Compilation of recent publications on compression wraps

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.

Objective:

The objective of this study was to compare the efficacy and comfort of inelastic bandages (IBs) and adjustable Velcro compression devices (AVCDs) in reducing venous leg edema in the initial treatment phase.

Methods:

Forty legs from 36 patients with untreated venous edema (C3EpsAsdPr) were randomized to two groups. Patients in the first group received IBs (n ¼ 20) and those in the second AVCDs (n ¼ 20). Both compression devices were left on the leg day and night, and were renewed after 1 day. Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose. Leg volume was calculated using the truncated cone formula at baseline (T0), after 1 day (T1) and after 7 days (T7). The interface pressure of the two compression devices was measured by an air filled probe, and the static stiffness index calculated after applying compression at T0 and T1, and just before removal of compression on T1 and T7. Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale.

Results:

At T1, the median percent volume reduction was 13% for the IB group vs 19% for the AVCD group; at T7 it was 19% vs 26%, respectively (P < .001). The pressure of the IBs was significantly higher compared with the AVCDs at T0 (63 vs 43 mmHg) but dropped by >50% over time, while it remained unchanged with AVCDs owing to the periodic readjustment by the patient. Comfort was reported to be similar with the two compression devices.

Conclusions:

Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema.

Main findings

• Group A had an inelastic bandage comprising of a cotton wadding layer, a short stretch cohesive bandage, and a short stretch non-adhesive bandage on top to the knee. Group B had a Circaid wrap to below the knee.
• Re-adjustable wraps with a resting pressure of around 40 mmHg are more effective in reducing chronic venous oedema than inelastic bandages with a resting pressure of around 60 mmHg.
• There was a drop in interface pressure in 24 hours by 50% and over in those wearing inelastic bandages compared to the group with wraps where the pressure is maintained due to re adjustment by the patient.
• The higher pressure exerted over time by the wraps compared to inelastic bandages might explain the greater effectiveness.
• It was easy to teach the client to effectively apply the wraps.
• It is a cost effective management approach.
• The author claims that this study shows that adjustable Velcro compression devices can be more effective than inelastic bandages in the initial treatment phase and are at least equally tolerated. However it is important to note the small sample size.
• The ability of the client to self-apply the wrap and therefore self-treat can significantly reduce the cost of treatment.

Background:

Inelastic multicomponent compression (ICM) bandages applied by specialized medical staff are the standard of care for compression therapy of lymphedema of the extremities. However, new adjustable compression wraps (ACWs), which can be applied by patients themselves and, up to now, have been mainly recommended for the maintenance treatment phase of lymphedema, may be an important step toward the self-management of the initial treatment phase.

Methods:

This prospective, randomized, controlled comparative study assessed the effectiveness of an ACW in the treatment of leg lymphedema, compared with the traditional treatment with conventional IMC bandages. Included were 30 hospitalized patients admitted due to moderate to severe unilateral lymphedema (stages 2-3) of the leg. The primary outcome measures in both groups were reduction in volume of the affected leg and interface pressure after 2 and 24 hours. Patients were randomized into two groups of 15 patients: group A received ACW and group B received IMC bandages, both applied by experienced staff. After 2 hours, the staff replaced IMC bandages and the patients applied ACW, as previously instructed. Finally, compression was removed after 24 hours. Classic water displacement volumetry was performed before compression and after 2 hours and after 24 hours of compression. The interface pressure was measured immediately after application of compression, 2 hours after compression, before and after compression renewal, and finally, after 24 hours. Patients in the ACW group were allowed to adjust the wrap themselves when they considered it necessary.

Results:

The reduction in median volume after 2 hours was 109 mL (interquartile range [IQR], 64-271 mL; -3.1%) in the ACW group and 75 mL (IQR, 41-135; -2.4%) in the IMC group (not significant). After 24 hours, the reduction in median volume was 339 mL (IQR, 231-493 mL; -10.3%) in the ACW group and 190 mL (IQR, 113-296 mL; -5.9%) in the IMC group (P < .05). The interface pressure dropped significantly after 2 and 24 hours in the IMC group (-50% and -6%), but significantly less in the ACW group (-26% and -44%), mainly due to self-readjustment. The median pressures achieved after self-application of ACW (52 mm Hg; IQR, 44-61 mm Hg) were of the same order as those produced by the nurses after the first application of ACW (53 mm Hg; IQR, 39-59 mm Hg), with less variation. Conclusions:

In patients with moderate to severe lymphedema of the legs, ACW achieved a significantly more pronounced reduction in volume after 24 hours than IMC bandages. Patients were able to apply and adjust the device after being instructed in its use and after an initial 2-hour period of wear. Autonomous handling of ACW seemed to improve the clinical outcome and is a promising step toward self-management involving effective compression.

