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The System 4 multi-layer system (SSL International) is a compression regime indicated for the treatment of venous leg ulceration. Compression bandaging has become the main treatment for effective healing rates in this type of leg ulcer. System 4 is simple to use and cost-effective.
This article gives an overview of the treatment and causes of venous leg ulcers and focuses on a new four-layer bandage system (K-Four from Parema) which can be used in the treatment of these ulcers. The article features preliminary observations of this new system, which was used on 10 patients who had previously worn multilayer compression.
This article describes how an assessor's guide and a student learning contract about compression and Doppler therapy was presented to community nurses and practice nurses in an NHS acute and community trust. The objectives were to provide potential assessors with standardized practice in the application of compression bandaging and the use of Doppler-assisted diagnosis in the treatment of venous leg ulceration. This was achieved by a teaching session using two checklists, one for the assessor and the other for the 'student'. Role play was used to allow experience of assessing or being assessed in a classroom setting. References to key pertinent articles were provided to support the learning contract, and the development of a resource file was proposed. In recognizing their own limited knowledge and experience, a small number of practitioners felt unable to assess 'officially' other members of their staff.
This paper reports the healing rates of venous leg ulcers in a community setting (Exeter and District Community Health Services NHS Trust) using the Charing Cross four-layer compression system. We report on 514 venous leg ulcers and show healing rates of 40% at 12 weeks, 50% at 17 weeks, 57% at 24 weeks and 80% predicted at 2 years. Patients were treated in one of 16 community leg ulcer clinics or in their homes. Nurses were allowed to use this system only after full training by the leg ulcer management service. Nurses had to prove their competence in leg ulcer assessment, Doppler measurement and the technique of four-layer compression. Even in patients whose leg ulcers did not heal, it was felt that the four-layer compression system was comfortable, convenient and cost effective with only weekly changes of bandages being necessary.
This study describes the construction and calibration of a three-channel bandage pressure monitor and evaluates its in-service use. The monitor was constructed from a range of commercially available, relatively inexpensive components consisting of a pressure sensor, piezoresistive transducer, differential amplifier and liquid crystal display. The pressure sensors show a good ratio of thickness to surface area (< 10%) and are sufficiently robust and flexible to conform to most anatomical profiles. The transducers are internally calibrated and temperature-compensated to provide an accurate and stable measurement of gauge pressure relative to atmospheric pressure. During laboratory assessment and in-service use, the system has proved to be reliable, accurate (typically < +/- 0.5 mmHg) and reproducible over repeated calibration.
This paper reports the results of an analysis designed to estimate the expected annual cost per patient of treating venous leg ulcers, and to evaluate the relative cost-effectiveness of a systematic treatment regimen using a four-layer compression bandaging system (Profore) compared with usual care. A Markov model has been developed which simulates the transition of patients between health states (healed and unhealed) over a 52-week period. Healing rates used in the model are derived from those reported in the literature. By running the model for a cohort of 100 patients over 52 weeks it is possible to estimate expected outcomes and annual budgetary costs for alternative treatment regimens. Results suggest that, when compared with usual care, a systematic treatment regimen using Profore is unambiguously more cost-effective. Patient outcomes are improved and annual treatment costs reduced. An important implication is that failure to co-ordinate treatment policies and to use the most cost-effective treatments may result in substantial inefficiency in the use of NHS resources. This inefficiency could represent the equivalent of between 350,000 Pounds and 1.08 million Pounds annually for a typical health authority.
Practitioners are generally advised not to use short-stretch bandages on patients who are immobile. But this appears to reflect confusion about calf muscle function, which research indicates still occurs during periods of limited mobility.
A bulky compression dressing (the Robert Jones bandage) is often used by orthopaedic surgeons. We have reviewed its history and monitored intramuscular compartment pressure under it after total knee replacement. We found that it increased compartment pressure and helped to reduce bleeding, tissue oedema and the size of effusions and haemarthroses.
We randomized 73 patients with grades II and III ankle sprain to treatment with an Air-Stirrup ankle brace or a compression bandage. All patients were instructed to attempt early motion and weight bearing when comfortable. Ankle function was evaluated after 3-5 days and 2, 4, and 10 weeks with a clinical examination, the Sickness Impact Profile questionnaire, Karlsson's scoring scale and recording of sick leaves. The group treated with the Air-Stirrup ankle brace was more mobile in the initial phase of rehabilitation and had a shorter sick leave. Ankle brace treatment resulted in socioeconomic savings.
PURPOSE: A major disadvantage of photorefractive keratectomy (PRK) is pain and discomfort in the first three postoperative days. We tried to assess the efficacy and safety to the cornea of a limited amount of topical tetracaine given to patients for use when needed to manage severe pain. METHODS: Sixty-nine eyes of 49 patients who underwent PRK between June 21, 1996 and June 15, 1998 by a single surgeon were prospectively included. Approximately 10 drops of commercial, non-preserved 0.5% tetracaine were given to patients to use when needed to control severe pain. A bandage soft contact lens was applied. Patients were examined at 1 and 3 days after surgery, at which time corneal re-epithelization was assessed and the number of tetracaine drops used was noted. No systemic analgesic or topical non-steroidal anti-inflammatory was prescribed. RESULTS: All eyes healed within 3 days. The mean number of drops of tetracaine used was 2.3 drops over 3 days, although in 33 eyes (48%) the patient did not use any tetracaine. There was no correlation between the attempted correction in diopters and the number of drops used. No significant difference was found in the number of drops used in the second eye of patients who had both eyes treated. CONCLUSIONS: Limited use of topical anesthetics is an effective and safe analgesic option after PRK. Use of tetracaine in this protocol did not prolong the time to re-epithelialization. Giving only a limited amount of tetracaine to patients prevents abuse and toxicity to the cornea while managing severe pain.
