Tubular Bandage Research Articles

Mycostructures—growth-driven fabrication processes for architectural elements from mycelium composites

The paper discusses how characteristics of the mycelium growth process—namely different growth effectiveness depending on the nutrition content of the substrate, gradual solidification of the inoculated substrate, and bio-welding—can be a driving force for developing sustainable biofabrication processes of mycelium based composites (MBC) for architectural application. To explore this potential one-semester (12 weeks) seminar and one block seminar (2 weeks) with master-level students were held at the University of Stuttgart, and independent work within the Institute IBK2 was performed. The free experimentation with fabrication tactics resulted in the emergence of different investigation paths, tested with small-scale demonstrators, from which the most interesting three this paper presents in detail. The first is the two-phase printing process of mycelium substrate and subsidiary reusable support materials. It applied tests with the small, inorganic, loose substances (plastic pellets) extractable mechanically and meltable substances (wax) extracted by heating. The second path of investigation followed lost formworks created from hemp strings positioned inside the material. Finally, the third path is a particular case of lost formwork approach utilizing different tubular bandages stuffed with MBC and utilizing it later as a thick filament for other different form-giving deposition practices: layering, hanging, braiding, and knotting. All three investigation paths prove feasible, although their upscaling potential correlates strongly with the successful automation of the processes using CNC machines, which could provide the precision and sterility needed for this highly heterogenous and sensitive material. In addition, further developments in the material cultivation protocols are indispensable to provide a higher repetition of the results.

A pilot randomized controlled trial of securement bundles to reduce peripheral intravenous catheter failure

BackgroundPeripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however failure rates are unacceptably high, with around half failing before prescribed treatment is complete. The most effective dressing and securement option to prolong PIVC longevity is unclear. ObjectivesTo determine feasibility of conducting a definitive randomized controlled trial (RCT) investigating evidence-based securement bundles (medical adhesive tapes and supplementary securement products) to reduce PIVC failure. MethodsIn this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized to Standard care (bordered polyurethane dressing plus non-sterile tape over extension tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed until study entry. Exclusions: laboratory-confirmed positive blood culture, current/high-risk of skin tear, or study product allergy. Primary outcome: feasibility (eligibility, recruitment, retention, protocol fidelity, participant/staff satisfaction). Secondary outcomes: PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and cost. ResultsOf 109 randomized participants, 104 were included in final analyses. Feasibility outcomes were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% confidence interval [CI] 0.4–2.7) and 2.1 (95% CI 0.9–5.1) for Bundles 1 and 2, respectively. ConclusionsA large RCT testing securement bundles is feasible, with adjustment to screening processes. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates.Trial registration ACTRN12619000026123.

Reducing pressure injuries in children caused by peripheral intravenous cannulae.

Medical devices such as peripheral intravenous cannulae (PIVC) are commonly used in the care of children across all hospital settings. However, the association between PIVC and the development of pressure injuries in this population became a concern on one Australian paediatric ward. A quality improvement project was conducted to reduce the incidence of pressure injuries in children caused by PIVCs. A tubular bandage and microfoam surgical tape were introduced to replace crepe bandage PIVC securement. At the same time, education was provided to alert nurses to medical device-related pressure injuries and the PIVC securement changes. The introduction of the tubular bandage and staff education improved skin inspections of PIVCs and decreased the incidence of pressure injuries from these devices.

Effects of leg compression and calf muscle contraction by active ankle motion on venous hemodynamics in sitting individuals.

To clarify the effects of compression and active ankle motion on venous hemodynamics in healthy sitting individuals. In the sitting position, 14 participants performed plantar flexion and dorsiflexion of the ankle for 3s each without compression. Changes in the calf volume were recorded using air plethysmography. Subsequently, the process was repeated with the application of tubular elastic bandage (TEB), followed by anti-thrombotic stocking (ATS). The median interface pressure at the calf was 16mmHg with TEB and 21mmHg with ATS. Without compression (N), the median venous volume was 76mL. This was reduced to 58mL with TEB and 56mL with ATS (p < .01 vs. N for both). On the other hand, ejection volume by plantar flexion in N (27mL) was not significantly changed with TEB (31mL) or ATS (31mL). Also, ejection volume by dorsiflexion in N (53mL, p < .001 vs. plantar flexion) was not significantly changed with TEB (53mL, p < .01 vs. plantar flexion) or ATS (41mL, p < .05 vs. plantar flexion). The venous volume, which is defined as the change in enclosed calf volume from elevation to dependency, in the sitting position reduced similarly with TEB and ATS; however, the ejection volumes did not change significantly. Dorsiflexion exerted a larger ejection volume than plantar flexion in the sitting position.

