Variation in Leg Tissue Dielectric Constant Values of Healthy Young Adult Females With and Without Compression Bandaging.

Background The clinical efficacy of a compression application has been often limited to the assessment of the change in limb volume, change in clinical symptoms (i.e., wound size, pain, range of motion, incidence of cellulitis), or vascular hemodynamics of the whole limb. Assessing compression-related biophysical changes of a localized area, such as around a wound, or in an area outside of an extremity cannot be objectively assessed by these measurements. Tissue dielectric constant (TDC) values, which provide a measure of the local tissue water (LTW) content, offer an alternative method to document variation in the LTW content of the skin in a specific location. The goals of the present research were (1) to characterize TDC values, expressed as percentage tissue water, from multiple areas along the medial aspect of the lower leg of healthy volunteers and (2) to explore the potential utilization of the TDC values to assess change in tissue water content in a localized area following compression applications. Methods TDC was measured at 10, 20, 30, and 40 cm proximal to the medial malleolus on the medial aspect of the right leg of 18 young adult healthy women with an age range of 18-23 years and a body mass index of 18.7 to 30.7kg/m2.. TDC was measured at baseline and after 10 minutes of exercise with compression in place on three separate days during which three different compression applications were assessed: a longitudinal elastic stockinette, a two-layer cohesive compression kit, and a combination of the two. Leg circumferences and compression-related interface pressures were also measured. Results Test-Retest Reliability of circumferential measurements and TDC values evaluated using Intraclass correlation coefficient (ICC 3,1) revealed excellent and moderate-to-good reliability, respectively. Analysis of TDC values along the length of the limb using Friedman's test, revealed a small but statistically significant overall difference among baseline TDC values attributable to a smaller value at 40 cm. The largest difference in cumulative average was 7.7% which occurred between 20 and 40 cm, with all other differences between locations less than 1%. No significant differences between the compression applications were observed. Conclusion  The present findings demonstrate the utility of TDC measurements as a modality to assess compression-related changes in the legs of healthy women as a foundation for their potential use in assessing outcomes of compression treatments for persons with lower extremity edema or lymphedema. The absence of a significant change in TDC values in these healthy non-edematous conditions and the demonstrated reliability of the TDC measurements on three different days provides further support for the utility of such applications of TDC measurements. The extension to patients with lower extremity edema or lymphedema needs to be evaluated.

Textile composition, not number of layers, impacts interphase pressure and static stiffness index: A pragmatic, comparative analysis of the in vivo interphase pressure of 7 different 2-layer cohesive bandage kits in healthy volunteers.

"OBJECTIVE: The aim of the study was to comparatively evaluate the in vivo interphase pressure (IP) and statis stiffness index (SSI), upon initial application, of 7, 2-layer cohesive bandage kits when applied on healthy volunteers. METHOD: Bandages were applied in random order, on non-consecutive days by a single experienced clinician. The IP at the time of application was measured on the right lower limb of 10 healthy volunteers at 2 different points (B1, C). Measurements were made in 2 positions, supine and standing. There were 2 consecutive applications and measurements made for each compression bandage set. Statistical analysis of the outcome data was performed, utilizing a repeated measures analysis of variance (ANOVA) to determine: the effects of the bandage type on IP and SSI for each of the measurement points and according to the subject's position. Post hoc analyses were performed by Tukey and Bonferroni test to identify significant differences. The dispersion of the recorded pressures within the study population (dispersion between subjects) was assessed by the coefficient of variations. RESULTS: The in vivo IP measured at B1 in the supine position varied from 50.1 mmHg (±5.3) to 73.7 mmHg (±13.4). The in vivo IP measured at C in the supine position varied from 53.2 mmHg (±7.6) to 69.3 mmHg (±10.6). Bonferroni post hoc analyses demonstrated with a 95% confidence interval, there was a significant difference between wraps and placed them into 5 groups for the IP measured at B1, and 3 groups for measurements taken at C. A regression model including the main effects of the wrap and the subject with their interaction were similar for the IP observed at B1 and C in the supine position (r2 = 0.881). The in vivo SSI measured at B1 varied from 11.95 (±5.4) to 6.65 (±4.4). Post hoc analyses similarly demonstrated significant differences placing the wraps into 3 different groups. Statistical analysis of the variability of the IP observed at B1 and C showed there was a significant difference at B1 (P = .001), which was not observed at C (P = .347). CONCLUSION: Sub-bandage pressure measurements produced by the 7, '2-layer cohesive' compression box sets were not equivocal. IP and SSI varied by textile composition, clinically supporting the trial of alternative '2-layer cohesive' compression box set if the desired outcome (ie, wound healing, edema reduction) is not achieved. Additional study in patients with edema is warranted to allow an evidenced-based approached to the selection of a compression bandage set.

Selecting appropriate compression for lymphedema patients: American Vein and Lymphatic Society position statement.

BACKGROUND: Lymphedema is a significant and disabling disorder affecting millions of people worldwide. Compression therapy is an important component of lifelong treatment but the specifics of appropriate compression garment selection and prescribing is not always well understood by practitioners and payers. METHOD: An expert panel of the American Vein and Lymphatic Society was convened to write a Position Statement with explanations and recommendations for the appropriate compression therapy to be used in the treatment of lymphedema patients. RESULT: A Position Statement was produced by the expert panel with recommendations for documentation and compression therapy treatment. Their recommendations were reviewed, edited, and approved by the Guidelines Committee of the society. CONCLUSION: This societal Position Statement provides a useful document for reference for medical care providers for the appropriate compression therapy selection and treatment of patients with lymphedema.

Experimental Simulation Study to Assess Pressure Distribution of Different Compression Applications Applied Over an Innovative Primary Wound Dressing.

