Progress of compression therapy in treatment of venous leg ulcer / 中华全科医师杂志

Venous leg ulcer (VLU) is the most common chronic ulcer of lower extremity caused by persistent venous hypertension. Although the mortality rate is low, VLU seriously affects the quality of life of patients, and has the potential for infection, deterioration, and amputation. The compression therapy is simple and easy to implement, it can effectively reduce venous hypertension and is the most important conservative therapy for treating and preventing recurrence of VLU. There are various devices and applications of compression therapy, and this article reviews the classification of compression therapy, and its application in treatment and recurrence prevention of VLU.

Applications of Compression Therapy in Vascular Diseases and its Research Progress / 医用生物力学

Vascular diseases including cardiovascular and cerebrovascular diseases and peripheral vascular diseases of the lower extremities are serious threats to human health. The emergence of compression therapy is of great significance for the effective prevention and treatment of these vascular diseases and the therapeutic value of compression therapy has been confirmed by many research results at present. Compression therapy is a non-invasive physical therapy implemented through a series of compression therapy devices, including external counterpulsation for the treatment of various ischemic diseases, intermittent pneumatic compression for the treatment of some peripheral vascular diseases in the lower extremities, graduated compression stockings for the treatment of deep vein thrombosis, and so on. This review summarizes clinical applications of these typical compression therapies in cardiovascular and cerebrovascular diseases and peripheral vascular diseases of the lower extremities, analyzes their advantages and limitations, and discusses the necessity and significance of biomechanical research on compression therapies.

Compression therapy in preventing deep vein thrombosis of lower extremities / 中华全科医师杂志

Drug prophylaxis is commonly used for prevention of deep vein thrombosis (DVT), but it has deficiencies such as causing thrombocytopenia and weakening coagulation function. Compression therapy is a safe and economical physiotherapy method, which can effectively prevent the occurrence of DVT with less adverse reactions. This article reviews the clinical application and efficacy of four pressure treatment methods: graduated compression stockings, intermittent pneumatic compression, venous foot pumps and continuous enhanced circulation therapy.

Uso de la miel en el manejo de las úlceras crónicas de miembros inferiores en el adulto. Revisión sistemática / Use of honey in the management of chronic leg ulcers in adults. Systematic review. / Uso de mel no tratamento de úlceras crônicas dos membros inferiores no adulto. Revisão sistemática

Introducción: las úlceras en miembros inferiores hacen parte de las enfermedades crónicas que afectan a la población mundial, las cuales generan deterioro en la calidad de vida de quienes las padecen. La miel es un alimento natural utili-zado a lo largo de la historia de la humanidad con fines curativos para el manejo de las lesiones en la piel; sin embargo, el beneficio de su uso en el tratamiento de las úlceras de miembros inferiores no ha sido definido, ya que la evidencia actual es controversial. Objetivo: evaluar la mejor evidencia científica disponible para determinar los beneficios de la miel en el tratamiento de las úlceras crónicas de miembros inferiores en la población adulta. Metodología: se realizó una revisión sistemática de la literatura de ensayos clínicos controlados, aleatorizados en las bases de datos PubMed, Ovid, ProQuest, EBSCO, BIREME. Se incluyeron 9 ensayos clínicos controlados. Se evaluó la calidad metodológica según los parámetros de PeDro y se utilizaron criterios de la colaboración Cochrane para definir la presencia de sesgos de cada estudio. Resultados: ocho de los 9 estudios incluidos reportaron desenlaces favorables en el uso de la miel. Los estudios conta- ron con buena calidad metodológica en su desarrollo, pero evidenciaron un riesgo poco claro de sesgo. Conclusión: la evidencia disponible no permite establecer la utilidad de la miel en el manejo de las úlceras de miembros inferiores. La evidencia actual muestra poca claridad en términos de sesgos, por lo que es necesario realizar nuevos ensayos clínicos, con mejores criterios de intervención, para poder establecer el beneficio del uso de la miel en esta enfermedad

