both PC elastic stocking and PC inelastic bandages) were significantly more effective than graduated compression in increasing the ejection fraction. The higher the pressure on the calf the higher the EF improvement. Maintaining the same strong pressure over the calf by means of two progressive stockings and increasing the pressure only over the calf to restore a graduated compression didn’t improve the EF. To improve venous pumping function in the ambulant patient stronger compression of the calf is more effective than graduated compression. This can be explained by the higher amount of blood volume pooled in the calf veins.