Medical Elastic Compression Stockings Research Articles

The recalcitrant venous leg ulcer – a never ending story?

SummaryIntroduction: In general, four particular causes of recalcitrant venous leg ulcers may be distinguished. These are foot pump insufficiency, chronic venous compartment syndrome and non-re-canalized popliteal vein thrombosis. The fourth cause of recalcitrant venous leg ulcers is lipodermatosclerosis as a symptom of severe chronic venous insufficiency.Methods: We reviewed the literature and based on this we describe four main causes of recalcitrant venous leg ulcers and their specific treatment.Results: Foot pump insufficiency arises when the plantar foot veins are not able to empty. Treatment should consist of physical therapy, a mechanical foot pump device and an insole. Lipodermatosclerosis may be treated by excision and split-thickness skin grafting (Vigoni procedure). Chronic venous compartment syndrome is usually caused by post-thrombotic syndrome and treatment consists of a fasciectomy, but is rarely used nowadays. Patients with non-re-canalized popliteal vein thrombosis may be supported by intermittent pneumatic compression, walking exercises, alternate standing and walking with lying down. All patients with recalcitrant venous leg ulcers must wear medical elastic compression stockings with high stiffness and high compression lifelong.Conclusions: Patients with recalcitrant venous leg ulceration are challenging. More specific treatment will heal more of these ulcers.

Design, Manufacture, Mechanical Testing and Clinical/Mri Assessment of the Medical Elastic Compression Stockings, Base on Taiwanese’s Leg Size

Chronic Venous Insufficiency (CVI) in the lower limb is commonly associated with varicose veins. In Asian countries, demand has increased for Medical Elastic Compression Stockings (MECS) as conservative treatment for varicose veins and CVI; however, their efficacy requires further investigation. The legs of 726 Taiwanese participants were measured, and MECS were designed and manufactured accordingly. Manufacturing processes included “fixation of the elastic fiber,” “design of the fabric,” “application of techniques for high-pressure stockings,” and “application of techniques for configuration.” Further techniques used for the production of functional MECS included “elastic yarn composite techniques,” “incremental pressure fabric weaving,” and “pressure shaping of fabrics.” Parameters for the mechanical testing of MECS included size measurement, extensibility, practical elongation, compression, and residual pressure on corresponding points of the leg. Clinical assessments and Magnetic Resonance Imaging (MRI) analyses using noncontract-enhanced Magnetic Resonance Venous (MRV) techniques were also performed on 100 participants with varicose veins pre-and post-MECS use. The average circumferences and lengths of specific points of the lower legs of the 726 participants were smaller than U.S. measurements by approximately 12% to 19%. This suggested that Taiwanese - and possibly Asian - MECS should not be manufactured according to Western sizes. Subjective clinical questionnaire results included relief of symptoms of heaviness of the legs, spasticity in the evenings, and convulsion during sleep. According to MRV analyses, deep venous blood flow increased significantly (relief of high pressure), and available hemoglobin in the deep vein increased (reduced tissue hypoxia) post-MECS use. Our findings provide important reference material for the establishment of Taiwanese and Asian standards for MECS. Results from clinical and MRV analyses confirmed the efficacy of prolonged use of MECS, with results indicating that 4 h/d and 112 h of use is sufficient to improve deep venous insufficiency.

Effect of compression therapy on knee swelling and pain after total knee arthroplasty

Knee swelling after total knee arthroplasty may impair postoperative mobilisation and training, and as medical elastic compression stockings are well tolerated and effective to prevent oedema, haematoma and postoperative pain after venous surgery, we wanted to study whether this effect could be transferred to total knee arthroplasty surgery reducing postoperative swelling and pain and thereby facilitating mobilisation and improving patient-reported knee function. In a randomised controlled study, 88 patients were randomised to use either a medical elastic compression stocking or no stocking from the first postoperative day and the following 4weeks after total knee arthroplasty. Outcome measures were knee, calf and ankle swelling, knee flexion, pain and patient-reported knee function. Seventy per cent of the swelling had occurred before application of the stocking the day after surgery. Knee, calf and ankle swelling and knee flexion measured on days 2, 7, 14 and 30 showed no significant difference between the two groups. Maximum pain level at rest and at walking was similar for both groups during the observation period. Also, the Oxford knee score was similar between the two groups on days 14 and 30. We did not find any clinical effect using a medical elastic compression stocking after total knee arthroplasty. I.