Background: Leg ulcer are part of chronic diseases that affect word population, generating a big burden in quality of life. Honey is a natural food used along humanity history as a topic medicine for skin conditions. The benefits of using honey as a treatment of chronic leg ulcers has not been clarified because off controversial evidence. Objectives: This review assess the best scientific evidence to establish the benefits of using honey in chronic leg ulcers in adult population. Methods: A systematic Review of randomized clinical trials was made in PubMed, Ovid, ProQuest, EBSCO and BIREME databases. 9 controlled clinical trials were included. Methodological quality was assessed using PeDro criteria. Risk of bias was assessed using Cochrane parameters. Results: Eight of nine clinical trials included reported beneficial outcomes using honey in chronical leg ulcers treatment. Trials were made with good methodological quality however their had unclear risk of bias. Conclusion: Available evidence does not let define the usefulness of applying honey in chronic leg ulcers. Data is unclear in terms of bias; thus, it is necessary to perform new randomized clinical trials with better intervention criteria to define if using topical honey in chronic leg ulcers is beneficial or not compared with conventional treatment

Introdução: as úlceras nos membros inferiores fazem parte das doenças crônicas que afetam a po- pulação mundial, as quais geram deterioração na qualidade de vida daqueles que sofrem com elas. O mel é um alimento natural usado ao longo da história da humanidade para fins de cura no tratamento de lesões de pele; no entanto, o benefício de seu uso no tratamento de úlceras nos membros inferio- res não foi definido, pois a evidência atual é controversa. Objetivo: avaliar a melhor evidência científica disponível para determinar os benefícios do mel no tratamento de úlceras crônicas de membros inferiores na população adulta. Metodologia: foi realizada uma revisão sistemática da literatura de ensaios clínicos controlados, randomizados nas bases de dados PubMed, Ovid, ProQuest, EBSCO, BIREME. Nove ensaios clínicos controlados foram incluídos. A qualidade metodológica foi avaliada de acordo com os parâmetros PeDro e os critérios da Cochrane Collaboration foram utilizados para definir a presença de viés em cada estudo. Resultados: Oito dos 9 estudos incluídos relataram resultados favoráveis no uso do mel. Os estudos tiveram boa qualidade metodológica em seu desenvolvimento, mas mostraram um risco claro de viés. Conclusão: a evidência disponível não permite estabelecer a utilidade do mel no manejo de úlceras nos membros inferiores. A evidência atual mostra pouca clareza em termos de vieses, portanto, é ne- cessário realizar novos ensaios clínicos, com melhores critérios de intervenção, a fim de estabelecer o benefício do uso do mel nesta doença.

The gait-dependent intermittent pneumatic compression ambulatory boot device: Preliminary reports on calf pressure and venous hemodynamics

RATIONALE@#Compression therapy has been demonstrated to be beneficial in a number of vascular conditions including chronic arterial ischemia, venous insufficiency and primary and secondary lymphedema. Its effectivity however is limited and questioned by the nature of the treatment procedure which requires that the patient be in a sitting or recumbent position while it is being administered.@*METHODS@#The author describes the development of a boot device which provides gait-dependent intermittent compression to the ankle and calf@*RESULTS@#In volunteer studies, the device produced a cycle of pressure changes from 15-40 mmHg at the interface. Simulated calf compression resulted in augmentation of venous flow recorded by duplex sonography at the superficial femoral vein area, indicating an improvement in venous hemodynamics with the use of the device.@*CONCLUSION@#These findings demonstrate the potential for an attractive ambulatory alternative to the commonly employed nonambulant therapies for venous insufficiency.

Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome / Uso da terapia compressiva ou não compressiva na trombose venosa profunda e síndrome pós-trombótica: dois caminhos divergentes

Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the "valve mechanism" generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

Resumo O uso da terapia de compressão para reduzir a incidência de síndrome pós-trombótica em pacientes com trombose venosa profunda apresenta controvérsias como o uso da compressão elástica versus inelástica, os níveis e a duração da compressão. Dispositivos inelásticos com índice de rigidez estática combinam uma pressão pequena e confortável em repouso com uma pressão forte o suficiente para restaurar o "mecanismo de válvula" gerado pela flexão plantar e dorsiflexão do pé. Uma vez que o índice de rigidez estática depende da rigidez do sistema de compressão e da força muscular dentro da área enfaixada, a melhoria da massa muscular com programas de fortalecimento e treinamento de resistência deve ser incentivada. Na fase aguda dos eventos de trombose venosa profunda, a anticoagulação acompanhada de terapia de compressão inelástica pode reduzir a extensão do trombo. Assim, são necessários estudos que avaliem a eficácia da terapia inelástica na trombose venosa profunda e na síndrome pós-trombótica.

The effectiveness and safety of continuous and intermittent ice compression therapy after total knee arthroplasty:a prospective cohort study / 中国实用护理杂志

Objective To compare the effectiveness and safety of continuous and intermittent ice compression therapy following total knee arthroplasty surgery. Methods Eighty patients were divided into two groups receiving continuous or intermittent 30 minutes every 2 two hours within 48 hours after the operation. The subjective pain (VAS score), additional pain-killer use, swelling of extremity, drainage, range of motion were observed and compared. Results Patients in the observation group had less pain than those in the control group (Z values in the first 3 postoperative day was-2.722,-3.359,-2.039, respectively, P<0.05). Less pain-killers were required in the experimental group (Z=-2.559, P<0.05). The postoperative swelling by the thigh circumferences in the first day in the observation group was (1.84 ± 1.11) cm, which was milder than the (3.30 ± 1.69) cm of the control group (t=4.565, P<0.01). So was it in the calf circumferences, (0.94 ± 0.89 ) cm vs. (1.46 ± 0.91) cm (t=2.627, P=0.01). Within the first 3 days after the operation, this mildness still existed in aspect of thigh circumferences, which was (3.09±1.39) cm in the observation group vs the (4.09 ± 1.71) cm in the control group, t=2.869, P < 0.01. Conclusions Continuous ice compression therapy has better effects than intermittent 48 hours after total knee replacement, with functional training and exercise not disturbed. It is considered safe and assured, and is therefore recommended.

Effects of light pressure compression therapy using a tubular bandage together with foam padding in patients having difficulty wearing compression garments and elastic bandaging

Complex decongestive therapy for lymphedema includes skin care, manual lymphatic drainage, compression therapy, exercise, and management of patients will include education about risk reduction and self-management. Specifically, compression therapy commonly employs elastic bandages with garments having more than 30 mmHg of compression. Some patients have difficulty wearing general compression garments due to complications, conflicts with activities of daily living（ADL）, and lack of compliance. Therefore, the effectiveness of light pressure compression using a tubular bandage together with foam padding was examined in 15 lymphedema patients of ISL（International Society of Lymphology）stageⅡ classification. In circumference comparisons among limb measurements between pre- and post-treatment, a significant decrease was found for all measurement points. In comparisons of shape change of limbs, we also noted significant improvements between pre- and post-treatment assessments. Furthermore, patient feeling and behavior tended to ameliorate along with increases in ADL and quality of life（QOL）. Based on these findings, light pressure compression using a tubular bandage along with foam padding may be an effective treatment option for ISL stageⅡ lymphedema patients who are unable to wear general compression garments and short stretch compression bandaging.

Treatment of Venous Stasis Ulcer with 3M(TM) Coban(TM) 2 Layer Compression System: A Case Report

