Haemodynamic effect of a leg compression bandage on the distal posterior tibial artery using 4D flow magnetic resonance imaging: A quantitative study.

The uncertainty concerning the physiological effects of compression bandaging on the peripheral blood flow is a challenge for healthcare professionals. The main objective was to determine the haemodynamic impact on the distal posterior tibial artery after the application of a high-compression leg multicomponent bandaging system using 4D flow magnetic resonance imaging. Leg dominance disparities of the posterior tibial artery before and after the application of the compressive bandage were also analysed. Twenty-eight healthy female volunteers were recruited (mean: 25.71, standard deviation: 4.74 years old) through a non-probability convenience sampling. The 4D flow magnetic resonance imaging of the distal tibial posterior artery was performed in all participants, first under standard resting conditions and after the application of a compression bandage in the leg. When the strong compressive bandage was applied, the area of the assessed artery decreased by 14.2%, whilst the average speed increased by 19.6% and the flow rate increased by 184.8%. There were differences between the haemodynamic parameters of both legs according to dominance, being statistically significantly lower in the dominant leg. The application of strong compressive bandaging significantly increases the arterial flow and mean velocity in the distal segment of the posterior tibial artery, in healthy volunteers by 4D flow magnetic resonance imaging. In this study, leg dominance influenced some of the haemodynamic parameters. According to the results, leg compression bandages cannot be contraindicated in vascular ulcers with arterial compromise.

The effect of complex decongestive physiotherapy applied with different compression pressures on skin and subcutaneous tissue thickness in individuals with breast cancer-related lymphedema: a double-blinded randomized comparison trial.

PURPOSE: The aim of this study was to evaluate the effect of compression bandage applied with different pressures on the skin and subcutaneous thickness in individuals with breast cancer-related lymphedema (BCRL). METHODS: 21 individuals with stage 2 unilateral BCRL participated in the study. Individuals were randomly allocated into two groups as low-pressure bandage (20-30 mmHg) (n: 11) and high-pressure bandage (45-55 mmHg) (n: 10). Skin and subcutaneous tissue thickness, extremity volume, sleep quality, treatment benefit, and comfort were evaluated by ultrasound from 6 reference points (as hand dorsum, wrist volar, forearm volar, arm volar, forearm dorsum, and arm dorsum), volumetric measurement, Pittsburgh Sleep Quality Index, Patient Benefit Index-Lymphedema, and visual analog scale, respectively. Complex decongestive physiotherapy was applied to both groups. Compression bandage was applied according to their group. Individuals were evaluated at the baseline, 1st session, 10th session, 20th session, and at 3-month follow-up. RESULTS: Skin thickness decreased significantly in the volar reference points of the extremity in the high-pressure bandage group (p = 0.004, p = 0.031, and p = 0.003). Subcutaneous tissue thickness significantly decreased at all reference points in the high-pressure bandage group (p < 0.05). In the low-pressure bandage group, skin thickness only decreased in the forearm dorsum and the arm dorsum (p = 0.002, p = 0.035) and subcutaneous tissue thickness changed for all points (p < 0.05) except for hand and arm dorsum (p = 0.064, p = 0.236). Edema decreased in a shorter time in the high-pressure bandage group (p < 0.001). No significant differences were found in sleep quality, treatment benefit, and comfort for both groups (p = 0.316, p = 0.300, and p = 0.557, respectively). CONCLUSION: High pressure was more effective in reducing subcutaneous tissue thickness in the dorsum of hand and arm. The usage of high-pressure can be recommended especially in cases which have edema in the dorsum of hand and arm which is difficult to resolve. Also, high-pressure bandage can provide faster edema resolution and can be used in rapid volume reduction as desired. Treatment outcomes may improve with high-pressure bandage without any impairment in comfort, sleep quality, and treatment benefit. TRIAL REGISTRATION NUMBER AND DATE: NCT05660590, 12/26/2022 retrospectively registered.

A meta-review of the impact of compression therapy on venous leg ulcer healing.

