Short-stretch Bandages Research Articles

Three-year follow-up of the compression use in lower limb edema during pregnancy: A case report

Lower limb edema with its accompanying subjective ailments has been increasingly frequent in gravid women and in the postpartum period. The management is essentially non-interventional based on compression therapy (CT) with physical exercise adapted to the severity of venous disease and edema. A case of lower limb edema in a woman in the thirty third week of pregnancy was described. CT including compressive bandaging (CB) by short-stretch bandage and compression garments (CG) with physical activity was applied. Edema volume reduction, changes in consistency from hard to mild in palpation and reduction of accompanying ailments by use of CB after two weeks were observed. Further improvement by use of CG before and after delivery, and 3 years later was confirmed. Compression and physical exercise have a positive impact on edema reduction and leg symptoms intensity during pregnancy and should be recommended.

Increasing competence in compression therapy for venous leg ulcers through training and exercise measured by a newly developed score-Results of a randomised controlled intervention study.

Compression therapy with short-stretch bandages is the most common treating option for patients with venous leg ulcers in the decongestion phase in Germany. This randomised controlled intervention study examined whether a training is suitable to sustainably improve the skills of health care professionals. Altogether 55 nurses from hospitals and outpatient care participated. They were randomly assigned to case and control groups. Participants' abilities to properly apply a compression bandaging were assessed before and after a training session as well as after 1 and 3 months using a newly developed score (CCB score) based on six control parameters (CPs): padding, starting point, heel inclusion, heart direction, pressure at forefoot (A) and calf base (B1). After training, a significant increase in competence was observed, which only decreased non-significantly over the observation period: The average CCB score was 2.796 at V0, 4.89 at V1, 4.88 at V2, and 4.66 at V3. The CPs for pressure at A and B1 were met by a maximum of 42.6 and 43.6%, respectively, at all timepoints. The CP starting point was fulfilled by at least 61.7% after training, the CPs heart direction, heel and underpadding by at least 89.4, 96.4, and 97.9%, respectively. As a result of our study, it can be concluded that training improves the ability of users to apply compression bandagings, but one-off training does not appear to be suitable to improve the ability to apply compression bandagings with a therapy-relevant pressure. Therefor more training especially with pressure measuring devices would be necessary.

A randomised controlled clinical trial comparing the effectiveness of bandaging compared to the JuxtaCures™ device in the management of people with venous ulceration: Feasibility study.

The mainstay of treatment for venous ulceration remains compression therapy. Velcro Wrap devices are being increasingly used in these patients despite limited evidence. This feasibility study aimed to compare standard bandaging to the JuxtaCures™ Velcro wrap device. A single centre, unblinded RCT compared participants with venous ulceration randomised to either the JuxtaCures™ device or short stretch bandaging. Participants were followed up for 26 weeks. 160 participants were screened with 40 randomised. 3 participants in bandaging and 1 in JuxtaCures™ didn't complete the study. 60% in JuxtaCures™ healed v 55% in bandaging despite larger ulcers in the JuxtaCures™ arm (9.33 cm2 v 6.97 cm2). There was no significant difference in time to healing (12.17 v 13.64 weeks). JuxtaCures™ showed improved ulcer reduction for those that didn't heal (14.91-5.00 cm2 v 14.20-8.62 cm2; P = 0.06). JuxtaCures™ had more consistent sub-bandage pressure dropping from 39-36 mmHg versus 41-25 mmHg in bandaging between application and removal (P < 0.001). Quality of life (EQ5D) was improved in JuxtaCures at 3 months (mean difference 0.14, p = 0.04), but not at 1 and 6 months, or in disease specific quality of life. Cost was lower in JuxtaCures™ £842.47 v £1064.68. Duration of appointment was significantly shorter in JuxtaCures™ (41 minutes v 53 minutes; P = 0.003). This study has shown the feasibility and necessity of running a multicentre trial to evaluate the use of Velcro wrap devices for venous ulceration. It highlights the potential benefits of more consistent pressure, increased self-care, and potential with regards to ulcer healing, cost, nursing resource and quality of life.

Venous leg ulcers treated with fish collagen gel in a 12-week randomized single-centre study.