Changes in the pressure and the dynamic stiffness index of medical elastic compression stockings after having been worn for eight hours: a pilot study

There is no data available at present on the changes in the exerted pressure together with the dynamic stiffness index (DSI) of medical elastic compression stockings (MECS). The objective of this pilot study was to measure the pressure and calculate the DSI of 12 different brands of MECS before and after having been worn for eight hours. In all, 12 different commercially available brands of MECS that were divided into two categories (class I round-knitted and class II flat-knitted MECS) were tested. The pressure was measured, and the DSI of the MECS was first calculated at the B1 level before wearing in the morning and again eight hours after they had been worn. All laboratory measurements were performed using a newly developed dynamic leg-segment model. The pressure at the B1 level dropped significantly in all 12 brands of MECS after having been worn for eight hours, whereas the DSI remained unchanged. The DSI of MECS reflects an important and particularly consistent therapeutic effect. As the pressure drops during the day, the pressure amplitude or pulsations remain the same. The pressure drop may be due to fatigue of the elastic material. The DSI would therefore form a valuable indicator for prescribing the most effective MECS for the patient.

Correlation Between the Static and Dynamic Stiffness Indices of Medical Elastic Compression Stockings

Correlation Between the Static and Dynamic Stiffness Indices of Medical Elastic Compression Stockings

Correlation Between the Static and Dynamic Stiffness Indices of Medical Elastic Compression Stockings

Compression therapy with medical elastic compression stockings (MECS) has been used effectively for treating patients with chronic venous insufficiency for many years. To study the correlation between static stiffness and the dynamic stiffness index of 18 different brands of MECS. In all, 18 different brands of MECS were divided into 5 categories (class II round-knit, class II flat-knit, class III round-knit, class III flat-knit, and class IV flat-knit) and tested. The tension of the textile of the MECS at the B1 level was measured according to the Institut de Textile France method to calculate the static stiffness index. The dynamic pressure pulsations were measured with a newly developed dynamic pressure-determining device to calculate the dynamic stiffness index. The results showed that there was a positive correlation between the static stiffness index and the dynamic stiffness index. The dynamic stiffness indices were higher than the static stiffness indices. Although the stiffness of MECS is a further refinement to the current classification, which classifies MECS according to the pressure they exert at the B level, the dynamic stiffness index does not have any additional value over the static stiffness index as far as the classification of MECS is concerned. Either or both of these characteristics should be used to select the most suitable MECS for the patient.

Variation in the dynamic stiffness index of different types of medical elastic compression stockings

To calculate the dynamic stiffness index (DSI) of 18 different brands of medical elastic compression stockings (MECS). In all, 18 different brands of MECS that were divided into five categories (class II round-knitted, class II flat-knitted, class III round-knitted, class III flat-knitted and class IV flat-knitted MECS) were tested. The static pressure and dynamic pressure pulsations at the B1 level were measured with a newly developed dynamic pressure-determining device. The DSI was calculated. The DSI of all 18 brands of MECS showed higher values compared with the static stiffness. A wide range of dynamic stiffness indices was observed not only between all brands of MECS, but also within the five categories. The DSI of MECS is independent of the compression class and the type of knit. The variation in the DSIs between MECS is not because of any measurement error and would indicate that different therapeutic effectiveness may be expected within one compression class. Therefore, a refinement in the current classification system for MECS with other characteristics such as the DSI is warranted.