Soft nasal bolster or tape nasal dressing after sinonasal surgery: The patient knows best

Background: Rolled up gauzes held in place under the nose with a sticky tape applied to the cheeks are routinely used immediately post-op on patients following their sinonasal surgery. Removal of the tape can be painful for patient. To avoid this, we introduced a nasal bolster made by putting a rolled up swab in an elasticated tubular bandage which is then tied at the back of the head. Methods: A prospective patient satisfaction survey questionnaire carried out over 8 months from inpatient stay patients who underwent sinonasal surgery. A database was created to record patient demographics, type of surgery, type of bolster used, patients reported satisfaction and preference for type of nasal bolster scored on a visual analogue scale (VAS) from 1-10. Results: A total of 130 (Male 77; age range 14-79 years) completed the questionnaires. Most common operations were FESS and septoplasty. Of the 130 patients, 100 used only the soft nasal bolster and scored it 8.5/10 on the VAS. A cohort of 30 patients used both types of bolsters and had preferred the soft bolster compared to the tape dressing (VAS 8.3 vs 3.8). Conclusion: Our simple service evaluation study shows that non-adhesive nasal bolster is preferred following sinonasal surgery. The soft nasal bolster is easy to make at a relative small cost and is non-abrasive and painless for post-op patients. Therefore, we propose the soft nasal bolster should be more widely used in post-operative care for patient comfort.

Geometric simulation for warp-knitted tubular bandages with the mesh model

The purpose of this paper is to geometrically simulate warp-knitted medical tubular bandages with a computer-aided simulator. A flat mesh model is established according to unfolded fabric considering the knitting characteristics of double-needle bed warp-knitted tubular fabrics. Moreover, a 3D (three-dimensional) mesh model corresponding to the actual product shape is created. To better describe the spatial geometry of stitches, eight-point models are introduced, and stitches are generated with the flat mesh model. Founded on matrix operations, the stitch position in the 3D mesh model is determined through coordinate mapping. Various stitch paths are rendered in computer programming languages C# and JavaScript to conduct simulations. Warp-knitted medical tubular bandages with a large number of shapes are effectively modeled.

Interface Pressures Derived from a Tubular Elastic Bandage.

Objective: We sought to clarify the interface pressure (IP) when using a tubular elastic bandage (TEB) and examine the possibility for TEBs to provide IPs comparable to those provided by anti-thrombotic stockings.Materials and Methods: In 40 healthy patients, IPs were measured at the level of calf at its maximum diameter (C) and transition of the medial gastrocnemius muscle into the Achilles tendon (B1) while a single or double layer of TEBs (17.5 cm in circumference) were applied with the patient in a supine position.Results: Including both the C and B1 levels, circumferences and IPs showed a good correlation (single layer; r=0.72, double layer; r=0.75). The IP obtained with a single layer of TEB at the C level (median, 17 mmHg [range, 12–23 mmHg]) was higher than that at the B1 level (14 mmHg [11–18 mmHg], p<0.001). When double-layer TEB was used, the IP at B1 level increased to 18 (14–23) mmHg (p<0.001 vs. single layer).Conclusion: Considering the characteristics of TEBs and using a single or double layer appropriately, creating a pressure profile mimicking that of an anti-thrombotic stocking seemed to be feasible when using a TEB.

Evaluation of Longitudinal and Tubular Compression Treatment for Lower Limb Edema.

Many patients with lower limb edema do not tolerate traditional higher-pressure compression devices and require alternative devices for edema control. Two systems were evaluated for control of bilateral or unilateral lower limb edema: an elasticized longitudinal stockinette (ELS; EdemaWear; Compression Dynamics, Omaha, Nebraska) and an elasticized tubular bandage (ETB; Tubigrip; Mölnlycke Health Care, Norcross, Georgia). Twenty-five patients were recruited; patients with bilateral edema (n = 12) wore the ELS on one limb, and the ETB on the other. Patients with unilateral edema (n = 13) were randomized to wear either the ELS or ETB. Edema measurements, leg pain, and patient preference were recorded. There were 14 females (56%) and 11 males (44%); mean age was 66 years (range, 32-88 years); and mean body mass index was 40.4 kg/m (range, 26.1-66.9 kg/m). Patients with bilateral edema wearing ELS had a foot-to-leg circumference between 25.5 and 42.9 cm pre-ELS that remained essentially unchanged at 2 weeks. The five patients with unilateral edema using ELS had a 24.3- to 43.7-cm circumference pre-ELS and 24.2- to 42.6-cm range at 2 weeks. The patients with bilateral edema using ETBs had a foot-to-leg circumference of 25.5 to 43.7 cm before treatment, unchanged 2 weeks later. The eight patients with unilateral edema using ETB had a 25.4- to 45.3-cm circumference pre-ETB and 24.8- to 42.0-cm range post-ETB. Mean pain levels decreased from 1.0 at week 0 to 0.5 at week 2. More patients preferred ELS (17/23, 78.3%) over ETB (5/23, 21.7%). Both systems were easy to apply and provided low compression without increased pain. The ELS was preferred by more patients (78.3%) than ETB (21.7%).