IntroductionVenous ulcers are difficult to heal chronic wounds. Most challenging are the non-healing and recurrent ulcers, because of which we are seeking for therapies that stimulate and support their healing.AimTo assess the efficacy of fish collagen and its impact on the process of healing of venous leg ulcers.Material and methodsThis 12-week randomized single-centre study included a total of 97 adults with venous leg ulcer, randomized into two groups: the study group (n = 48) and the control group (n = 49). All patients received specialist medical care including skin and limb care, wound development according to the TIME scheme (tissue debridement, infection and inflammation control, moisture balance, edge) and short-stretch bandage compression (compression class II). In addition, the study group received tropocollagen gel applied to the skin around the wound. Every 2 weeks we evaluated the wound surface and temperature distribution on the shin (average temperature, median, minimum and maximum) – symmetrically on the sick and healthy limb.ResultsWe observed a greater number of complete ulcer healing in the study group (week 12: 29.2% vs. 22.4%; week 24: 52.1% vs. 36.7%). Faster healing time in the study group was observed in both big and small ulcers. The thermographic analysis showed statistically significant reduction in periwound inflammation among patients from the study group (p < 0.05). Statistically significant reduction in mean as well as maximum values of limb temperature occurred only in the study group (Tx: R = 0.37, p < 0.001; Tmax: R = 0.40, p < 0.001).ConclusionsThermographic analysis showed better wound healing effects in the group using tropocollagen. Significant impact of collagen on the healing process was observed only after 8 weeks of application.

The Comparative Efficacy of Conventional Short-Stretch Multilayer Bandages and Velcro Adjustable Compression Wraps in Active Treatment Phase of Patients with Lower Limb Lymphedema.

Background: Compression is the most important component of complete decongestive therapy (CDT), but there is no standard best method for applying compression. The aim of this study was to evaluate the comparative efficacy of conventional multilayer short-stretch bandaging, and a velcro adjustable compression wrap with regard to volume reduction, ultrasonographic measurements, functional-status, and quality of life (QoL) in the active CDT period of patients with lower limb lymphedema. Methods and Results: The demographic and clinical variables of lower limb lymphedema patients were recorded. All patients received skin care education, manual lymphatic drainage, and supervised lyphedema exercises, and were randomly allocated to Group1 (multilayer short-stretch bandaging-Rosidal-K®) or to Group 2 (adjustable-compression-velcro-wrap-Circaid Reduction-kit®) for a duration of 3 weeks with 15 sessions. Limb volumes were assessed by perometer. Ultrasonographic measurements included subcutaneous soft tissue thickness. The functional disability and QoL were evaluated by the Lower Extremity Functional Scale and LYMQOL-Leg (Lymphedema Quality of Life Questionnaire-Leg), respectively, at baseline, after CDT, and at first-month follow-up. Thirty-six patients (10 male and 26 female) with mean age of 51.6 ± 11.7 years were included. Fourteen patients had primary and 22 patients had secondary lymphedema. The median duration of lymphedema was 68 months. Significant improvements in volumes and ultrasonographic measurments were observed in both groups at the end of therapies, and improvements sustained up to a month. Appearance, symptoms, and overall QoL-subscores were improved only in Group 2. Conclusion: In conclusion, adjustable compression velcro-wrap performed as a part of CDT can greatly reduce the volume similiar to conventional multilayer bandages, as well as improve the QoL. It can be a comfortable alternative to the conventional multilayer bandages in the active treatment phase of the CDT.

Comparative Study of Long- and Short-Stretch Woven Compression Bandages

Abstract Compression therapy using bandages or socks is the most common treatment for venous leg ulcers and edema. This article aims to compare the compression between long- and short-stretch bandages (LSB and SSB, respectively). Load-elongation curves, cyclic loading, and elastic recovery are investigated for both Cotton/Polyamide/Polyurethane and 100% bleached cotton bandages as LSB and SSB, respectively. Static (resting) and dynamic (working) pressures are measured on seven male legs, 31 ± 3.6 years old, using both two and three layers bandaging. Picopress pressure tests are performed on the ankle and mid-calf positions at gradual decreasing compression from the ankle to the knee. The deviation percentage between the experimental results by Picopress and theoretical calculations using Laplace's law and Al-Khaburi equations is compared. LSB recovered approximately 99% of its original length after stress-relaxation whereas SSB recovered only 93% of its original length after 5 days of cyclic load-relaxation. Moreover, SSB lost approximately 28.6% of its activity after wearing on the human leg for 5 days.