Skin pressure profiles and variations with body postural changes beneath medical elastic compression stockings

Medical elastic compression stockings (GCSs) are one of the most widely used mechanical compression approaches to relieve venous disorders of the lower limb. The skin pressure profiles applied by compression stockings may be altered with body postural changes, thus exerting influences on their therapeutic efficiency. To examine and quantify objectively the skin pressure distribution and magnitude beneath GCSs with body postural changes, and to analyze the possible reasons for skin pressure variations. The pressure levels of four different kinds of commonly used GCS were measured using piezoelectric sensors and a multichannel measuring system in six female healthy volunteers in 10 different body positions. Body postural changes significantly influenced the skin pressure profiles (P < 0.001). Skin pressures at the ankle and on the anterior side of the leg were always highest when tested in all positions. Extension and flexion of the knee joint significantly influenced the skin pressure at the anterior and posterior aspects of the leg, especially when tested in the sitting position with the knee flexed at 90 degrees and in the supine position with the knee flexed at more than 90 degrees (P < 0.001). Plantar flexion of the ankle joint, such as up-heel standing and heel-off walking, significantly increased the skin pressure in the ankle region. Contraction, extension, and relaxation of the calf muscle did not produce large fluctuations in skin pressure when tested in positions with full knee extension. Body postures may be one of the most important factors influencing the skin pressure profiles applied by compression stockings. The anatomic structure of individual legs, the special design of compression stockings, and the physical properties of stocking materials also influence skin pressure variations at different tested locations in different body positions. Appropriate leg postural changes and exercise may improve the therapeutic effectiveness of GCSs.

Calculating the Pressure and the Stiffness in Three Different Categories of Class II Medical Elastic Compression Stockings

Medical elastic compression stockings (MECSs) are currently classified according to the pressure they exert at the ankle at the point of its minimum girth (B level). Despite this classification, there are considerable differences between MECSs belonging to the same compression class from the same manufacturers and between different manufacturers. This makes it difficult for the clinician to choose the most suitable MECS for the patient. The stiffness may be used to distinguish between MECSs of different brands. To calculate the pressure and the stiffness at the B level in three categories of class II MECSs from nine different brands. Nine different brands of class II MECSs that were divided into three categories (flat-knitted custom-made, classic round-knitted ready-made, and modern (ultrathin) round-knitted ready-made) were tested. The tension of the textile of the MECSs was measured with the Instron tester (Instron International Ltd., Edegem, Belgium). The pressures and stiffness at the B level were calculated. The pressures exerted by flat-knitted custom-made MECSs were higher than those exerted by the ready-made round-knitted MECSs. Surprisingly, the former showed higher pressures than those published by the European Committee for Standardization. A wide range of stiffness was observed within the different brands and within the three different categories of MECS. Despite their assignment to compression class II, all nine brands of MECSs that were tested had widely ranging stiffness. This would indicate that the stiffness is an additional important characteristic for distinguishing between MECSs from different brands, which should be taken into account by the clinician in selecting the most suitable MECSs for the patient.

Calculating the Pressure and the Stiffness in Three Different Categories of Class II Medical Elastic Compression Stockings

BACKGROUND Medical elastic compression stockings (MECS) are currently classified according to the pressure they exert at the ankle at the point of its minimum girth (B level). Despite this classification, there are considerable differences between MECS belonging to the same compression class from the same manufacturers and between different manufacturers. This makes it difficult for the clinician to choose the most suitable MECS for the patient. The stiffness may be used to distinguish between MECS of different brands. OBJECTIVE To calculate the pressure and the stiffness at the B level in three categories of class II MECS from nine different brands. METHODS Nine different brands of class II MECS that were divided into three categories (flat-knitted custom-made, classic round-knitted ready-made, and modern (ultrathin) round-knitted ready-made) were tested. The tension of the textile of the MECS was measured with the Instron® tester. The pressures and stiffness at the B level were calculated. RESULTS The pressures exerted by flat-knitted custom-made MECS were higher than those exerted by the ready-made round-knitted MECS. Surprisingly, the former showed higher pressures than those published by the European Committee for Standardization. A wide range of stiffness was observed within the different brands and within the three different categories of MECS. CONCLUSION Despite their assignment to compression class II, all nine brands of MECS that were tested had widely ranging stiffness. This would indicate that the stiffness is an additional important characteristic for distinguishing between MECS from different brands, which should be taken into account by the clinician in selecting the most suitable MECS for the patient.