INTRODUCTION: Compression is integral to the management of edema and the prevention of venous leg ulcers (VLUs). OBJECTIVE: The aim of this study is to assess the sub-bandage pressure distribution under 3 compression applications as well as to assess the impact of an innovative primary wound dressing, applied under the compression products, on pressure distribution. MATERIALS AND METHODS: A series of controlled tests were performed using a simulated leg model (SLM). A pressure mapping sensor and system software was used to measure the interface pressure (IP) and pressure distribution created by the application of 3 different compression systems with and without the addition of an elastic longitudinal stockinette (fuzzy wale compression; FWC). These included: (1) 2-layer cohesive wrap; (2) 3-layer compression application; and (3) 4-layer compression application. The IP was pressure between the SLM and the innovative dressing over which the compression applications were applied. Seven different configurations were tested, including the compression applications alone and in combination with the FWC. In addition to the IP measurements, pressure mapping visualizations were captured with the pressure mapping sensor and system software. A custom MATLAB program was written for data analysis, differentiations in discrete high- and low-pressure locations across the compressed area, and graphing of the pressure readings. RESULTS: The overall average pressure for each testing setup without FWC ranged from 34.65 ± 4.84 mm Hg for the 2L configuration to 63.92 ± 7.08 mm Hg for the 4L configuration. The addition of the FWC resulted in a 19% increase for the 2L, 9% increase for the 3L, and 7% increase for the 4L compression systems. Additionally, it was noted that the inclusion of FWC resulted in a significant change in pressures vertically oriented under the 2-, 3-, and 4-layer compression applications of 34.52 ± 9.06 mm Hg, 99.21 ± 29.81 mm Hg, and 128.96 ± 22.97 mm Hg, respectively. The pressure distribution under the compression alone was observed to be largely uniform except for areas of overlap that produce horizontal bands of elevated pressures. The presence of the primary wound dressing did not have a significant impact on the IP measurements. The addition of FWC to all compression applications demonstrated a vertical distribution of compression along the sensor with alternating areas of little or no compression. CONCLUSIONS: The unique alternating pressure distribution observed in the in vitro pressure testing with the use of FWC in a clinical setting has been observed to produce better edema management and wound edge migration that mirrors the vertical pressure distribution observed in the study. Additional in vitro and in vivo research to evaluate the biophysical impact of IP created by the use of a combination of primary wound dressings and compression applications with focus on the total pressure and the distribution across the surface of intact tissue and open wound bed is warranted.

A dual compression system: preliminary clinical insights from the US.

There is growing evidence on an interconnection between the venous and lymphatic systems in venous leg ulceration, and the possible effects of prolonged oedema and lymphatic impairment in delayed wound healing. Compression therapy is a widely accepted treatment for venous and lymphatic disorders, as it decreases recurrence rates and prolongs the interval between recurrences. Compression bandages improve venous return, increase the volume and rate of venous flow, reduce oedema and stimulate anti-inflammatory processes. The pressure at the interface (IP) of the bandage and the skin is related to the elastic recoil of the product used and its resistance to expansion. The pressure difference between the IP in the supine and standing positions is called the static stiffness index (SSI). Elastic materials provide little resistance to muscle expansion during physical activity, resulting in small pressure differences between resting and activity, with an SSI <10mmHg. Stiff, inelastic materials with a stretch of <100% resist the increase of muscle volume during physical activity, producing higher peak pressures, an SSI of >10mmHg and a greater haemodynamic benefit than elastic systems. UrgoK2 is a novel dual-layer high-compression system consisting of an inelastic (short stretch) and elastic (long stretch) bandage, resulting in sustained tolerable resting pressure and elevated working pressures over extended wear times. It is indicated for the treatment of active venous leg ulcers and the reduction of chronic venous oedema. Each bandage layer has a visual aid to enable application at the correct pressure level. Published European studies have assessed this compression system, exploring its consistency of application, tolerability and efficacy. This article presents the first reports of health professionals' clinical experience of using the compression system in the US, where it has been recently launched. Initial feedback is promising.

S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity.

The following supplement is a rare example of a paper that combines clinical experience and theoretical knowledge on textiles used in compression therapy. The authors' intention is to propose a decision support system for choosing specific compression devices, which can be adjusted to counteract the individual signs and symptoms in an optimally adopted way. The document concentrates on compression devices which can be self-applied by the patients-compression stockings and adjustable wraps. The acronym 'S.T.R.I.D.E.', incorporating both textile characteristics and clinical presentation, stands for: Shape, Texture, Refill, Issues, Dosage and Etiology. The intent of the mnemotechnical value is to highlight that successful compression includes more than dosage alone. In addition to dosage, etiology and patient presentation need to be incorporated, including a patient's physical ability to use compression effectively as part of the daily routine, thereby promoting adherence. The suggested algorithms provide a valuable guide to stride across the important, but still underestimated field of medical compression therapy and will help to put the prescription of a specific product on a more rational basis. Enjoy reading! Hugo Partsch Emeritus Professor Medical University of Vienna, Austria.

Case report to demonstrate the need for selection criteria for optimal adjustable Velcro wrap prescription.

Compression, in the form of either a compression bandage or a compression stocking, has been touted as the gold standard for treatment of swelling and venous leg ulcers (VLUs). Adjustable Velcro wraps have been marketed as compression alternative. Although there is a growing body of evidence to support use of these products, there has not been a critical evaluation of the functionality of the devices to best matching product to patient presentation and ability to use the device effectively. Unlike compression garments, which are classified by compression category (class I/II or flat knit/circular), there is not an algorithm to direct health professionals to best match a specific adjustable Velcro wrap to an individual patient presentation. This small case series demonstrates that although each product performed as marketed in vitro, performance in clinical setting varied greatly dependent on patient presentation and functional skill level.