Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC)

Compression therapy is considered to be the most important conservative treatment of venous leg ulcers. Until a few years ago, compression bandages were regarded as first-line therapy of venous leg ulcers. However, to date medical compression stockings are the first choice of treatment. With respect to compression therapy of venous leg ulcers the following statements are widely accepted: (1) Compression improves the healing of ulcers when compared with no compression; (2) Multicomponent compression systems are more effective than single-component compression systems; (3) High compression is more effective than lower compression; (4) Medical compression stockings are more effective than compression with short stretch bandages. Healed venous leg ulcers show a high relapse rate without ongoing treatment. The use of medical stockings significantly reduces the amount of recurrent ulcers. Furthermore, the relapse rate of venous leg ulcers can be significantly reduced by a combination of compression therapy and surgery of varicose veins compared with compression therapy alone.

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Compression for the management of venous leg ulcers: which material do we have?

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514528129 ◽

2014 ◽

Vol 29 (1_suppl) ◽

pp. 140-145 ◽

Cited By ~ 36

Author(s):

Hugo Partsch

Keyword(s):

Time Pressure ◽

Wide Spectrum ◽

Compression Therapy ◽

Venous Hypertension ◽

Leg Ulcers ◽

Interface Pressure ◽

Compression Stockings ◽

Venous Leg Ulcers ◽

Compression Bandages ◽

Hybrid Devices

Compression therapy is the most important basic treatment modality in venous leg ulcers. The review focusses on the materials which are used: 1. Compression bandages, 2. Compression stockings, 3. Self-adjustable Velcro-devices, 4. Compression pumps, 5. Hybrid devices. Compression bandages, usually applied by trained staff, provide a wide spectrum of materials with different elastic properties. To make bandaging easier, safer and more effective, most modern bandages combine different material components. Self-management of venous ulcers has become feasible by introducing double compression stockings (“ulcer kits”) and self-adjustable Velcro devices. Compression pumps can be used as adjunctive measures, especially for patients with restricted mobility. The combination of sustained and intermittent compression (“hybrid device”) is a promising new tool. The interface pressure corresponding to the dosage of compression therapy determines the hemodynamic efficacy of each device. In order to reduce ambulatory venous hypertension compression pressures of more than 50 mm Hg in the upright position are desirable. At the same time pressure should be lower in the resting position in order to be tolerated. This prerequisite may be fulfilled by using inelastic, short stretch material including multicomponent bandages and cohesive surfaces, all characterized by high stiffness. Such materials do not give way when calf muscles contract during walking which leads to high peaks of interface pressure (“massaging effect”).

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Safety of medical compression stockings in patients with diabetes mellitus or peripheral arterial disease

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001316 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001316

Author(s):

Ulrich Rother ◽

Anna Grussler ◽

Colin Griesbach ◽

Veronika Almasi-Sperling ◽

Werner Lang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Peripheral Arterial Disease ◽

Compression Therapy ◽

Arterial Disease ◽

Compression Stockings ◽

Doppler Flowmetry ◽

Venous Diseases ◽

Patients With Diabetes ◽

Peripheral Arterial ◽

Medical Compression Stockings

IntroductionCompression therapy is highly effective in the treatment of many venous diseases, including leg edema. However, its relevance in patients with peripheral arterial disease (PAD) or diabetes mellitus is critically discussed. The aim of the present study was to assess the influence of compression therapy on microperfusion and its safety in patients with PAD or diabetes mellitus.Research design and methodsA prospective analysis of 94 consecutive patients (44 patients with diabetes, 45 patients with PAD and 5 healthy controls) undergoing medical compression therapy was performed. Microperfusion was assessed by a combined method of white light tissue spectrometry and laser Doppler flowmetry under medical compression therapy (classes I and II), in different body positions (supine, sitting, standing and elevated position of the leg) and at different locations (great toe, lateral ankle and calf).ResultsDuring the entire study, no compression-related adverse events occurred. Evaluation of microcirculation parameters (oxygen saturation of hemoglobin and flow) at the different locations and in sitting and standing positions (patients with diabetes and PAD) under compression therapy classes I and II revealed no tendency for reduced microperfusion in both groups. In contrast, in the elevated leg position, all mean perfusion values decreased in the PAD and diabetes groups. However, the same effect was seen in the healthy subgroup.ConclusionsIn consideration of the present inclusion criteria, use of medical compression stockings is safe and feasible in patients with diabetes or PAD. This study did not find relevant impairment of microperfusion parameters under compression therapy in these patient subgroups in physiologic body positions.Trial registration numberNCT03384758.

