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PubMed1993

Coronary circulation in dogs with an experimental decrease in aortic compliance.

OBJECTIVES: This study was designed to investigate the effects of decreased aortic compliance on the coronary circulation. BACKGROUND: A decrease in aortic compliance due to arteriosclerosis is observed in patients with coronary artery disease. However, the effects of decreased aortic compliance on the coronary circulation have not yet been investigated sufficiently. METHODS: Hemodynamics, subendocardial electrocardiogram (ECG), myocardial segmental length and myocardial blood flow were investigated in six dogs with aortic bandaging (bandaged group) and five dogs with a sham operation (control group) at rest and during pacing 4 weeks after surgery. RESULTS: Aortic compliance in the bandaged group was less than that in the control group (0.24 +/- 0.20 vs. 0.50 +/- 0.22 ml/mm Hg, p < 0.05). Pulse pressure and the tension-time index were significantly greater in the bandaged group than in the control group, but systemic vascular resistance was not altered significantly. The subendocardial/subepicardial flow ratio was lower in the bandaged group than in the control group (0.95 +/- 0.31 vs. 1.57 +/- 0.26, p < 0.05). In the region supplied by the left circumflex artery with a stenosis that was adjusted to eliminate reactive hyperemia, rapid atrial pacing (heart rate 200 beats/min) further decreased endocardial flow and the endocardial/epicardial flow ratio in the bandaged group. Moreover, both the reduction of segmental shortening and the ST elevation on the subendocardial ECG in the left circumflex-supplied region during pacing were greater in the bandaged group. CONCLUSIONS: These results indicate that decreased aortic compliance greatly increases the risk of subendocardial ischemia in the presence of coronary stenosis.

Animals↗
PubMed1999

Biomechanical assessment of gait in below-knee walking casts.

The introduction of modern synthetic casting bandages for splinting of fractures and soft tissue injuries has allowed the development of new casting techniques. Casts can be constructed with a greater degree of function so that controlled motion and stabilisation can be provided within the same cast. This study has shown that a very efficient gait can be achieved with modern synthetic bandages, if they are correctly applied. The authors have compared the gait of volunteer subjects fitted respectively with below-knee walking casts constructed from a rigid glass fibre bandage and a flexible glass fibre bandage which is reinforced. These casts were wrapped so that minimal amounts of bandage were used whilst appropriate strength and stiffness was provided. The temporal and spatial factors of cast gait were not statistically different from normal gait. The cast gait was found to be slightly more asymmetrical (dominant versus non-dominant leg) when a cast was worn and there was also a greater Physiological Cost Index (PCI). The flexible bandage has some advantages compared with the rigid bandage as normal footwear can be worn, the casts are more comfortable and they could be removed with shears, obviating the need for a power saw.

Adult↗
PubMed2007

A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers.

OBJECTIVES: We evaluated the effectiveness of pentoxifylline, knitted viscose or hydrocolloid dressings, and single-layer or four-layer bandaging for venous ulceration. METHOD: A factorial randomized controlled trial with 24-week follow-up was conducted in leg ulcer clinics in Scotland with blinded allocation to pentoxifylline (1200 mg) or placebo, knitted viscose or hydrocolloid dressings, and single-layer or four-layer bandages. The study enrolled 245 adults with venous ulcers. The main outcome measure was time to complete healing. Secondary outcomes included proportions healed, withdrawals, and adverse events. Analysis was by intention to treat. RESULTS: There was no evidence of interaction between the drug, bandages, and dressings. Pentoxifylline was associated with nonsignificant increased ulcer healing (62% vs 53%; P = .21). Four-layer bandages were associated with significantly higher healing rates (67% vs 49%; P = .009). There was no difference in healing between knitted viscose and hydrocolloid dressings (58% and 57%; P = .88). Cox regression models increased the significance of the pentoxifylline effect (relative risk of healing, 1.4; 95% confidence interval, 1.0 to 2.0). CONCLUSIONS: Pentoxifylline increased the proportion healing compared with placebo to the same extent as shown in recent systematic reviews, although this finding was only statistically significant when a secondary adjusted analysis was conducted. Four-layer bandaging produced higher healing rates than single-layer bandaging. There was no difference in time to healing between knitted viscose and hydrocolloid dressings.