Healing Rates of Venous Leg Ulcer Using Four Layer Bandage and Short Stretch Bandage- A Comparative Study in Aspect of Bangladesh

Background: Chronic venous leg ulcer is one of the common medical conditions encounter by the vascular surgeons in Bangladesh. Many of these patients develop venous leg ulcer as a sequel of the disease. In advance chronic venous disease such as development of ulcer, single or multilayer dressings are usually used.&#x0D; Objective: To find out a compression therapy (single layer crepe/short stretch bandage and multilayer/four layer bandage) in patients with venous leg ulcer. Materiel &amp; Methods: This study was conducted on 200 patients with in last two years, march 2017 to february 2019 at Bangabandhu Sheikh Mujib Medical University (BSMMU), Department of vascular surgery. In which 100 patients with venous leg ulcer where treated with four layer bandage and another 100 patients with same condition were treated with single layer crepe bandage. Before application of bandage, proper history of patient was taken and duplex scan was done. The primary outcome was measured by time duration of ulcer healing. Secondary outcome included incidence and number of adverse events in every patient. Results: Healing time of venous ulcers was accessed with periodic interval. The four layer bandage was associated with significantly shorter time of healing. P value reached from unpaired t-test. Primary outcome shows 68% of patients who received four layer bandages achieved healing within one month. On the other hand, 12% of patients who received single layer/crepe bandage did so.&#x0D; Conclusion: Four layer bandages heals venous leg ulcer more rapidly than the single layer crape bandage. These data suggest that the benefits observed the consistent despite prognosis is different. Patients with large ulcers have poor healing prognosis regardless of its treatment modalities.&#x0D; University Heart Journal Vol. 16, No. 2, Jul 2020; 78-85

Lay Caregivers Education in Multicomponent Compression Bandaging in Obese Patients with Lower Limb Edema: A Case-Control Pilot Study.

Background: A report on the usefulness of the instruction of lay carers in multilayer short-stretch compression bandaging within the initial intensive phase physical treatment of mixed-etiology chronic lower limb edema. Methods and Results: In a group of adult obese patients (including 24 females) with venous insufficiency and chronic bilateral lower limb edema, and without a history of physical therapy, 20 (ambulatory managed) were bandaged once daily (four layers, short stretch with cotton tube, and foam padding underneath) for 3 weeks (Monday-Friday) by skilled physiotherapists, and in 20 cases (education group, EG), the patients' lay carers were educated by these physiotherapists according to the same regime during one session. The outcome measures included limb volume (the method of circumference measurement with a tape at 4 cm intervals) after 1, 3, and 6 months, the time to reach the maintenance phase, the frequency of complementary bandaging during this phase, and the sense of self-efficacy (General Self-Efficacy scale, GSEs). No significant differences were noted between the two groups in the baseline measurements of age, body mass, and limb volume. The carers were able to apply compression bandages in all cases during the observation period. The time to reach the maintenance phase was longer in EG (6 vs. 1 weeks; p < 0.001). A similar median reduction in edema volume was observed at the end of the bandaging period, which continued for 3 and 6 months. It was only in EG that further improvement between 1 and 3 months was observed (p = 0.008). All participants represented an equally high optimistic sense of personal competence (GSEs). Conclusions: The instruction of lay carers in bandaging may provide a simple clinically effective solution for lower limb edema management, thus lowering its costs.