This meta-review aimed to appraise and synthesise findings from existing systematic reviews that measured the impact of compression therapy on venous leg ulcers healing. We searched five databases to identify potential papers; three authors extracted data, and a fourth author adjudicated the findings. The AMSTAR-2 tool was used for quality appraisal and the certainty of the evidence was appraised using GRADEpro. Data analysis was undertaken using RevMan. We identified 12 systematic reviews published between 1997 and 2021. AMSTAR-2 assessment identified three as high quality, five as moderate quality, and four as low quality. Seven comparisons were reported, with a meta-analysis undertaken for five of these comparisons: compression vs no compression (risk ratio [RR]: 1.55; 95% confidence interval [CI] 1.34-1.78; P < .00001; moderate-certainty evidence); elastic compression vs inelastic compression (RR: 1.02; 95% CI: 0.96-1.08; P < .61 moderate-certainty evidence); four layer vs

Modified compression therapy in mixed arterial-venous leg ulcers: An integrative review.

Leg ulcers remain an increased burden to healthcare cost and morbidity in modern society. While most leg ulcers are venous in origin, recognition and prompt identification of concomitant arterial occlusive disease is critical to determine underlying aetiology and subsequent management. This integrative review presents the current evidence to establish the role of modified compression therapy (MCT) in treatment of mixed arterial venous leg ulcers (MAVLU). A literature search was conducted using the electronic databases CINAHL, MEDLINE, PUBMED, and Embase. Ten studies met the eligibility criteria and were subsequently analysed. Our review concludes that MCT, with compression pressures between 20 and 30 mmHg, can promote healing in MAVLU with moderate arterial insufficiency (0.5 ≤ ABPI ≤0.8). If ABPI is <0.5, MCT can be considered once restoration of acceptable ABPI is achieved. Intolerance, lack of response or further deterioration of disease within 3 months should prompt further arterial imaging and intervention. MCT is generally well tolerated with no adverse outcomes reported. A holistic yet individualised approach is vital in order to account for all factors influencing this patient-led decision-making process, ultimately ensuring effective treatment, which improves patient's quality of life and reduces socioeconomic burden of the disease.

Velcro compression wraps as an alternative form of compression therapy for venous leg ulcers: a review.

The first-line treatment for venous leg ulcers (VLUs) is compression therapy, most commonly, with compression bandages. A similar treatment measure is used for lymphoedema in the form of Velcro compression wraps (VCWs). However, the use of VCWs for VLUs is less evident, and a direct comparison to compression bandaging is not evident. This review explores the evidence to support the use of VCWs for the treatment of VLUs in order to raise awareness of alternative forms of compression therapy. Nine primary research studies were analysed, from which four key themes emerged: quality of life, cost of treatment, ulcer healing time and pressure maintenance. The findings suggest that VCWs decrease material costs by at least 50%, and further savings may be realised by reducing the costs associated with nursing time. The benefits of promoting self-care, maintaining compression, and eliciting greater healing rates are clearly evident, and the impact on quality of life is substantiated.

High compression leg bandaging prevents seated postural hypotension among elderly hospitalized patients.

Postural hypotension (PH) is a very common and often symptomatic disorder among elderly hospitalized patients. Little is known about measures for preventing previously unknown PH in this population. We evaluated the effectiveness of high compression leg bandaging in preventing seated PH during the initial phase of ambulation, among elderly inpatients without a history of PH. We compared the occurrence of seated PH between patients who were bandaged (n = 100) and unbandaged (n = 100). The rate of seated PH was significantly lower in the bandaged than the unbandaged group (27% vs. 51%, p < 0.001, relative risk reduction 47%, and the number of patients needed to treat 4.2). On multivariate analysis, not wearing leg bandaging was one of the variables most significantly associated with eventual occurrence of PH (p = 0.002, odds ratio 2.65, and 95% confidence interval 1.42-4.97). We conclude that during ambulation of elderly inpatients, high compression leg bandaging is beneficial to prevent seated PH.