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Influence of Medical Compression Stockings on Skin Hydration in Mainly Health Care Givers with Occupational Leg Symptoms and Edema

Skin Pharmacology and Physiology ◽

10.1159/000512642 ◽

2021 ◽

Vol 34 (2) ◽

pp. 57-73

Author(s):

Marina Mayer-Yousif ◽

Wolfgang Konschake ◽

Hermann Haase ◽

Michael Jünger ◽

Helene Riebe

Keyword(s):

Skin Barrier ◽

Compression Therapy ◽

Transepidermal Water Loss ◽

Skin Hydration ◽

Skin Barrier Function ◽

Interface Pressure ◽

Compression Stockings ◽

Care Givers ◽

Leg Edema ◽

Medical Compression Stockings

Background and Objective: Although compression therapy is a very effective therapy in reducing stasis-induced complaints, the wearing comfort is not always as requested. Most frequent problems are dryness of the skin and itching. This randomized, cross-over trial investigated 33 healthy participants and compared 2 different medical compression stockings: conventional stockings (type A = MCS) versus compression stockings with integrated care emulsion (type B = MCS-SkC). Methods: Participants were divided into 2 cohorts. Both compression types were worn one after the other, 1 week each. The cohorts were named according to the sequence of the wearing periods (cohort AB/BA). Primary outcome: skin hydration. Secondary outcomes: transepidermal water loss (TEWL), skin roughness, leg volume, interface pressure, and questionnaires about stasis-induced complaints and wearing comfort. Results: Skin hydration: significant reduction after wearing MCS in both cohorts (p < 0.001); preservation of skin moisture after wearing MCS-SkC (p = 0.546 and p = 0.1631). TEWL: significant increase after wearing MCS (p = 0.007 and p = 0.0031); significant reduction by wearing MCS-SkC (p = 0.006 and p = 0.0005). Skin roughness: significant increase after wearing MCS (p = 0.0015 and p = 0.010), and nonsignificant decrease of skin roughness after wearing MCS-SkC (p = 0.933 and p = 0.4570). Leg volume: significantly reduced with both stockings (p = 0.004 and p = 0.0047). Regarding stasis-induced complaints, both stockings achieved good results. Conclusions: Both compression stockings are appropriate to reduce leg edema and minimize leg symptoms. MCS-SkC helps to obtain the natural skin barrier function in preserving the epidermal water content and reducing the TEWL.

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Efficacy and comfort of medical compression stockings with low and moderate pressure six weeks after vein surgery

Phlebology The Journal of Venous Disease ◽

10.1177/0268355513484142 ◽

2013 ◽

Vol 29 (6) ◽

pp. 358-366 ◽

Cited By ~ 12

Author(s):

Stefanie Reich-Schupke ◽

Felix Feldhaus ◽

Peter Altmeyer ◽

Achim Mumme ◽

Markus Stücker

Keyword(s):

Randomized Study ◽

Early Period ◽

Compression Therapy ◽

Pressure Control ◽

Moderate Pressure ◽

Compression Stockings ◽

Significant Difference ◽

Group A ◽

Group B ◽

Medical Compression Stockings

Objective The first two authors contributed equally to this work. A prospective, randomized study to evaluate efficacy, safety, and comfort of thigh-high, round knitted medical compression stockings (MCSs) with different pressure six weeks after vein surgery. Methods Female patients undergoing vein surgery were randomized for a compression therapy with low (18–21 mmHg, group A) or moderate (23–32 mmHg, group B) pressure MCSs. Follow-up was done by a phlebological experienced, blinded physician (pressure control, clinical aspect, duplex scan, and questionnaire) one and six weeks after surgery. Results Totally, 88 patients (41 in group A and 47 in group B) were analyzed. One week after surgery, patients of group B had significantly lower edema scores than patients of group A either in the clinical assessment (0.7 vs. 0.3; p = 0.016) or in the B-mode scan (0.9 vs. 0.4; p = 0.013). Significant less patients of group B had a feeling of “tightness” ( p = 0.01) and significant more a reduction of discomfort ( p = 0.01) after week 1 but with no significance in week 6. There was no significant difference according to other clinical and ultrasound findings such as hematoma, infection, hyperpigmentation, cording, or thrombosis after one or six weeks. In week 1 and week 6, more patients suffered from pain in group A (week 1 p = 0.24, week 6 p = 0.063). Application of the MCSs was easier in group A in week 1 but similar in groups A and B in week 6. Muscle vein thrombosis occurred in one patient of group A. Conclusion Compression stockings with a pressure of 23–32 mmHg facilitate a faster resolution of clinical and ultrasound verified edema and the subjective feelings of pain, tightness, and discomfort of the leg in the early period after surgery but have no difference in the longer post-surgical period compared to stockings with a pressure of 18–21 mmHg.

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Primary varicose veins

Phlebologie ◽

10.1055/s-0037-1622305 ◽

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.

