Flap Surgery and Compression Therapy

2018 ◽  
pp. 199-203
Author(s):  
Joon Pio(Jp) Hong ◽  
Hyunsuk Peter Suh
Keyword(s):  
Compression Therapy ◽  
Flap Surgery

scholarly journals Is Early Compression Therapy after Perforator Flap Safe and Reliable?

2018 ◽  
Vol 35 (05) ◽  
pp. 354-361 ◽  
Author(s):  
Hyunsuk Suh ◽  
Hyung Hwa Jeong ◽  
Joon Pio Hong
Keyword(s):  
Flow Velocity ◽  
Perforator Flap ◽  
Compression Therapy ◽  
Postoperative Phase ◽  
Flap Surgery ◽  
Compression Garment ◽  
Early Ambulation ◽  
Custom Made ◽  
Before And After ◽  
Extremity Reconstruction

Background Due to the concern of circulation compromise, many surgeons hesitate to dangle or challenge the flap in the early postoperative phase. In our experience, early compression may have advantages such as collapse of dead space, evacuation of hematoma, reduction of edema, and stabilization of flap when ambulating. In this study, the effect of early compression of flaps with regard to flap physiology and outcome is evaluated. Methods From postoperative day 3 to 5, a custom-made compression garment was fitted aiming to compress with a pressure of 30 to 35 mmHg. A total of 52 patients (52 flaps) were enrolled for the study and 48 flaps underwent early compression. The compression was applied not only over the flap but also over the extremity or trunk. The flap outcome as well as flow velocity and flow volume of the pedicle before and after compression was measured and evaluated. Results There was no flap complication during the early compression and early ambulation. And, there was no statistical difference either in the flow velocity or in the volume before and after the compression therapy (29.21 vs. 29.42 cm/s and 7.13 vs. 6.56 cm3/s, respectively). Conclusion Early compression with a 30-mmHg pressure customized pressure garment after the flap surgery does not affect the hemodynamics of the perforator and can be safely used after extremity reconstruction before ambulation.

Lymphedema and lipedema - an overview of conservative treatment

VASA ◽  
2011 ◽  
Vol 40 (4) ◽  
pp. 271-279 ◽  
Author(s):  
Wagner
Keyword(s):  
Conservative Treatment ◽  
General Practitioners ◽  
Subcutaneous Tissue ◽  
Compression Therapy ◽  
Compression Stocking ◽  
Lymph Drainage ◽  
Intensive Phase ◽  
Manual Lymph Drainage ◽  
Causal Therapy

Lymphedema and lipedema are chronic progressive disorders for which no causal therapy exists so far. Many general practitioners will rarely see these disorders with the consequence that diagnosis is often delayed. The pathophysiological basis is edematization of the tissues. Lymphedema involves an impairment of lymph drainage with resultant fluid build-up. Lipedema arises from an orthostatic predisposition to edema in pathologically increased subcutaneous tissue. Treatment includes complex physical decongestion by manual lymph drainage and absolutely uncompromising compression therapy whether it is by bandage in the intensive phase to reduce edema or with a flat knit compression stocking to maintain volume.

Primary varicose veins

Phlebologie ◽  
2010 ◽  
Vol 39 (03) ◽  
pp. 133-137
Author(s):  
H. Partsch
Keyword(s):  
Varicose Veins ◽  
Compression Therapy ◽  
Daily Practice ◽  
Clinical Severity ◽  
Compression Stockings ◽  
Primary Varicose Veins ◽  
The Cost ◽  
Convincing Data ◽  
Long Term Studies

SummaryBackground: Compression stockings are widely used in patients with varicose veins. Methods: Based on published literature three main points are discussed: 1. the rationale of compression therapy in primary varicose veins, 2. the prescription of compression stockings in daily practice, 3. studies required in the future. Results: The main objective of prescribing compression stockings for patients with varicose veins is to improve subjective leg complaints and to prevent swelling after sitting and standing. No convincing data are available concerning prevention of progression or of complications. In daily practice varicose veins are the most common indication to prescribe compression stockings. The compliance depends on the severity of the disorder and is rather poor in less severe stages. Long-term studies are needed to proof the cost-effectiveness of compression stockings concerning subjective symptoms and objective signs of varicose veins adjusted to their clinical severity. Conclusion: Compression stockings in primary varicose veins are able to improve leg complaints and to prevent swelling.

Therapeutic use of lowmolecular weight heparin for capillaritis alba

Phlebologie ◽  
2008 ◽  
Vol 37 (05) ◽  
pp. 259-265 ◽  
Author(s):  
H. Kutzner ◽  
G. Hesse
Keyword(s):  
Case Studies ◽  
Randomized Study ◽  
Compression Therapy ◽  
Venous Hypertension ◽  
Therapeutic Use ◽  
Prospective Randomized Study ◽  
Anti Inflammatory ◽  
Positive Effect ◽  
Inflammatory Effect

SummaryThe reason of the so called ulcerated capillaritis alba or idiopathic atrophie blanche is vasculopathy caused by severe venous hypertension. Thrombosed and rarificated vessels worsen the oxygenation, increase permanent inflammation and impede the necessary compression therapy. The anti-inflammatory effects of heparin alleviate pain and being independent from the antithrombotic ones it needs much lower doses for treatment. This anti-inflammatory effect is now becoming more important in clinical phlebology. Case studies of more than 50 patients and one prospective randomized study of 87 patients clearly demonstrate the ameliorated healing of ulcerated atrophie blanche. In our office we could document this positive effect with 22 patients. We present the pathophysiology of low molecular heparins for ulcerated capillaritis alba and our own experiences with it.