[Compression devices for decongestion therapy : A cross-sectional observational survey of handling, pressure, and comfort]. / Kompressionsmittel für die Entstauungstherapie : Vergleichende Erhebung im Querschnitt zu Handhabung, Anpressdruck und Tragegefühl.

BACKGROUND: If compression bandaging is not performed in a professional manner, the objectives of the therapy may not be achieved and side effects or complications may result. OBJECTIVES: This cross-sectional observational survey examines the handling of the treatment options: short-stretch bandages with padding, multicomponent compression systems, and adaptive compression bandages. PARTICIPANTS AND METHODS: During several training sessions on the topic of compression therapy, 137 participants performed compression bandagings on each other. In this regard, they were asked to achieve a predetermined pressure range (short-stretch bandages: 50-60 mm Hg, multicomponent compression systems: 40-50 mm Hg, adaptive compression bandage: 35-45 mm Hg). To evaluate the efficiency, the time used for application, the achieved pressure value, and the comfort were determined. RESULTS: Of the 302 bandagings (n = 137 participants), 28.4% lay within the given target pressure value range. This included 11.2% of performed short-stretch bandages, 35.2% of multicomponent compression systems, and 85.0% of adaptive compression bandages. Significant differences in the mean deviations are found between the treatment options. The bandage was described as being comfortable by 37.7% of users of short-stretch bandages with padding, by 65.0% of those wearing a multicomponent compression system, and by 94.6% of participants with an adaptive compression bandage. CONCLUSIONS: In practice, short-stretch bandages are still the most frequently used care option for the creation of a phlebological compression bandage. In this survey, they proved to be unsafe, time-consuming, and uncomfortable in relation to other treatment options. Multicomponent compression systems and adaptive compression bandages are treatment options that may be a contemporary alternative which also bares more comfort for the patient.

[Compression bandages with and without padding : Observational controlled survey of pressure and comfort]. / Kompressionsverbände mit und ohne Unterpolsterung : Eine kontrollierte Beobachtungsstudie zu Kompressionsdruck und Tragekomfort.

BACKGROUND: In the context of compression therapy, padded bandages are designed to prevent skin damage, increase adherence and support the success of therapy. Routine use is discussed, because comparative studies are lacking. OBJECTIVES: This study examines effectiveness, comfort, and impact of short-stretch bandages without padding compared to underpadded bandages. PARTICIPANTS AND METHODS: In all, 61 healthy participants wore padded bandages foam or synthetic cotton wool on one leg and nonpadded bandages on the other. On both sides, a resting pressure of 50 mm Hg was generated. After 60 min resting pressure, skin condition, comfort, pain, and fitting of the bandages were assessed. RESULTS: All bandages showed pressure losses after 1 h; 82.0% of nonpadded bandages had a pressure drop of 9 mm Hg or more. The following were observed in unpadded bandages: constrictions (100.0%), severe redness (77.0%) and bruises (42.6%). Comfort was rated as pleasant by 3.3% without padding, by 83.9% with foam padding, and by 73.3% with synthetic cotton wool padding. Nonpadded compression bandages caused in 62.3% pain from 1-3 (numerical rating scale 0-10). CONCLUSIONS: Padded compression bandages maintain the therapy-relevant pressure better, provide more comfort, and cause less pain and skin problems than nonpadded compression bandages. These aspects are crucial for adherence, and therapeutic success. After 1 h of use on the healthy leg, there were obvious differences. Significantly more side effects may appear after several hours of use on previously damaged skin. Therefore, compression bandages should always be padded.

[Compression therapy of chronic leg ulcers : Practical aspects]. / Kompressionstherapie des chronischen Ulcus cruris : Praxisrelevante Aspekte.