Statistical ankle-shape and pressure analysis for design of elastic tubular bandage.

Ankles can benefit from the elastic tube bandage (ETB) by providing the ankle joint with compression, but partial high- or low-pressure leads to body discomfort. The aim of this paper is to propose a method for analyzing the ankle shape with the fabric compression which is basis on the comfortable pressure on human body. First, a standard model of ankle is established from the scanned data of 306 samples, and the mapping of the fabric shape curves on ankle were constructed by the U-direction convex curves of the model. The positions or areas of maximum and minimum pressure are then marked by extracting the curvatures of the fabric shape curves. According to the Laplace's Law, the sizes of ETBs can be calculated given that the value of comfortable pressure on human body is the maximum one. The data of calculation is approximate to the relevant previous studies which has the same parameters of ETBs. Nine groups of the ankle shapes from the database are discussed, each group has a proportional coefficient to the standard model, and the result shows that six sizes of ETBs with comfort pressure match for the nine groups. These can be applied to the comfort design, and the method proposed can boost size customization of ETBs, as well as will inspire the research on other elastic compression garments.

Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial

Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs. We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.

The efficacy of wet wrap therapy in children with atopic dermatitis in a single center

Purpose: Wet wrap therapy is a well-known treatment for severe atopic dermatitis (AD). However, wet wrap therapy with usual ban dage was a troublesome and time-consuming process of application. The aim of this study was to evaluate the efficacy, safety and convenience of wet wrap therapy with new garments in children with moderate-to-severe AD. Methods: We compared 56 AD children treated with wet wrap therapy and 14 AD children treated with only conventional therapy. We retrospectively reviewed the clinical features, change of SCORing Atopic Dermatitis (SCORAD) index, adverse effects and par ent’s reports. Results: The initial mean SCORAD index was 60.3±15.3 points. No significant differences in sex, age, initial SCORAD index, total eo sinophil count, total IgE level, food allergen sensitization, inhalant allergen sensitization or associated allergic diseases were found between the wet wrap and conventional groups. The pharmacological and nonpharmacological interventions except wet wrap therapy were same in the 2 groups. Wet wrap therapy with garments or tubular bandage was easily done one time per day over night in 10.6±3.5 days by parents. Improvement in total SCORAD index, intensity, subjective symptoms and pruritus were signifi cantly higher in the wet wrap group than in the conventional group (36.2 vs. 26.9, 6.0 vs. 4.0, 9.9 vs. 7.4, and 4.8 vs. 3.6 points). No fol liculitis and serious adverse effects were reported. Conclusion: Wet wrap therapy with new garments could be easily done by parents. Wet wrap therapy may be effective and safe in controlling moderate-to-severe AD in children. (Allergy Asthma Respir Dis 2019;7:13-21)

Cost-Utility Analyses in Foot &amp; Ankle Surgery

Category: Other Introduction/Purpose: Orthopedic surgery lies at the forefront of the initiative to deliver value-based care. As a result, cost utility analyses have gained increased importance in the orthopedic literature. While other authors have previously reviewed the quality of US-based cost-utility analyses in orthopedic trauma, spine, sports, and arthroplasty, a similar analysis specific to foot and ankle surgery has not been performed. As such, the practicing foot and ankle surgeon does not yet have a comprehensive analysis of the available cost-utility analyses or the quality of the available evidence. The purpose of this study was to perform a systematic review of cost-utility analyses in foot and ankle surgery. Methods: A systematic review of foot and ankle studies was conducted to identify cost-utility based analyses published between 2000 and 2017. Of 687 studies screened by abstract, eight cost-utility foot and ankle studies were identified that met inclusion criteria and were scored by the Quality of Health Economic Studies instrument for overall quality. Results: Of the eight studies that met inclusion criteria, four were published in the U.S. Regarding topic, three examined end-stage arthritis, two examined diabetic foot ulcers, two examined ankle fractures and one examined ankle sprains. Cost-effective interventions identified by these studies included total ankle arthroplasty over ankle fusion or nonoperative treatment, adjunctive hyperbaric oxygen therapy for diabetic foot ulcers, suture button fixation over syndesmotic screws for unstable supination-external rotation type IV ankle fractures, and below knee cast and fracture boot immobilization over tubular bandages for acute severe ankle sprains respectively. The mean Quality of Health Economic Studies scores for these studies was 81.9 with interquartile range, 25th percentile score of 74.8 to 75th percentile score of 86. Conclusion: Despite the increasing focus on value-based care delivery, there are few foot and ankle cost-utility analyses in the current literature. Nonetheless, the quality of existing analyses is high as rated by the Quality of Health Economic Studies and certain interventions have been identified as cost-effective as highlighted above. The findings of this review can be used to help design future analyses in order to best demonstrate the cost-effectiveness of foot and ankle interventions.

