Daniel J. Hageman, Shuying Wu, Sharon Kilbreath, Stanley G. Rockson, Chun Wang and Melissa L. Knothe Tate. Trends in Biotechnology, May 2018, Vol.36, No. 5

Main findings

• Recent studies indicate a lack of consistency in these gradients and thereby provide a key focus for improvement in garment design. Also, the effects of compression garments on flow pathways, the associated resistances, and longer-term effects on lymphatic function need to be determined.
• Few published clinical studies have addressed design specifications of sleeves or validation of pressure delivery promised by sleeve manufacturers. No current standardization for compression garments exists, and numerous variables influence the effective pressures.
• Without such a comparison, consistency in sleeve use, as well as the resulting benefits of compression therapy treatment, cannot be achieved.
• Looking forward, the development of a spatially and temporally appropriate pressure profile for a compression sleeve depends on three variables: (i) garment characteristics such as mechanical and material properties; (ii) patient characteristics such as limb morphology and application technique; and (iii) the method by which the pressure at the skin–sleeve interface is measured.
• Once complete profiles of commercial compression sleeves and their respective pressure gradients become available, together with increasing ease and availability of rapid manufacturing methods, the opportunity to design bespoke mechanical and material properties for individual patients will become a reality.
• Regardless of materials and garment specifications, for any given size and class of compression garment, pressure profiles delivered at the interface of the garment and the lymphedematous limb depend highly on individual patient characteristics, from the size and geometry to the degree and spatial distribution of edema.
• Modern rapid manufacturing methods lend themselves to the development of bespoke garments, which will then necessitate the concomitant development of real-time, spatially- and temporally-resolved pressure measurements.
• While a gold standard for the future would fully integrate garment and sensing functions, current standards of pressure measurement typically rely on individual probes to measure pressure at a specific point of contact. Therefore, the characterization of pressure distribution, through measurement at a variety of discrete locations along the limb, is limited in resolution and overall pressure profile accuracy. Since the majority of manufactured compression garments apply a gradient of pressure, promoting fluid flow in a specific direction, it is important to investigate other methods or technologies for which one can measure and characterize the pressure profiles of BCRL compression sleeves.
• Volume increases vary in different areas of the arm depending on the regional tissue characteristics. With size and morphology as significant factors to consider when conducting compression garment measurements, one must also consider the position of the limb when a measurement is performed, as this too has been shown to affect the morphology of the limb, the deformation of the compression garment, and overall pressure balance.
• Flexible membranes with an array of pressure sensors would lend themselves well to the evaluation of BCRL compression sleeves [59]. The spatial resolution offered by such sensors, combined with the capacity for direct measurement at the interface between the patient’s skin and the compression sleeve, could offer useful insight into the pressures delivered to the affected limb. This in turn would lend itself to the optimization of compression therapy protocols to maximize the efficacy of volume reduction.
• Such a sensor should be able to be embedded onto compression garments or intertwined as part of the fabric enabling conformation to the body contour. Unfortunately, no such commercial pressure sensors can fully comply with these requirements.
• The integration of sensors into garment studies would have benefits far beyond the accurate design of consistent garment fits. Such quantitative characterization will provide insight into the robustness of compression garments in the context of the evolution of mechanical properties and/or limb volume over time as well as product lifespans for effective function of garments for individual patients. This will in turn lead to practical insights regarding how often garments need to be replaced due to material fatigue or changes in the patient’s limb volume over time. There is limited understanding in the field with regard to the necessary tolerances for a garment to be effective as well as the change in said tolerances over time due to regular patient use.