Compression therapy, together with modern moist wound treatment, is the basis for a successful conservative treatment of patients with chronic leg ulcers. In clinical practice, it is often the patients themselves who apply compression therapies. Many of the mostly elderly patients, however, are not able to reach their legs and feet due to movement restrictions, such as arthritis, arthrosis and even obesity. An adequate compression therapy also requires extensive experience and regular training. In practice only the minority of patients can perform bandaging well and therefore this should not be recommended. Self-management with do-it-yourself medical devices will become more and more important in the future. In addition to the psychological factors, cost aspects and demographic change, an expected lack of qualified nursing staff due to the number of elderly patients who are potentially in need of care means that self-management is becoming increasingly more important. For the essentially important compression therapy of patients with chronic leg ulcers, there already exist various therapy options. The needs, preferences and abilities of the patients concerned can be considered when selecting the appropriate system. Particularly for the self-management of compression therapy, adaptive compression bandages are suitable for patients with leg ulcers during the initial decompression phase and ulcer stocking systems in the subsequent maintenance phase.

Healing of an arterial leg ulcer by compression bandaging: a case report.

This case report demonstrates that arterial ulcers may heal with compression therapy. The patient was a 72-year-old woman with elevated blood pressure and type II diabetes mellitus, who underwent angiography because of a painful, non-healing ulcer over the shin. The angiography showed multisegment arterial occlusive disease, not amenable to surgical revascularisation. After 4 months of wearing inelastic bandages, with increased pressure over the ulcer area and hypertension and diabetes under control, the patient was pain-free and the ulcer had healed. The ankle-brachial pressure index (ABPI) increased from 0.54 at the start of treatment to 0.70. In patients with arterial leg ulcers, properly applied compression therapy using increased pressure over the wound may lead to an improvement of the arterial flow and to complete healing.

Effectiveness of compression bandaging education for wound care nurses.

OBJECTIVE: Compression bandaging is an essential component in the treatment of venous leg ulcers (VLUs). An adequate pressure and stiffness is needed in order for the treatment to be successful. The aim of this study was to evaluate the effectiveness of a training workshop on compression bandaging among wound care nurses who had no previous experience in application of compression bandages, immediately post-training and six months after training. METHOD: A quasi-experimental design, conducted at Maccabi Healthcare Services, in which nurses underwent a four-hour educational session, including practising with a device that measures sub-bandage pressure. RESULTS: We assessed 37 nurses. Before training, 5.4% of nurses bandaged in the optimal range; after training, 58% bandaged in optimal range, and six months post-training, 37% bandaged in optimal range. At post- and six months post-training, no nurse bandaged 'too low' (≤20mmHg). Stiffness of the bandage was achieved in only 5.4% of nurses before training; 62% immediately after, and 75% six months after training. CONCLUSION: We conclude that the proposed educational session using a device that measures the pressure applied is an effective way to teach wound care nurses how to use compression bandages. However, more practise is needed to achieve an optimal range of pressure over time.

Compression therapy - cross-sectional observational survey about knowledge and practical treatment of specialised and non-specialised nurses and therapists.

Knowledge about methods and materials and their correct usage is the basis for compression therapy. This study compares knowledge and practical skills of participants with further training with those who had no training. This comparison provides information on whether further qualifications have an impact on knowledge and practical skills. In seminars for compression therapy, data on specific and non-specific expertise were acquired. A practical test determined the participants' skills for creating a compression bandage in a pressure value range of 50-60 mmHg. In total, 1338 participants with specific expertise and 138 participants with non-specific expertise took part. Knowledge evaluation showed that 7·9% of the specific expertise group had knowledge regarding padding, 10% regarding multi-component systems and 13·6% regarding ulcer stocking systems. In the practical test, 12·3% of all participants achieved the target range. The majority of users in both groups is not familiar with the different compression materials or their appropriate usage. In the non-specific expertise group, knowledge concerning up-to-date materials and methods is one-third lower. The practical test showed major deficits on both sides. Appropriate exercises, for example, with pressure-measuring devices, should be mandatory for all professional groups who perform compression bandaging.

[Compression therapy in leg ulcers]. / Kompressionstherapie des Ulcus cruris.

