Does the use of compression bandaging as an adjunct improve outcomes for people following excision of keratinocyte cancers of the lower leg with secondary intention healing?

Bandages are common in many health-related treatments, including management of edema of the lower limb where they may remain in place for several days. The behavior of 2 bandage fabrics was investigated after exposure for up to 5 days to a multiaxial extension laboratory setup on a tensile tester in compression mode. The fabrics were extended 20% and remained under that machine setting. Stress-relaxation over time was determined by analyzing the rate of change over 24 hours and over 5 days. Most change, a rapid drop in force, occurred during the first 15 minutes; thereafter, for the next 12-hour period, a slower rate of decrease was observed. Both fabrics continued to relax gradually during the next 12 hours and continued to do so for up to 5 days. Little further change was evident during the last 12 hours or so. This phenomenon suggests that rewrapping may be appropriate (albeit not practical) after 12 hours of compression therapy to optimize the compression given to the lower leg. Relaxation behavior of these 2 fabrics can be explained using the generalized Maxwell-Wiechert model.

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Surgical debulking of podoconiosis nodules and its impact on quality of life in Ethiopia

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009053 ◽

2021 ◽

Vol 15 (1) ◽

pp. e0009053

Author(s):

Wendemagegn Enbiale ◽

Kristien Verdonck ◽

Melesse Gebeyehu ◽

Johan van Griensven ◽

Henry J. C. de Vries

Keyword(s):

Quality Of Life ◽

Standard Procedure ◽

Teaching Hospitals ◽

Secondary Intention ◽

Compression Bandaging ◽

Resource Limited ◽

Surgical Debulking ◽

One Year ◽

Limited Setting

Background In Ethiopia, severe lymphedema and acute dermato-lymphangio-adenitis (ADLA) of the legs as a consequence of podoconiosis affects approximately 1.5 million people. In some this condition may lead to woody-hard fibrotic nodules, which are resistant to conventional treatment. We present a series of patients who underwent surgical nodulectomy in a resource-limited setting and their outcome. Methods In two teaching hospitals, we offered surgical nodulectomies under local anaesthesia to patients with persisting significant fibrotic nodules due to podoconiosis. Excisions after nodulectomy were left to heal by secondary intention with compression bandaging. As outcome, we recorded time to re-epithelialization after surgery, change in number of ADLA episodes, change in quality of life measured with the Dermatology Quality of Live Index (DQLI) questionnaire, and recurrence rate one year after surgery. Results 37nodulectomy operations were performed on 21 patients. All wounds re-reepithelialised within 21 days (range 17–42). 4 patients developed clinically relevant wound infections. The DLQI values were significantly better six months after surgery than before surgery (P<0.0001). Also the number of ADLA episodes per three months was significantly lower six months after surgery than before surgery (P<0.0001). Conclusion Nodulectomy in podoconiosis patients leads to a significant improvement in the quality of life with no serious complications, and we recommend this to be a standard procedure in resource-poor settings.

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Compression bandaging does not compromise peripheral microcirculation in patients with cellulitis of the lower leg

European Journal of Dermatology ◽

10.1684/ejd.2019.3606 ◽

2019 ◽

Vol 29 (4) ◽

pp. 396-400

Author(s):

Sophie Bojesen ◽

Mette Midttun ◽

Lothar Wiese

Keyword(s):

Lower Leg ◽

Compression Bandaging ◽

Peripheral Microcirculation

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Numerical steady flow solutions of the lower leg venous circulation: effects of external compression

The European Physical Journal Applied Physics ◽

10.1051/epjap:2007066 ◽

2007 ◽

Vol 38 (3) ◽

pp. 287-297

Author(s):

J.-M. Fullana ◽

P. Flaud

Keyword(s):

Steady Flow ◽

Lower Leg ◽

External Compression ◽

Venous Circulation

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Comparison of standardised lymphoscintigraphic function test and high resolution sonography of the lymphoedema of legs

Phlebologie ◽

10.1055/s-0037-1622238 ◽

2008 ◽

Vol 37 (05) ◽

pp. 247-252 ◽

Cited By ~ 4

Author(s):