Interest of a standardized treadmill test to evaluate pressure drops and stiffness indices under short stretch bandages

Introduction: Under short stretch bandages (SSB), the pressures drop over time. These pressures are documented in non standardized-way and vary from one study to another. Objective: A standardized stress test on a treadmill should help to better understand this evolution and thus to document with more precision the behavior of 3 bandages in use. Materials and Methods: Three bandage kits (Urgo K2, Kit Biflex and a kit consisting of padding + 2 cotton SSB2 were tested in 30 subjects (60 legs) before and after a treadmill test (3 km/h, 6% slope for 30 min or 1.5 km). Results: Before the test, the bandages were applied with nonsignificantly different resting interface pressures (respectively 40.58 ± 2.7 mmHg, 41.05 ± 2.17 mmHg, 38.16 ± 2.98 mmHg). When standing, the pressures were significantly different between Urgo K2, Kit Biflex and SSB2(55.58 ± 6.15 mmHg, 57.3 ± 6.53 mmHg versus 62.3 ± 5.07 mmHg for SSB2). Similarly, the static stiffness indexes (SSI) showed significant differences (15 ± 5.05mmHg and 16.25 ± 6.28 mmHg versus 24.13 ± 4.65 mmHg for SSB2). After the test, resting pressures drop but more significantly under the SSB2 compared to the other 2 multilayer bandages (resting pressures: 31.95 ± 2.66 mmHg and 34.61 ± 2.28 mmHg vs. 25.95 ± 3.15 mmHg for SSB2). However, the SSI is not significantly different from the SSI calculated before the treadmill test (15.41 ± 4.44 mmHg and 15.66 ± 4.85 mmHg vs. 25.06 ± 4.98 mmHg). Conclusions: The treadmill test makes it possible to quantify and to compare the drop in pressure under different bandages in the same conditions. This test could be useful in clinical research before the clinical phases of development, especially in the case of venous leg ulcer. On the other hand, in case of mixed ulcers, the drop in pressure in lying position in multilayer bandages ensure a continuation of the arterial influx in case of mixed ulcers.

Innovations in medical compression therapy

For the treatment of phlebological and lymphological diseases as well as constitutional edema diseases, a discussion of innovative concepts of medical compression therapy is essential. It is recommended that medical compression stockings should always be prescribed based on symptoms and with the lowest effective interface pressure to optimize the tolerability of compression therapy. Likewise, medical compression stockings with an integrated care formula, but also the application of additional skincare can improve the quality of life and compliance in patients with chronic venous insufficiency. Optimization of ulcer therapy can be achieved by using two-component compression stocking systems. These consist of anunderstocking and afirm outer compression stocking, which improve the venous and capillary hemodynamics with good wearing comfort and lead to the healing of venous ulcerations. Multicomponent compression bandages and short stretch bandages are proven in the decongestion phase of edema. Multicomponent bandages ensure asustained interface pressure for at least 5days and are ideal for outpatient treatment with less frequent dressing changes. For compression therapy in patients with arterial-venous leg ulcers (ABI [ankle brachial index] >0.5), specially developed "lite" versions of the multicomponent dressings can be used.

Sliding-cupping along meridian for lymphedema after breast cancer surgery: A randomized controlled trial

ObjectiveTo observe the clinical efficacy difference between sliding-cupping along meridian combined with short-stretch elastic bandage wrapping and comprehensive detumescence therapy in treating lymphedema after breast cancer surgery. MethodsSixty patients with lymphedema after breast cancer surgery were randomly divided into the sliding-cupping group and the comprehensive detumescence therapy (CDT) group, with 30 cases in each one. The sliding-cupping group used the sliding-cupping along meridian therapy, and the sliding-cupping was applied along the three yin meridians and three yang meridians on the hand of the affected-side upper limbs, continuing for 25–30 min. After the sliding-cupping was finished, the affected limb was wrapped with the short-stretch elastic bandage. The CDT group was treated with comprehensive detumescence therapy (CDT). Both groups were treated once a day, with14 times as one course of treatment, and there was totally 1 course of treatment. The changes of circumferences before and after treatment of the affected limb were measured by a flexible ruler, and the efficacy was evaluated. The subcutaneous tissue thickness and the full skin layer thickness of the patients with moderate to severe edema in sliding-cupping group were measured by color Doppler ultrasound. ResultsAfter treatment, the circumferences at the cubital crease, 5 cm above olecranon, and 10 cm above the olecranon of the affected limbs in the sliding-cupping group were (26.02 ± 2.42) cm, (28.43 ± 3.13) cm, and (30.05 ± 2.80) cm respectively, which were all reduced compared with the pre-treatment circumference (27.95 ± 3.00) cm, (30.80 ± 3.38) cm, and (32.17 ± 2.96 cm). In the sliding-cupping group, the post-treatment subcutaneous tissue thicknesses at 5 cm above the olecranon, 10 cm above the olecranon and 5 cm below the olecranon, and full skin layer thickness at 10 cm below the olecranon of the 15 patients with moderate to severe edema were (8.71 ± 2.83) cm, (8.53 ± 2.4) cm, (6.46 ± 1.38) cm, and (1.61 ± 0.17) cm respectively, which were all reduced compared with pre-treatment (11.90 ± 3.56) cm, (11.84 ± 3.27) cm, (9.12 ± 1.84) cm, and (1.87 ± 0.23) cm, and the difference was statistically significant (all P < 0.05). The total effective rate of the sliding-cupping group was 86.6%, and the total effective rate of the CDT group was 80%, and the difference was statistically significant (P < 0.05). ConclusionCompared with CDT, the sliding-cupping along meridian combined with short-stretch elastic bandage wrapping for the treatment of lymphedema after breast cancer surgery was more effective.