Compression therapy is well-tried treatment with only few side effects for most patients with leg ulcers and/or edema. Despite the very long tradition in German-speaking countries and good evidence for compression therapy in different indications, recent scientific findings indicate that the current situation in Germany is unsatisfactory. Today, compression therapy can be performed with very different materials and systems. In addition to the traditional bandaging with Unna Boot, short-stretch, long-stretch, or multicomponent bandage systems, medical compression ulcer stockings are available. Other very effective but far less common alternatives are velcro wrap systems. When planning compression therapy, it is also important to consider donning devices with the patient. In addition to compression therapy, intermittent pneumatic compression therapy can be used. Through these various treatment options, it is now possible to develop an individually accepted, geared to the needs of the patients, and functional therapy strategy for nearly all patients with leg ulcers.

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.

Factors associated with prevention of postural hypotension by leg compression bandaging.

AIM: We evaluated the eventual effects of leg compression on seating-induced postural hypotension (PH) in the context of various relevant clinical variables. METHODS: Included were 73 hospitalized patients with various acute conditions, aged ≥ 60 years, bedridden for ≥ 8 h, with diagnosed PH [≥ 20 mmHg systolic and/or ≥ 10 mmHg diastolic blood pressure (BP) falls] at the first seating. BP, heart rhythm, dizziness and palpitations were recorded before and during 5 min of sitting. The next day, the patients were reevaluated, this time using compression bandages applied along both legs before seating. RESULTS: Compared with the non-bandaged state, PH was registered in only 53% of bandaged patients (p < 0.001). Moreover, the appearance of PH symptoms decreased (p < 0.001). On the second day (bandaged), supine diastolic BP values were higher in the persisting vs non-persisting PH group (p = 0.027). In the bandaged state, PH symptoms were significantly reduced in the non-persisting PH group (p = 0.003). Even in patients with persistent PH, the magnitude of BP decline and appearance of PH symptoms were decreased while wearing bandages (p = 0.004 and 0.002, respectively). CONCLUSION: During mobilization of inpatients, leg compression seems to reduce the seating-induced PH and relevant symptoms. Even in patients with persisting PH, bandaging may improve hemodynamics and attenuate associated symptoms.

Review of Mixed Arterial Venous Leg Ulcers (MAVLU) Disease in Contemporary Practice.

BACKGROUND: Mixed Arterial and Venous Leg Ulcers (MAVLU) are challenging. Clinical evidence specific to MAVLU management is scarce. We evaluated our recent experience with MAVLU patients and reviewed current data regarding MAVLU epidemiology, aetiology, diagnostic assessment and management options. METHODS: A prospective leg ulcer database was retrospectively interrogated to determine the prevalence and clinical outcome of MAVLU over 2-year period (2021-2022). The literature was reviewed to determine if optimal treatment strategies. RESULTS: 307 patients attended the ulcer clinic over a 2-year period. Most were venous leg ulcers (71%), 24% were arterial and 5% were MAVLU. The highest healing rate was in MAVLU (93%), followed by (74%) and (41%), in arterial and venous leg ulcer groups, respectively. CONCLUSION: Evidence-based guidelines for MAVLU remain lacking. Well-developed randomised controlled trials are warranted to guide current clinical practice.

The Impact of Nutritional Condition and Compression Treatment on Venous Ulcer Recovery: A Systematic Review.