V. S. Brauer ◽

W. J. Brauer

Keyword(s):

Lower Leg ◽

Clinical Findings ◽

Lower Limbs ◽

Fatty Tissue ◽

Qualitative And Quantitative ◽

Function Test ◽

Unreliable Method ◽

Negative Conclusion ◽

Fine Disperse

SummaryPurpose: Comparison of qualitative and quantitative sonography with the lymphoscintigraphic function test and clinical findings in legs. Patients, methods: In 33 patients a lymphoscintigraphic function test of legs combined with measurement of lymph node uptake was performed and subsequently compared with sonography. Sonographic criteria were: Thickness of cutis, thickness of subcutanean fatty tissue and presence of liquid structures or fine disperse tissue structure of lower limbs, foots and toes. Results: In 51 legs uptake values lie in the pathologic area, in four legs in the grey area and in ten legs in the normal area. The cutis thickness in the lower leg shows no significant correlation with the uptake. The determination of the thickness of the subcutanean fatty tissue of the lower leg and of the cutis thickness of the feet turned out to be an unreliable method. In 47% of the medial lower legs and in 57% of the lateral lower legs with clinical lymphoedema sonography is falsely negative. Conclusion: Early lymphoedema is only detectable with the lymphoscintigraphic function test. In the case of clinical lymphoedema clinical examination is more reliable than sonography.

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Evidence Summary: Venous leg ulcers: Multi-layer compression bandaging

Wound Practice and Research ◽

10.33235/wpr.27.1.49-51 ◽

2019 ◽

pp. 49-51

Author(s):

Emily Haesler

Keyword(s):

Leg Ulcers ◽

Venous Leg Ulcers ◽

Compression Bandaging ◽

Evidence Summary

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Maisonneuve fracture

Perspectives in Surgery ◽

10.33699/pis.2020.99.2.77-85 ◽

2020 ◽

Vol 99 (2) ◽

pp. 77-85

Keyword(s):

Open Reduction ◽

Lower Leg ◽

Fracture Dislocation ◽

Deltoid Ligament ◽

Ct Reconstruction ◽

Distal Fibula ◽

Ct Examination ◽

Maisonneuve Fracture ◽

Fibular Fracture ◽

Wide Range

Introduction: Maisonneuve fracture (MF) is a generally known entity in ankle trauma. However, details about this type of injury can be found only rarely in the literature. For these reasons we have decided to perform a study on MF epidemiology and pathoanatomy. Methods: The group comprised 70 patients (47 men, 23 women), with the mean age of 48 years, who sustained an ankle fracture-dislocation involving the proximal quarter of the fibula. Ankle radiographs in three views and lower leg radiographs in two views were performed in all patients. A total of 59 patients underwent CT examination in three views, including 3D CT reconstruction in 49 of these patients. MRI was performed in 4 patients. Operative treatment was used in 67 patients; open reduction of the distal fibula into the fibular notch was opted for in 54 of them. Results: The highest MF incidence rate was recorded in the 5th decade in the whole group and in men, while in women the peak incidence was in the 6th decade. After the age of 50, the share of women significantly increased. In 64 cases, the fibular fracture was subcapital, and in 6 cases it involved the fibular head. In 24% of the patients, the fibular fracture was seen only in the lateral radiograph of the lower leg. Widening of the tibiofibular clear space was shown by radiographs in 40 cases. Posterior dislocation of the fibula (Bosworth fracture) and tibiofibular diastasis were recorded in 2 cases each. An injury to the anterior and posterior tibiofibular ligaments was found in all 54 patients with open reduction of the distal fibula. A fracture of the medial malleolus was identified in 27 cases (39%) and a complete lesion of the deltoid ligament in 36 cases (51%); in 7 cases (10%) the medial structures were intact. A fracture of the posterior malleolus occurred in 54 (77%) patients. Osteochondral fracture of the talar dome was diagnosed in 2 patients and compression of the articular surface of the distal tibia in the region of the fibular notch in 1 patient. Conclusion: Maisonneuve fracture includes a wide range of injuries both to bone and ligamentous structures of the ankle. Therefore, CT examination is an indispensable part of assessment of this type of fracture.

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