PURPOSE: Venous stasis ulcer is the most severe form of chronic venous insufficiency and this commonly appears in the lower limb. Pharmacological therapy, reconstruction of the venous system, surgical management, cellular therapy and compression therapy are known as the treatments of venous stasis ulcer, but relapses are common, which make it a typical chronic wound. We report here on a case of recurrent venous stasis ulcer that healed with compression therapy without any other treatment. METHODS: A 35-year-old man with a 13 years history of venous stasis had developed an ulcer on the distal third portion of the lower left limb which was developed 12-year before enrollment in this study. He had been treated with vacuum assist closure, 2 times of cell therapy and 3 times of skin graft for 8 years, but the lesion recurred. From November, 2008 compression therapy was done with the 3M Coban(TM) 2 Layer Compression System(3M, St. Paul, USA). The ulcer at that time was oval shaped and 3x4cm in size. A comfort layer bandage was applied from the proximal phalanx of the great toe to the knee. A compression layer bandage was applied on the previous layer with it being overlapped one half the width of the comfort layer bandage. The dressing was changed every 4 days and the change was recorded with photography. RESULTS: A total of 12 Coban(TM) 2 Layer Compression Systems were used. The size of the ulcer decreased to 2.5x2.5cm in one month, to 2x2cm in 2 months, it was 1x1.8cm in size at 3 months and it completely healed in 4 months. CONCLUSION: The venous stasis ulcer was completely healed using the 3M Coban(TM) 2 Layer Compression System. This method was easy to apply, made the patient comfortable and it provided an excellent compression effect. As in the previous studies, this compression therapy has been proven to play an important role for the treatment and prevention of venous stasis ulcer.

Vacuum-compression therapy for ischemic disease of the extremities: Experience with 40 patients / 西安交通大学学报·英文版

Objective: To study the clinical effects of vacuum-compression therapy for ischemic disease of the extremities. Methods: A total of 40 cases of peripheral arterial disorders, including 23 thromboangiitis obliterans (31 limbs) and 17 arteriosclerosis obliterans (23 limbs), were treated by a self-made vacuum-compression therapeutic apparatus. Results: The effective rate in thromboangiitis obliterans and arteriosclerosis obliterans groups was 96.77% and 92.23%, respectively. The cuffs on the apparatus were improved to eliminate discomfort in the patients during treatment. "Rebound symptom" was observed during treatment, which had not been reported previously. Conclusion: Vacuum-compression therapy has a good prospect for treating ischemia of the extremities.

Vacuum-compression therapy for ischemic disease of the extremities: experience with 40 patients / 药物分析学报

Objective To study the clinical effects of vacuum-compression therapy for ischemic disease of the extremities. Methods A total of 40 cases of peripheral arterial disorders, including 23 thromboangiitis obliterans (31 limbs) and 17 arteriosclerosis obliterans (23 limit), were treated by a self-made vacuum-compression therapeutic apparatus. Results The effective rate in thromboangiltis obliterans and arteriosclerosis obliterans groups was 96.77% and 92.23%, respectively. The cuffs on the apparatus were improved to eliminate discomfort in the patients during treatment. "Rebound symptom" was observed during treatment, which had not been reported previously. Conclusion Vacuum-compression therapy has a good prospect for treating ischemia of the extremities.

Sequential Intermittent Pneumatic Compression Therapy in Lymphedema

We tried to assess the effect of sequential intermittent pneumatic compression therapy in patients with lumphedema and analyze the potential prognostic factors in response to the therapy. Ninety lymphedema patients were i ncluded in the analysis. Among them, thirty-six subjects who were in clinical stage 2 or 3, infection-free and free of documented metastasis in the involved extremity were treated with the Lympha-Press. All patients were admitted for 3 days clinical trial. Comparison of circumferential limb measurements before and after a 3-day treatment period was performed. As a result of sequential intermittent pneumatic compression therapy, the volume reductions of arm and leg were 37.95(12.27% and 35.21%(24.42%, respectively. The calf, wrist and lower forearm levels showed the greatest reduction. In contrast with this, the proximal levels of arm and leg showed comparatively boor reduction than distal levels. Almost 90% of arm patients and 76% of leg patients experienced significant reduction (>25%) after therapy. The previous history of secondary infection was significantly associated with the extent of initial leg edema. But the duration and the previous history of radiotherapy or secondary infection were not a negative prognostic factor for response of pneumatic compression therapy. This study clearly indicates that sequential intermittent pneumatic compression therapy is an effective treatment for lymphedema regardless of the duration of edema and previous history of radiotherapy or secondary infection.