Venous ulcers are open wounds commonly associated with chronic venous insufficiency. Each patient's healing process is unique, and factors like nutrition and compression therapy can affect it. Compression therapy and optimal nutritional status can assist in improving venous blood circulation, decreasing swelling, and promoting wound healing. This in-depth review looks at all the recent research on how nutrition and compression therapy can help heal venous ulcers, aiming to develop evidence-based guidelines for improving treatment outcomes. The systematic review, registered in the International Prospective Register of Systematic Reviews (PROSPERO) and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles, conducted an extensive electronic search in databases such as PubMed, MEDLINE, Cochrane, Web of Science, and Scopus. Using Medical Subject Headings (MeSH) terms and different types of studies, the search method focused on studies that directly looked at how nutrition and compression therapy affected the healing of venous ulcers. After deduplicating and screening publications, a collaborative full-text review was conducted to determine their inclusion. As a result, several research studies were chosen for the qualitative synthesis. The authors created a data extraction form to document important variables such as demographics, therapy specifics, and wound features. Several studies on patients with venous ulcers have shown that consuming basic nutrients can improve wound healing. Treatment results differed depending on the types of compression and pressure intensity. Although minimal data indicates the possible benefits of two-layer therapy, a definitive comparison is still uncertain. Further clinical studies are necessary to investigate a wider range of dietary factors and to evaluate different treatments in similar situations.

Chronic progressive lymphedema in draft horses.

Chronic progressive lymphedema is a disorder of many draft horse breeds that presents with progressive swelling of the distal portions of the legs. This is associated with scaling, marked dermal fibrosis, and the development of skin folds and nodules. There seems to be a genetic predisposition to altered elastin metabolism and impaired function of the lymphatic system in the distal extremities. Management is palliative and involves keeping the feathers clipped short, treating secondary infections, daily exercise and skin care, hydrotherapy, manual lymph drainage and compression bandaging.

Dogmas and controversies in compression therapy: report of an International Compression Club (ICC) meeting, Brussels, May 2011.

The International Compression Club (ICC) is a partnership between academics, clinicians and industry focused upon understanding the role of compression in the management of different clinical conditions. The ICC meet regularly and from these meetings have produced a series of eight consensus publications upon topics ranging from evidence-based compression to compression trials for arm lymphoedema. All of the current consensus documents can be accessed on the ICC website (http://www.icc-compressionclub.com/index.php). In May 2011, the ICC met in Brussels during the European Wound Management Association (EWMA) annual conference. With almost 50 members in attendance, the day-long ICC meeting challenged a series of dogmas and myths that exist when considering compression therapies. In preparation for a discussion on beliefs surrounding compression, a forum was established on the ICC website where presenters were able to display a summary of their thoughts upon each dogma to be discussed during the meeting. Members of the ICC could then provide comments on each topic thereby widening the discussion to the entire membership of the ICC rather than simply those who were attending the EWMA conference. This article presents an extended report of the issues that were discussed, with each dogma covered in a separate section. The ICC discussed 12 'dogmas' with areas 1 through 7 dedicated to materials and application techniques used to apply compression with the remaining topics (8 through 12) related to the indications for using compression.

Acute Effects of Manual Lymphatic Drainage and Compression with Exercise Therapy on Breast Lymphedema Following Breast-Conserving Surgery and Radiotherapy.

Background: Breast lymphedema is a common complication of breast cancer treatments but there are limited studies about the treatment of breast lymphedema. The aim of this study was to investigate the acute effects of manual lymphatic drainage (MLD), compression with exercise on the local tissue water percentage, pain, and stiffness following breast-conserving surgery and radiotherapy. Materials and Methods: Twenty-two patients (52.54 ± 12.18 years, 28.55 ± 5.11 kg/m2) were included. The sociodemographic and clinical information was recorded. The pain and stiffness severity were measured with Visual Analog Scale. Measurements of water percentages in local tissue were performed in all quadrants of the breast with the Moisture Meter D Compact device. All measurements were performed baseline, after MLD, and after compression with exercise. Results: There was a significant difference in local tissue water percentages between the affected and unaffected sides before treatment. The percentage of water only in the lower outer quadrant of the affected breast increased significantly after acute treatment (p: 0.002). In addition, pain (p: 0.001) and stiffness (p: 0.001) scores decreased. Conclusions: Local tissue water percentages increased with MLD and decreased with compression with exercise. In the treatment of breast lymphedema, MLD and compression bandage with exercise may be beneficial in the management of the symptoms of swelling, pain, and stiffness.