Main findings

• This study compared Group A that wore compression wraps (Juxta-Fit) and Group B that wore a 3 layer bandaging system (Tricofix layer, 2 layers of synthetic cast wadding and 2 layers of Trico bandaging) in the initial phase of treatment. The primary outcome measure was the change in volume achieved by the compression systems. The secondary outcome was the changes in sub-bandage pressure and stiffness.
• 2 hours after the application of the compression systems the median volume reduction was 3.1% in the wrap group and 2.4% in the bandage group.
• The interface pressures dropped considerably after 2 hours by 26.1% in the wrap group and 50% in the bandage group. After 24 hours this had reduced to 33mmHg for the wrap group (initial reading 52mmHg) and 25mmHg for the bandage (initial reading 49mmHg).
• Advantage of the wrap is that the patient can readjust the tension during the day. This enables a better fit and the patient being empowered by being involved in their own treatment.
• The compression wrap group achieved a significantly higher volume reduction after 24 hours compared with the bandage group.
• The authors claim that it can be effectively used in the initial treatment phase or in the maintenance phase. It is important to note the small sample size.

Swelling is a common phenomenon after total knee arthroplasty, with potential for negative impact on the rehabilitation process and final outcome. The aim of this study was to investigate the effectiveness of a new compression protocol with a self-adjustable, nonelastic compression wrap for the knee region. This study was conducted as a prospective comparative study. Total leg volume and the circumference of the knee at three levels were compared between groups. The results of our study suggest that the application of the new compression protocol has no effect on swelling in the acute postoperative phase (0-2 days) but reduces swelling at Day 14 within the subacute phase. The observed positive effect of the compression protocol could be of clinical importance in the subacute phase as well as for a subgroup of patients suffering from aberrant quadriceps weakness concomitant with knee swelling.

Objective: The conservative treatment of post-thrombotic syndrome includes application of compression on the affected extremity. However, the type and the level of compression required to manage post-thrombotic syndrome are still unclear. The aim of our proof-of-concept study was to assess the compression required to reduce cross section area of post-thrombotic deep veins in 22 patients with post-thrombotic syndrome.

Methods: The circumference and cross section area of posterior tibial veins and saphenous vein trunk were assessed on mid-calf level using 3T magnetic resonance scanner, at increasing compression (0, 30, 40, and 50mmHg), provided by a novel adjustable Velcro compression wrap, the CircAid JuxtaLiteV R .

Results: A significant reduction of baseline vein cross section area in post-thrombotic syndrome patients in the lying position required compression of at least 30mmHg for posterior tibial veins, and at least 40mmHg for the saphenous trunk. Apart from morphological changes of the compressed veins, we observed extinction of T2w signal at compression above 40mmHg, which corresponded to accelerated blood flow in the veins, and therefore may be considered as a hemodynamic marker of compression effectiveness.

Conclusion: CircAid adjusted to compression level 40mmHg accelerates blood flow in affected deep veins, thus it may facilitate post-thrombotic syndrome management.