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Randomized trial of medical compression stockings versus two-layer short-stretch bandaging in the management of venous leg ulcers

Phlebologie ◽

10.1055/s-0037-1622268 ◽

2009 ◽

Vol 38 (04) ◽

pp. 157-163 ◽

Cited By ~ 9

Author(s):

A. Franek ◽

L. Brzezinska-Wcislo ◽

E. Blaszczak ◽

A. Polak ◽

J. Taradaj

Keyword(s):

Drug Therapy ◽

Randomized Clinical Trials ◽

Therapy Group ◽

Long Term Results ◽

Leg Ulcers ◽

Compression Stockings ◽

Venous Leg Ulcers ◽

Group A ◽

Group B ◽

Medical Compression Stockings

SummaryA prospective randomized clinical trial was undertaken to compare a medical compression stockings with two-layer short-stretch bandaging in the management of venous leg ulcers. Study endpoints were number of completely healed wounds and the clinical parameters predicting the outcome. Patients, methods: Eighty patients with venous leg ulcers were included in this study, and ultimately allocated into two comparative groups. Group A consisted of 40 patients (25 women, 15 men). They were treated with the compression stockings (25–32 mmHg) and drug therapy. Group B consisted of 40 patients (22 women, 18 men). They were treated with the short-stretch bandages (30–40 mmHg) and drug therapy, administered identically as in group A. Results: Within two months the 15/40 (37.50%) patients in group A and 5/40 (12.50%) in group B were healed completely (p = 0.01). For patients with isolated superficial reflux, the healing rates at two months were 45.45% (10/22 healed) in group A and 18.18% (4/22 healed) in group B (p = 0.01). For patients with superficial plus deep reflux, the healing rates were 27.77% (5/18 healed) in group A and 5.55% (1/18 healed) in group B (p = 0.002). Comparison of relative change of the total surface area (61.55% in group A vs. 23.66% in group B), length (41.67% in group A vs. 27.99% in group B), width (46.16% in group A vs. 29.33% in group B), and volume (82.03% in group A vs. 40.01% in group B) demonstrated difference (p = 0.002 in all comparisons) in favour of group A. Conclusion: The medical compression stockings are extremely useful therapy in enhancement of venous leg ulcer healing (both for patients with superficial and for patients who had superficial plus deep reflux). Bandages are less effective (especially for patients with superficial plus deep reflux, where the efficiency compared to the stockings of applied compression appeared dramatically low). These findings require confirmation in other randomized clinical trials with long term results.

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Healing venous ulcers with different modalities of leg compression

Phlebologie ◽

10.1055/s-0037-1622150 ◽

2006 ◽

Vol 35 (05) ◽

pp. 349-355 ◽

Cited By ~ 9

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.

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Comfort Properties of Medical Compression Stockings from Biodesigned and Cotton Fibers

Fibers and Polymers ◽

10.1007/s12221-021-0615-8 ◽

2021 ◽

Author(s):

Ferid Kırcı ◽

Ecem Karamanlargil ◽

Sena Cimilli Duru ◽

Banu Nergis ◽

Cevza Candan

Keyword(s):

Cotton Fibers ◽

Compression Stockings ◽

Medical Compression Stockings

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Postural differences in the immediate effects of active exercise with compression therapy on lower limb lymphedema

Supportive Care in Cancer ◽

10.1007/s00520-020-05976-y ◽

2021 ◽

Author(s):

Kiriko Abe ◽

Tetsuya Tsuji ◽

Asako Oka ◽

Junichi Shoji ◽

Michiyo Kamisako ◽

...

Keyword(s):

Clinical Trial ◽

Supine Position ◽

Lower Limb ◽

Gynecological Cancer ◽

Compression Therapy ◽

Bicycle Ergometer ◽

Therapeutic Effects ◽

Clinical Trial Registration ◽

Mixed Effect ◽

Compression Bandages

Abstract Purpose Although regarded as an important treatment for lymphedema, the therapeutic effects of active exercise with compression therapy (AECT) are supported by little evidence. The purpose of this study was to determine the relative benefits of AECT with different postures for patients with lower limb lymphedema (LLL). Methods Eighteen women with LLL secondary to surgical treatment of gynecological cancer, completed (1) AECT in a seated position (seated AECT), (2) AECT in a supine position (supine AECT), and (3) compression-only therapy in a supine position (CT) in this randomized, controlled, crossover trial. AECT was performed on a bicycle ergometer while wearing elastic compression bandages. Each intervention was performed for 15 min, and the three conditions were separated by a 1-week washout period. Lower-limb volumes were evaluated using a PerometerTM sensor (Pero-system, Wuppertal, Germany), and symptom severity was assessed before and after each intervention using a visual analog scale (pain, heaviness) and palpation (pitting, stiffness). The effects of the interventions were estimated using linear mixed-effect models. Results The magnitude of limb volume decreases differed significantly among the interventions, with a greater decrease after supine AECT than after CT. Pre-intervention pitting severity and skin stiffness were significantly correlated with the magnitude of volume decrease after all interventions and after AECT in the supine position, respectively. Conclusions Supine AECT using a bicycle ergometer has marked immediate effects to decrease the fluid volume of severe LLL. Clinical trial registration UMIN clinical trial registry (UMIN-CTR; ID000020129) by CONSORT 2010, TRN R000023253, December 9, 2015

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