Efficacy, safety and acceptability of a new two-layer bandage system for venous leg ulcers.

OBJECTIVE: To evaluate the efficacy, tolerability and acceptability of a new two-bandage compression system in the local management of venous or mixed aetiology ulcers predominantly of venous origin. METHOD: This was a prospective non-comparative open label phase III clinical study. Forty-two patients were recruited from 12 centres. Inclusion criteria included ulcers with at least 50% granulation tissue, a surface area of 2-20 cm2, an ulcer duration of 1-24 months, an ankle circumference of less than 28 cm, and no history of deep vein thrombosis in the three months before enrolment. The primary endpoint was reduction in ulcer surface area, and secondary endpoints were the evolution of leg oedema and patient comfort. During the six-week follow-up, patients underwent weekly clinical assessments and their ulcer surface area was measured by planimetry and photography every alternate week. RESULTS: The mean ulcer surface area at inclusion was 7 +/- 6 cm2. The mean surface reduction after six weeks was 58.5%, with 24% of the treated wounds healing in a mean time of 25.9 +/- 9.46 days. The patients considered that the new compression system had a better effect on quality of life, evaluated by parameters such as pain, heat, itching and general comfort, than the system worn before entry into the study. Patient concordance with the new system was excellent and 86% of leg ulcers improved or healed after six weeks. Local tolerance was considered very good. CONCLUSION: This new two-bandage compression system is effective and well accepted by patients.

[Elastic compression by calibrated bandage]. / La contention élastique par bandes étalonnées.

Elastic compression using the interchangeable bandage is still one of the best treatments of uncompensated venous deficiency, which has reached the complications stage. Of the three parameters necessary to the proper use of this treatment, only the strength of the bandages and the number of turns or overlaps used to be accessible. Today, the Thuasne Firm has achieved a gauge of the bandage using an original printing method, which involves drawing out 30% of this bandage by showing squared geometric figures, concealed, clearly, by an overlap of 2/3 or 3/4. In this way, for the "light" bandage of the category Biflex 16, a pressure-bracket of 15-30 mm Hg is obtained, and for a "heavy" bandage, Biflex 17, pressures ranging from 35-80 mm Hg. Thus, the empiricism always in mind when interchangeable bandages were the issue, ought from now on to make way for a more rigorous approach, interchangeable compression becoming constant, easily reproduced, and easily manageable.

[Therapy of white atrophy during the hyperalgesic phase or unusual use of cortico steroid therapy in phlebology]. / Modalités thérapeutiques de l'atrophie blanche en phase hyperalgique ou de l'utilisation exceptionnelle de la corticothérapie en phlébologie.

An ischaemic atrophic ulcer is a serious disease because of the pain it causes and because of its lingering course which is due to the poor effectiveness of available treatments. Today, at the first sign of pain (which precedes the ulcer) or in the first 48 hours after the appearance of the ulcer, high dose corticosteroid therapy (0.6 mg/kg Prednisolone) is prescribed for the first few days, reducing over one week to a local corticosteroid treatment (betamethasone cream) Dressings should be changed twice weekly. A splint may be added depending on the seventy of the oedema and sclerosis will be avoided during the hyperalgesic phase.

[Left predominance of varices: myth or reality?]. / Prédominance gauche des varices: mythe ou réalité?

The study of 843 legs operated for major varices shows that they are equally distributed between the two lower limbs (48.6% on the right, 51.4% on the left). There is little sex-determined variation in this distribution (410 women - 184 men), the main difference being that found in men: +4.6% on the left. Other studies carried out in Europe come to much the same conclusion. Two of these studies do, however, note a much clearer predominance of left-leg varices in men (+10%). For some studies, the lack of information about the type of varices being considered has proved troublesome (for example the many isolated telangiectasis and varices) and means that it is impossible to come to any exact conclusion. Clinical quantification is therefore desirable: at least it takes into account the diameter of the varices studied.

[Attempt at quantification of the clinical picture of varices for epidemiologic, therapeutic and data-processing purposes]. / Essai d'une quantification clinique des varices pour l'épidémiologie, la thérapeutique et l'informatique.

The expression "presence of varices" does not mean it is possible to anticipate their importance. The use of qualifications such as large, average or small by no means solves the problems of their evaluation for they often take on a different meaning according to the interpretation of the observer. The authors suggest the use of a system of clinical evaluation whose chief characteristic is the measurement of the diameter of varices. In the field of epidemiological studies, quantification is subjected to the determination of a coefficient of maximal invasion (CMI). This is equal to the product of the maximal diameter (MD) of the varices present, by their total length (TL). CMI = MD X TL. The clinical quantification for therapeutics, that is, the quantification that can be used in daily practice, is more simple. It is achieved by the intermediary of three parameters the maximal diameter, the maximal number and height of the varices present in each area. The regular analysis of these three variables makes it possible to follow in figures, and therefore in a way which is readily transmissible, the mode of evolution of the varicose disease. Generally, this quantification completes the usual schemas, makes the teaching of sclerotherapy much easier, makes phlebology more accessible for computer data, with cartography as a basis for the anatomical reference points. The main interest in these two systems lies in the use of a simple language which can be easily understood by everyone, whatever their nationality, and this makes for a more exact appreciation of the work that has been carried out and results in much better communication.