Compression therapy is an important element to the treatment of venous leg ulcers. The factors to be considered when applying compression bandage therapy are discussed in detail.
This article discusses the different techniques that should be used for compression bandaging.
OBJECTIVE: Early closure of the tympanic membrane, after removal of longstanding ventilation T tubes (VTs), is a desirable outcome. A prospective randomized control study was undertaken to determine if spontaneous healing of the tympanic membrane is promoted with a bandage contact lens (BCL). METHOD: Thirty-nine paediatric patients, who required removal of VTs under general anaesthesia, were selected. After removal of the ventilation tubes, one tympanic membrane was randomly selected for patching with a BCL, while the other underwent conservative management. Follow-up examination was performed at 2 weeks. Remaining perforations of the tympanic membranes were noted. The mean length of time VTs were present was 35.7 months. RESULTS: Chi-square analysis reveals that a significantly greater proportion of tympanic membranes patched with a BCL were healed at 2 weeks (p < .005). CONCLUSIONS: Thus, promotion of spontaneous healing with BCL may allow for decreased risk of infection, improved hearing, and earlier avoidance of precautions necessary for perforated tympanic membranes. Also, it is possible that promoting spontaneous healing at the early phase may decrease the number of persistent tympanic membrane perforations after VT removal.
OBJECTIVE: To report on the use of a new bandage contact lens (BCL) for a leaking filtering bleb. PATIENTS AND METHODS: A hollow BCL, with an internal central opening of 6 mm, has been applied on three eyes that had leaking blebs shortly after either trabeculectomy or combined cataract extraction and trabeculectomy, each with a fornix-based conjunctival flap. RESULTS: The treatment with this lens was found beneficial: the leakage subsided and the patients were comfortable with the lens. The internal hollow of the BCL enabled us to monitor the intraocular pressure throughout the entire follow-up period without transient and repeated removal of the BCL. CONCLUSION: The new hollow BCL was found efficacious. The study suggests that this lens may have advantages over the commonly used BCLs that are related to the elimination of the need for its frequent removal and reinsertion for tonometry. This decreases the risk of both the exposure of the lens and the filtering bleb to contamination and the interference with the continuity of the process of conjunctival epithelial closure.
OBJECTIVE: To evaluate whether applying pressure equivalent to that of pressure immobilisation bandages (PIB) causes release of additional venom from discharged jellyfish nematocysts. DESIGN: In-vitro experiment--the venom beads released from electrically activated Chiropsalmus sp. nematocysts were viewed under direct microscopy before and after applying 40 mmHg pressure (replicating the pressure of PIB); and saline washings of discharged nematocysts before and after applying pressure were tested for toxicity (time to ventricular standstill after injecting into live prawns). RESULTS: Applying 40 mmHg pressure caused the venom beads to visibly increase in size, consistent with pressure expressing further venom from the discharged nematocysts. First washings of the nematocyst shafts before compression produced ventricular standstill in prawns within 60 seconds (n=3); second washings did not produce standstill during 540 seconds of observation (n=3); and washings after applying 40 mmHg pressure showed a return of toxicity, with ventricular standstill in all prawns within 180 seconds (n=3). CONCLUSION: Discharged nematocysts are by no means empty and harmless. Applying pressure results in further release of nematocyst venom. The currently recommended practice of applying PIB in the initial treatment of patients stung by a jellyfish may exacerbate the envenomation, and thus should not be recommended.
Post cardiac catheterization puncture site care is usually done with a tight pressure dressing by an elastic adhesive bandage (Tensoplast) due to the belief that it should prevent bleeding. The practice is uncomfortable to the patients. The authors compared a new way of dressing using light transparent tape (Tegaderm) to the conventional tight pressure one. 126 post coronary angiography patients were randomized to have their groins dressed either with Tensoplast or with Tegaderm. Patients ambulated 8 hours after the procedures. The groin was evaluated for pain, discomfort and bleeding complications. 49 per cent in the Tensoplast vs 26.9 per cent in the Tegaderm group experienced pain (p value of 0.01). 55.5 per cent in the Tensoplast group vs 11.1 per cent in the Tegaderm group reported discomfort. 4.7 per cent in the Tensoplast vs 1.6 per cent in the Tegaderm group developed bleeding or hematoma. Dressing of the puncture site after cardiac catheterization with Tegaderm was more comfortable than the conventional Tensoplast without any difference in bleeding complications.
Neurogenic orthostatic hypotension (OH) often causes troublesome symptoms such as dizziness, syncope and falling, interfering active daily life or various therapies in rehabilitation. Nonpharmacologic measures for treating patients with OH include wearing elastic leotard, head-up tilting at night, etc. Elastic garment or antigravity suits is certainly effective, but it may be uncomfortable and not practical. Although elastic bandage (EB) bound on the lower limbs has been thought to be useful, there is few clinical report about its beneficial evidence. We investigated short-term clinical effects of commercially available EB on OH, and estimated the mechanism of its effectiveness by measuring some blood pressure-related humoral variables in neurodegenerative patients with OH.
Short-stretch compression bandages have been shown to be as cost-effective and efficient as other compression systems in healing venous ulcers, independent of associated factors (Scriven et al, 1998; Nelson, 1996). However, as they do not contract around a limb they do not exert pressure during inactivity (resting pressure) (Klose Norton, 2003). But their stability creates a high resistance to stretch when pressure is applied through internal muscle contraction and joint movement (working pressure) (Tuckwood, 1996).