Main findings

• The clinical manifestation of post-thrombotic syndrome (PTS) includes chronic edema, impaired skin perfusion, hemosiderin accumulation, and, finally, development of venous leg ulcer. These signs result from irreversible vein damage after thrombosis with chronic obstruction, fibrosis, and valvular destruction in the affected vein, leading to increased vascular resistance, reflux, and venous hypertension with some dilatation of veins located mainly in the lower leg.
• The study involved 22 adults (mean age 54.7>13.9 years, including 18 males and 4 females) with postthrombotic changes involving distal femoral, popliteal, or calf deep veins, with patency of saphenous vein trunk, with ankle/brachial pressure index (ABPI) >0.8.
• Prior to MRI examination, patients were advised to wear CircAid JuxtaLite System (Medi GmbH, Bayreuth, Germany) daily, at least for two weeks, with compression adjusted to 30mmHg, in order to familiarize them with the device.
• After the first scan, the wraps were applied with increasing compression levels, 30, 40, and 50mmHg, respectively, verified by PicoPress measuring transducer (MICROLAB Elettronica, Italy). Coronal scans of the calf and axial scans of mid-calf (at C point) were acquired with high-resolution T2w images. Our evaluation focused on the morphological changes of the deep posterior tibial veins (PTV) and the superficial great saphenous vein (GSV) by measuring their diameters, circumferences, and mean cross-section areas.
• The pressure required for T2 signal extinction in the GSV trunk was considered as an indicator of compression effectiveness for superficial veins.
• This study shows that only a high resting pressure of 40–50mmHg is able to reduce the vein caliber to a degree, for which a reduction of venous refluxes may be expected also in the upright position when the pressure of the inelastic wrapping material will further increase considerably. This pressure range corresponds to values which are produced by first time appliers of adjustable compression wraps, to whom it is explained that they should apply the system very tightly, without causing pain.
• In the acute phase of DVT, the large individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL) study has convincingly shown that strong compression using inelastic material does not only reduce pain and leg swelling but also reduces the incidence of residual venous occlusions and of PTS after several months. It was demonstrated that such compression and mobilization applied already in the acute stage of DVT were able to significantly reduce the incidence of PTS. Randomized controlled trials to investigate the potential role of adjustable compression wraps in acute DVT have been initiated.

ackground: Adjustable compression wraps are used for treating lymphedema and chronic venous insufficiency. These diseases often affect elderly patients with associated pathologies or other limiting factors. These can prevent the self-application of the device by patients on themselves. A better understanding of these factors or the associated pathology in the elderly is important before prescribing or not prescribing a wrap.

Methods: The objective of this prospective cohort study was to determine the main factors that prevent the self-application of the device (Circaid Juxtalite, Medi Italia S.r.l., Bologna, Italy) to the lower limb in the elderly. A private nurse selected the first 30 retired subjects over 65 years of age seen at home for routine nursing care. After a demonstration, she asked them to put on the wrap to reach a pressure of 40 mmHg in the calf (point B1). She recorded the pressures as the subjects applied the wrap twice in a row. The next day, the subject repeated the application of the wrap twice. We considered that an average pressure of more than 30 mmHg is recommended to treat venous edema or ulceration.

Results: Thirty percent of the subjects put on the wrap by themselves with an average pressure of at least 30 mmHg. Age is not a limiting factor. Obesity, gripping difficulties, cognitive impairment and low social status seem to be factors limiting the daily self-management of an adjustable compression wrap in the elderly.

Conclusions: The self-management of adjustable compression wraps in the elderly person encounters obstacles that need to be known. The investigation has revealed that obesity, gripping difficulties, cognitive impairment and low social status are limiting factors. Age was not shown to be a limiting obstacle.

Objective:

The aim of this small pilot audit was to record the performance of an adjustable Velcro compression wrap, ReadyWrap, and the experiences of patients and health-care professionals using the system as a self-care option for the management of venous and lymphatic leg conditions in both the treatment and maintenance phases.

Methods:

This audit was held within a 4-week review period. Participants included venous leg ulcer (VLU) patients with and without oedema, and patients with lymphoedema. Where open wounds were present they were managed with debridement, skin care and dressings according to clinical need. Lymphoedema patients received manual lymphatic drainage and skin care regimens as per standard practice. The Velcro system evaluated formed part of a treatment pathway with compression bandages and/or compression hosiery as clinically indicated. Patients, carers and health-care professionals applied the garments following assessment and training. Objective data recorded included change in circumferential measurements and improvement in wound status. Observation of health-care professionals, patients and carers with regard to the comfort and ease of application/removal of the device were recorded.

Results:

There were 17 patients included in the audit. Within the 4-week period a reduction in limb circumference was recorded in all cases. Improvements in open wounds were recorded in most cases. Following the 4-week audit period 94% of the application of the device was performed by either the patient (59%) or the carer (35%) thereby reducing the health-care professional contact that was required for application.

Conclusions:

Early results in this small audit demonstrate that this adjustable Velcro compression wrap may provide a simple, clinically effective and patient-acceptable solution for self-care with compression. Use of this type of device could have the potential to reduce overall health-care burden by reducing necessary skilled treatment visits and/or cost while still achieving good clinical outcomes. Further studies are required to confirm this pilot study and provide additional data.

Main findings

• There was a small sample size and a larger study is required.
• It showed following the 4 week audit that 94% of the application of the devices was performed by either the patient (59%) or the carer (35%). This reduces health professional contact and reduces the cost of treatment.
• Despite the lack of robust economic evaluation, claims regarding cost savings are compelling.