Compression Therapy in Patients with Leg Ulcers - which Costs do Really Occur?

Patients with leg ulcers often have severe edema of the lower extremities, which should be treated as part of a successful wound treatment. Today in Germany the necessary compression therapies are often performed with very error-prone and time-consuming short-stretch bandages only. Multicomponent systems, adaptive compression bandages and leg ulcer stocking systems are newer, much less error-prone treatment options. In addition to the often lacking knowledge, the fears of high costs are also mentioned as reasons for the lack of prescription of these systems. It was therefore our aim to investigate the costs of different treatment options, differentiated in the outpatient and inpatient sector. For the economic calculations, both material andpersonnel costs were taken into account for different scenarios. Both material and personnel costs were included in the calculation. We were able to demonstrate that the cost for a continuous compression therapy for inpatients accrues between 5.29 Euros to 18.50 Euros per day. For the outpatient setting costs of 2.29 Euros to 34.29 Euros per day were calculated. The different constellations of compression therapy can make sense thus not only for medically but also for economically aspects. As a consequence of this data, both the different systems and the economic factors of compression therapy in patients with leg ulcers should be known to the therapists. These treatment options should then be prescribed and performed according to individual factors, taking into account the needs and abilities of the patients.

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).

Limb edema in patients with advanced disease — a pilot study of compression therapy combined with diuretics

Introduction. Management of edema due to advanced disease is seldom recognized in palliative care. The purpose of this pilot study was to assess the effectiveness and tolerance of conservative edema therapy. Material and methods. Prospective analysis of limb volumes, edema symptom burden and quality of life (QoL) in 119 patients diagnosed with edema was performed. Eighteen patients in their last days of life complaining of edema were treated by limb elevation, supportive (palliative) bandaging, manual lymphatic drainage, Kinesio Taping and/or controlled subcutaneous needle drainage. Forty-six with longer prognosis were treated by one-week multilayer short-stretch limb bandaging and then re-evaluated. Twenty-eight of them with venous congestion resistant to previously given diuretics received additionally furosemide infusion in hypertonic saline. Subgroups analysis of the patients with diuretic therapy and primary lymphatic congestion was performed. Results. Within 46 patients re-evaluated the reduction of limb volume was accompanied by a decrease of edema symptom intensity and an improvement of QoL. Subgroup analysis revealed both volume and symptomatic improvement, equally effective in cases with suspected lymphatic congestion or when diuretics were added. Conclusion. Edema of advanced disease irrespective of the lymphatic component can be effectively managed conservatively with short–stretch limb bandaging. In cases resistant to oral diuretic fluid overload, parenteral hypersaline furosemide addition to the compression may be the safe therapeutic option enhancing treatment tolerance.

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.

Randomized study to compare efficacy of short stretch bandage systems from KOB with locally used Cotton Crepe Bandages in the treatment of lower limb lymphoedema

Not available

Reliable self-application of short stretch leg compression: Pressure measurements under self-applied, adjustable compression wraps.