Compression therapy following ambulatory phlebectomy

Phlebologie ◽  
2008 ◽  
Vol 37 (01) ◽  
pp. 3-6 ◽  
Author(s):  
F. G. Bruins ◽  
H. A. M. Neumann ◽  
K.-P. de Roos
Keyword(s):  
Clinical Outcome ◽  
Adverse Events ◽  
Operative Treatment ◽  
Varicose Veins ◽  
Compression Therapy ◽  
Patient Discomfort ◽  
Short Period ◽  
Major Adverse Events

Summary Aim: The study was designed to evaluate the feasibility, results and safety of a very short period of compression after ambulatory phlebectomy. Patients, methods: From September to December 2006 we prospectively studied 49 subsequent patients who underwent ambulatory phlebectomy for branch varicose veins. Post-operatively the treated part of the leg was bandaged for forty-eight hours. Results: No major adverse events occurred. Although 46.9% of treated patients had visible haematomas two days post-operatively, after six weeks this was only visible in one patient. The results of this study show that the clinical outcome of ambulatory phlebectomy in combination with compression for forty-eight hours is at least equal to a conventional (longer) period of compression. Conclusion: Post-operative treatment can be safely reduced without the need of adjuvant compression hosiery. This will reduce patient discomfort after ambulatory phlebectomy without jeopardizing the clinical outcome.

Actual procedures of diagnostics and treatments of crural venous ulcer in specialized German praxis and clinics

Phlebologie ◽  
2009 ◽  
Vol 38 (02) ◽  
pp. 77-82 ◽  
Author(s):  
P. Altmeyer ◽  
M. Stücker ◽  
S. Reich-Schupke
Keyword(s):  
Annual Meeting ◽  
Polyurethane Foam ◽  
Surgical Therapy ◽  
Compression Therapy ◽  
German Society ◽  
Venous Ulcer ◽  
Ulcus Cruris ◽  
Wound Dressings

Summary Background: To evaluate the implementation of the guidelines of the German Society of Phlebology for venous crural ulcer a survey was conducted during the annual meeting of the German Society of Phlebology 2008 in Bochum. Methods: All 719 medical participants got an anonymized questionnaire asking for supply of crural ulcer in their institution. Results: The recurrent 66 questionnaires (9.2%) were filled by colleagues from practice or hospital, mostly surgeons, dermatologists, phlebologists and vascular surgeons. As basic diagnostics vein doppler (56.1%), duplex (75.8%) or measurement of brachial-ankleindex (83.3%) were performed. Compression therapy is used in all institutions. Mainly used wound dressings are polyurethane foam dressings, alginates, hydrocolloids and silver dressings. About 2/3 conduct surgical therapy of ulcers. Conclusion: Supply of ulcus cruris by the participants of the annual meeting of the DGP corresponds mainly, but not in all aspects to the guidelines. Further efforts for a spread of the guidelines are necessary.

Healing venous ulcers with different modalities of leg compression

Phlebologie ◽  
2006 ◽  
Vol 35 (05) ◽  
pp. 349-355 ◽  
Author(s):  
E. O. Brizzio ◽  
G. Rossi ◽  
A. Chirinos ◽  
I. Cantero ◽  
G. Idiazabal ◽  
...  
Keyword(s):  
Wound Care ◽  
Univariate Analysis ◽  
Compression Therapy ◽  
Healing Time ◽  
Clinical Parameters ◽  
Compression Stockings ◽  
Local Pressure ◽  
Ulcer Size ◽  
Venous Ulcers ◽  
Unexpected Findings

Summary Background: Compression therapy (CT) is the stronghold of treatment of venous leg ulcers. We evaluated 5 modalities of CT in a prospective open pilot study using a unique trial design. Patients and methods: A group of experienced phlebologists assigned 31 consecutive patients with 35 venous ulcers (present for 2 to 24 months with no prior CT) to 5 different modalities of leg compression, 7 ulcers to each group. The challenge was to match the modality of CT with the features of the ulcer in order to achieve as many healings as possible. Wound care used standard techniques and specifically tailored foam pads to increase local pressure. CT modalities were either stockings Sigvaris® 15-20, 20-30, 30-40 mmHg, multi-layer bandages, or CircAid® bandaging. Compression was maintained day and night in all groups and changed at weekly visits. Study endpoints were time to healing and the clinical parameters predicting the outcome. Results: The cumulative healing rates were 71%, 77%, and 83% after 3, 6, and 9 months, respectively. Univariate analysis of variables associated with nonhealing were: previous surgery, presence of insufficient perforating and/or deep veins, older age, recurrence, amount of oedema, time of presence of CVI and the actual ulcer, and ulcer size (p <0.05-<0.001). The initial ulcer size was the best predictor of the healing-time (Pearson r=0.55, p=0.002). The modality of CT played an important role also, as 19 of 21 ulcers (90%) healed with stockings but only 8 of 14 with bandages (57%; p=0.021). Regression analysis allowed to calculate a model to predict the healing time. It compensated for the fact that patients treated with low or moderate compression stockings were at lower risk of non-healing. and revealed that healing with stockings was about twice as rapid as healing with bandages. Conclusion: Three fourths of venous ulcers can be brought to healing within 3 to 6 months. Healing time can be predicted using easy to assess clinical parameters. Irrespective of the initial presentation ulcer healing appeared more rapid with the application of stockings than with bandaging. These unexpected findings contradict current believes and require confirmation in randomised trials.

Reversed Arterial and Venous Flow in Free-Flap Surgery for Leg Reconstruction

2006 ◽  
Vol 22 (04) ◽  
Author(s):  
Soo Hahn ◽  
Sung Kim ◽  
Ho Kang ◽  
Sun Joo
Keyword(s):  
Free Flap ◽  
Flap Surgery ◽  
Venous Flow ◽  
Free Flap Surgery
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