Medical elastic compression stockings in the treatment of venous insufficiency.

Medical elastic compression stockings in the treatment of venous insufficiency.

The Oedema-Protective Effect of Lycra® Support Stockings

Background: Oedema may be an early sign of chronic venous insufficiency (CVI), but swelling of the lower legs is a common phenomenon in many people. The distinction between physiological swelling and CVI is not clear. There is a gradual transition between healthy legs and the early stages of CVI. In case of CVI, medical elastic compression stockings are used in order to prevent oedema completely. In case of healthy people without demonstrable CVI, no medical stockings are required in the prevention of oedema but stockings exerting less compression. Objective: The aim of this study was to investigate the effect of mild compression on the development of swelling of the legs and the effect on subjective complaints in healthy subjects. Methods: The diurnal volume change (DVC) of the lower legs during full working days was monitored with an optical leg volume meter in 118 healthy volunteers (60 males, 58 females) without objective symptoms of CVI. The DVCs after wearing two kinds of class I support stockings (X: average pressure at the ankle of almost 14 mm Hg; Y: almost 18 mm Hg) were compared with the DVC after wearing a control stocking (Z: almost 6 mm Hg). Also, the effect on subjective feelings of the legs was noted. Results: It appeared that healthy people have a mean daily volume increase of the legs of 2.3% in females and 1.6% in males. Mild compression stockings reduced this daily increase with 31 and 18% in males and females, respectively, by stocking X and 37 and 32% by stocking Y. Subjective feelings occurred in 57% of all cases. A beneficial effect on subjective feelings, in particular of tired and swollen legs, was found. A difference in this beneficial effect between stocking X and Y was not obvious. Conclusions: Mild compression stockings reduce diurnal oedema and unpleasant feelings of the legs in healthy individuals.

Compression Therapy: European Regulatory Affairs

Objective: Updating the status of the European standardisation for medical elastic compression stockings, including custom-made stockings (class 030606, EN29999), knitted from threads made of natural fibres or synthetic fibres and elastic threads. Design: Review of the literature. Setting: Department of Dermatology at the University Hospital of Maastricht (The Netherlands). Methods: Systematic review of the European regulations within the European Committee for Standardisation (CEN), by a special committee researching non-active medical devices (CEN/TC205). A special working group was set up for medical elastic compression stockings (CEN/TC205/WG2) and for anti-embolism stockings (CEN/TC205/WG2/P1) linked to the scientific background and literature on medical elastic compression stockings. Results: CEN/TC205 formalised a European prestandard (prEN12718) for medical elastic compression stockings. The pre-standard describes five compression classes, instructions for measurement, instructions for residual pressure and instructions for knitting. Still lacking is a good instrument for the comparison of laboratory measurements and a durability test. The problem of the elasticity coefficient is neglected in the standard. Conclusions: Normalisation of non-active medical devices is an important quality instrument. The medical profession should give attention to adequate compression classes, a good understanding of the elasticity coefficient and the durability of stockings.

Compression therapy with medical elastic stockings for venous diseases.

Compression therapy is the cornerstone in the treatment of venous disease. In many cases, but especially for the maintenance of compression, medical elastic compression stockings (MECS) are being used. Preprescription investigation includes determining the severity of venous insufficiency and the arterial system. An ankle/arm index < 0.6 will be the contraindication for compression therapy. MECS can be divided in flat-knitted and round-knitted MECS. Flat-knitted MECS can be made tailor sized, with a tolerance up to 0.5 cm. Several classes of MECS are characterized by the elasticity coefficient (EC) of the used elastic threads. The stiffer the stocking (high EC), the better a MECS will prevent edema formation during the day, but the more difficult it is to put them on. MECS with a high EC are always flat-knitted. Most round-knitted MECS will last 4-6 months, and flat-knitted MECS, 6-9 months. The physician can prescribe MECS for a wide variety of venous and some other diseases. He can determine the amount of compression as well as the stiffness of the MECS. Only a well-motivated patient and an experienced physician together are able to ensure ongoing successful compression therapy with MECS.