A novel medical bandage with enhanced clothing comfort

Compression garments are special textile products which apply a pressure on needed body zones for supporting medical, sport or casual activities. Medical bandages are a group of these garments and they have a very common usage for compression effect on legs or arms. These bandages are generally produced by using synthetic raw materials such as polyamide or polyester fibres. Medical bandages are in contact with skin. Even if the synthetic fibres are used, they may cause both comfort and health problems like allergies. Nowadays in textile sector, the expectations of clients include using of natural fibres as far as possible in all garments. Natural fibres have good advantages such as breathability, softness, moisture management ability, non-allergenic and ecologic structure and these characteristics present optimum utilization conditions. In this study, tubular medical bandages were manufactured by using core spun yarns (sheath fibres are selected as tencel, bamboo and cotton, core material is elastane) and their pressure and comfort (air and water vapour permeability) characteristics were investigated. The results indicated that the bandages have good comfort abilities beside adequate pressure values for compression effect. These garments can constitute a new production field for medical bandages with their comfort properties in addition to pressure characteristics.

The role of compression in the management of soft tissue ankle injuries: a systematic review.

Ankle sprains are very common injuries which can lead to long-term pain, swelling and instability. Compression is often used in the treatment of these common injuries but is it effective and how best is it delivered? MEDLINE (1966-current), EMBASE (1980-current), Cochrane Library (2011:1) and MEDION were included in our search. Studies evaluating compression in the treatment of ankle sprains were included. Two authors independently reviewed potential studies according to a set eligibility criteria. Twelve studies including 1,701 patients with ankle sprains were identified (level of evidence: four grade 1b; five grade 2b; three grade 4). Intermittent pneumatic compression (IPC), elastic tubular bandage and compression bandaging were all evaluated. Five of the 12 studies reported that compression therapy improves recovery after ankle injury, of which one evaluated IPC, and the remaining four elastic bandages (Elastoplast, class II elastic stockings, wool and crepe, focal compression with air stirrup). Five studies evaluating Tubigrip in ankle sprains concluded that Tubigrip has no positive effect on functional recovery and may increase the requirement for analgesia compared with no intervention. Compression may be an effective tool in the management of ankle injuries and has been shown to reduce swelling and improve quality of life in single studies. Definitive conclusions are hampered by the poor quality of evidence and the variety of treatments used. The most effective form of compression to treat ankle sprains or is yet to be determined. Adequately designed randomized control trials are clearly needed.

弾性包帯や弾性着衣による圧迫が困難な患者に対する筒状包帯とウェーブスポンジ併用による弱圧圧迫治療効果の検討

リンパ浮腫の保存的治療は,スキンケア・用手的リンパドレナージ・圧迫・圧迫下での運動・日常生活指導を総合した複合的治療である.このうち圧迫は,多層包帯法と弾性着衣による中圧（30 mmHg）以上での圧迫治療が一般的である.しかし,合併症やADL,治療コンプライアンス不足から一般的な圧迫治療が困難な患者も多い.本研究では,通常の圧迫治療が困難なISL（International Society of Lymphology）分類Ⅱ期の15例に対し,装着しやすい筒状包帯とウェーブスポンジ併用による,弱圧の圧迫を行い,効果を検討した.治療前後の周径比較では,平均周径値が有意に減少し,治療前後の患肢容姿の点数評価でも有意に改善がみられた.患者のADL・QOLの向上がみられ,思考・行動に前向きな変化を生じた.弱圧での簡易的圧迫でも,ISLⅡ期の患者に対する治療効果が認められた.一般的な圧迫療法が困難な患者では,ウェーブスポンジ併用弱圧での圧迫治療が治療選択肢となると考えられた.

The role of wet wrap therapy in skin disorders – a literature review.