Self-application of properly performed compression bandages is generally considered as problematic. Therefore, the aim of this study was to measure the pressure of self-applied short stretch adjustable compression wrap compression systems (Juxta fit™) and to compare the results with the pressure achieved by bandaging other legs using the same material. In the two training courses for nurses, specifically interested in leg ulcer treatment, the new bandage type of adjustable compression wrap was explained and workshops were organized, in which the interface pressure achieved by Juxta fit™ was measured. In the first course, the nurses applied the compression system to each other, and in the second course, another group did it on their own legs. Bandagers were instructed to apply the system strongly, with a target range of more than 50-60 mmHg. In the first course with mutual application ( n = 34), the median pressure at the medial lower leg was 58.5 mmHg (minimal 31, maximal value 137 mmHg), in the second course in which self-application was tested ( n = 36), the corresponding values were 61.5 mmHg (minimum 35, maximum 102 mmHg). No pressures less than 30 mmHg were seen on the distal calf in either group. In contrast to short stretch bandages that are frequently applied by bandagers with too low pressure, the adjustable compression wrap devices handled by the patients themselves produce more appropriate and more consistent pressure.

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.

Evaluation of three different devices to reduce stasis edema in poorly mobile nursing home patients.

Prolonged immobility in the sitting position in the elderly is known to produce venous stasis with leg edema and possible skin changes. Compression stockings are often applied for this clinical problem. There is few experienced nursing staff available to supervise the difficult task of stocking application. The authors have researched other effective and simple devices that may be suitable alternatives. This article reports the results of three different devices to reduce leg edema, as measured by reduction in leg volume: an electro-stimulation device, an adjustable compression Velcro® wrap and a short stretch bandage, each tested over a two-hour period. In this randomized pilot study including 38 patients, the authors observed no difference in leg volume following electro-stimulation (Veinoplus®). They noted a significant reduction in leg volume following use of the other two devices, more with the adjustable Velcro® wrap compression (Circaid Juxtafit®) than with the short stretch bandage (Rosidal K®). Measurement of the interface pressures created by these two devices and also assessing the stiffness created by applying each device for two hours confirm that pressure is more important than stiffness in the reduction of edema in these particular patients. This pilot study is to be added to the results of previous published studies showing the efficacy in reducing leg edema of Velcro® adjustable compression wrap and its ease of use.

Effect of Impulsive Compression Treatment on Postoperative Complications After Open Peripheral Vascular Revascularization (In Situ): Protocol for a Randomized Control Trial

BackgroundIn patients with critical leg ischemia (CLI), the standard operative choice is an in situ bypass to the lower extremity to improve the patients´ prognosis and quality of life. Postoperative complications after surgery occur in 18 % of the patients, prolonging hospitalization and convalescence. The main operative complication is edema. This can be prevented by early mobilization or stimulation of the natural venous pump in the leg.ObjectiveTo investigate whether compression therapy with foot pump reduces postoperative edema, facilitates wound healing of the operation wounds, promotes healing of ischemic ulcers, and shortens hospitalization, increasing and improving the patient’s subjective quality of life faster.MethodsThe protocol is designed as a randomized, unblinded prospective study with 50 patients in each group. Standard postoperative routines after bypass surgery, including short-stretch bandaging of the operated legs, are compared to supportive stimulation of the venous pump by an impulsive compression foot pump. The postoperative edema of the leg is measured 10 cm below the patella and 8 cm proximal to the medial malleolus. Measurements are performed preoperatively, 1 and 4 days postoperatively and at discharge.ResultsThe primary endpoint is reduction of leg edema by at least 50%. The secondary endpoint includes earlier mobilization in the pump group and decreased length of stay in hospital. Quality of life is evaluated through the European Health Related Quality of Life Questionnaire 5 Dimensions (EQ-5D) and Vascular Quality of Life Questionnaire-6 (VascuQol-6) questionnaires. The start of the study is February 1, 2018, and the end of the study is February 1, 2020. First results will be available April 2020.ConclusionsIn orthopedic surgery of the lower extremities, the use of foot pumps has shown a reduction of edema and thrombosis in risk patients. Although important positive effects may be expected after vein bypass surgery, no reports have yet investigated the use of the device in vascular-operated patients and no analysis or meta Cochrane reviews are available in this field.Trial RegistrationClinicalTrials.gov NCT03192982; https://clinicaltrials.gov/ct2/show/NCT03192982 (Archived by WebCite at http://www.webcitation.org/6xMZJ06dw)