Wet wrap therapy, based on skin application of a double layer of tubular bandages or gauze with a moist first inner layer and a dry second outer layer, is utilized to treat various pruritic conditions, in particular severe and refractory atopic dermatitis. This review, by literature search, evaluates current knowledge about wet wrap therapy. Wet wrap therapy superimposed topical corticosteroids appears more efficient than emollients only, at least for short-time treatments. Despite higher efficacy, there is a tendency towards more frequent infections when topical corticosteroids are covered with wet wrap bandages compared to emollients only. While temporary suppression of hypothalamic-pituitary-adrenocortical-axis was seen due to systemic bioactivity of corticosteroids, no long-term observation studies on putative adverse effects were identified. One hypothesis suggests that wet wrap therapy may trigger increased lamellar body secretion resulting in recovery of the damaged intercellular lipid laminar structure. Otherwise, little investigation on mechanisms exists.

The Tubular Elastic Net Bandage: A Useful Penile Dressing in Pediatric Hypospadias.

We describe the use of the tubular elastic net bandage for penile dressing in surgical repair of pediatric hypospadias. The tubular elastic net bandages were used in 126 hypospadiac boys after corrective operations. The penis was wrapped with a silicone mesh netting. Then, the tubular elastic net bandage was put around the penis over the silicone netting. The bandage proved to be well tolerated and effective. After a catheter was removed, a patient could void with the dressing on the penis. The bandage did not need to be changed due to becoming wet during voiding. The tubular elastic net bandage is a very useful dressing for surgical repair of pediatric hypospadias.

Low‐grade elastic compression regimen for venous leg ulcers – an effective compromise for patients requiring daily dressing changes

Venous leg ulcers (VLUs) affect millions of patients worldwide and are a tremendous financial burden on our health care system. The hallmark of venous disease of the lower extremities is venous hypertension, and compression is the current mainstay of treatment. However, many patients are non-compliant, partly because of the complexity of the dressings and the difficulties with application and removal. The aim of our study was to test an effective compression dressing regimen for patients with VLUs who require changing the ulcer primary dressing twice daily. We used two layers of a latex-free tubular elastic bandage for compression. The primary endpoint of our study was increased wound-healing rate and our secondary endpoint was complete wound closure. All active study subjects had positive healing rates at week 4 and week 8. Two subjects achieved complete wound closure by week 8. We conclude that compression with a latex-free tubular elastic bandage can be safely used in patients with VLUs requiring frequent dressing changes. This type of compression allows for daily inspection of wounds, dressing changes at home, flexibility in the context of clinical trials, and is a compromise for patients who are intolerant to compression dressings.

Randomized clinical trial of three‐layer tubular bandaging system for venous leg ulcers

The safety and efficacy of three-layer (3L) tubular bandaging as a treatment for venous ulcer healing has not been evaluated despite its use in many clinical settings to treat people with venous leg ulcers. We evaluated the safety and efficacy of 3L tubular bandage compared with short-stretch compression bandage to heal venous ulcers in a multicenter, open-label, parallel-group, randomized controlled trial. We randomized 45 patients with venous leg ulcers of up to 20 cm(2) area and an ankle brachial pressure index of >0.8 from hospital outpatient wound clinics in Victoria and Queensland, Australia. We measured time to healing and percentage reduction of wound size from baseline to week 12. Secondary outcomes were proportion of ulcers healed, self-reported compliance of compression bandage, and health-related quality of life, costs, recurrence rates, and adverse events. A total of 27 ulcers healed, the proportion of healed ulcers was higher for the 3L group (17/23 [74%] vs. 10/22 [46%]) (p = 0.05). Reported bandage tolerance at all treatment visits was 21 (91%) in 3L group vs. 17 (73%) (p = 0.10). There was no difference between the groups in adverse events. Costs were substantially less in 3L group.

Modelling the rate of change in a longitudinal study with missing data, adjusting for contact attempts

The Collaborative Ankle Support Trial (CAST) is a longitudinal trial of treatments for severe ankle sprains in which interest lies in the rate of improvement, the effectiveness of reminders and potentially informative missingness. A model is proposed for continuous longitudinal data with non-ignorable or informative missingness, taking into account the nature of attempts made to contact initial non-responders. The model combines a non-linear mixed model for the outcome model with logistic regression models for the reminder processes. A sensitivity analysis is used to contrast this model with the traditional selection model, where we adjust for missingness by modelling the missingness process. The conclusions that recovery is slower, and less satisfactory with age and more rapid with below knee cast than with a tubular bandage do not alter materially across all models investigated. The results also suggest that phone calls are most effective in retrieving questionnaires.