Administration, Oral↗
PubMed2006

A new technology for reducing shear and friction forces on the skin: implications for blister care in the wilderness setting.

OBJECTIVE: It is well known that physical trauma to skin caused by repetitive friction is a primary component of blister formation. Although friction blisters in a wilderness setting particularly occur on the feet and ankles, they often form on the hands and fingers during such activities as white-water rafting, kayaking, and canoeing. These blisters are often incapacitating and can have disabling consequences. This article describes laboratory and clinical experiments testing the efficacy of a new bandage technology in reducing shear and friction forces on the skin. METHODS: A custom-made apparatus was used in a laboratory setting to measure and compare the surface coefficient of friction of 11 bandages. In addition, a controlled clinical study was conducted on 15 healthy, able-bodied female subjects (mean age 35 years), where the same apparatus was used to measure the coefficient of friction of the skin over the medial tibial cortex with and without the new technology device in place. RESULTS: This laboratory study demonstrated the new device to have the lowest surface coefficient of friction of any bandage tested (0.57). For example, the common product Moleskin was 21% higher (0.67), with all other products testing at least 64% higher (>0.94). In the clinical study, the new technology device reduced the coefficient of friction on the skin by 31% (0.225 vs. 0.327), and this difference was statistically significant (P < .001). CONCLUSIONS: A bandage containing a new technology demonstrated the lowest surface coefficient of friction of any bandage tested. In addition, clinical tests performed with the same bandage demonstrated significant reduction of the coefficient of friction on the skin.

Adolescent↗
PubMed1999

[Value of compression therapy in treatment of deep venous thrombosis].

Therapy in the acute phase of deep vein thrombosis aims to prevent the longitudinal growth of the thrombus as well as the life-threatening complication of pulmonary embolism. Compression therapy is part of all revascularisative and conservative treatment strategies, but hardly mentioned in most of the literature. Clinical efficacy of a sufficient compression therapy in patients with acute deep vein thrombosis is marked by a quick ease of subjective complaints as well as a reduction of the edema. The long-term risk of deep vein thrombosis, the postthrombotic syndrome, is avoidable by the use of compression therapy. Clinical studies about the effectiveness in relation to the length of the thrombus and the incidence of pulmonary embolism are missing as well as studies about the selection of the best compression material. Recently compression pressures were experimentally measured between long and short stretch bandages and the skin in order to select bandage material. It can be concluded that long stretch bandages can be used in the treatment of acute phlebothrombosis in mobile out-patients. Short stretch bandages should be used in immobile patients in order to avoid high pressures between the skin and the bandages. Compression stockings (Class III) represent an equivalent alternative to compression bandages after the resolution of edema.

Acute Disease↗
PubMed1985

[Compression in vascular pathology. Practical applications].

A better use of the methods of compression in vascular disease would be based on a progression of the available techniques: fixed compression, elastic bandages, elastic stockings, so that one can pass from one degree to another, but only in the direction indicated, except in the case of regression of the disease, when treatment of the previous stage would be required. One should never replace elastic stockings by elastic bandages except in the case of regression, nor the bandage by the boot, except when the bandage fails. On the other hand, a favourable clinical evolution means that the boot can be replaced by the bandage, the bandage by the stocking, or directly from the boot to the stocking. The optimal choice of the method of compression is made from this progressive range on the basis of the evaluation of the severity of the vascular disorders.

Bandages↗
PubMedDate not supplied

Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation.

OBJECTIVES: To demonstrate and define normal lymphatic transit times by lymphoscintigraphy and to evaluate the efficacy of the currently recommended first-aid measures for the management of snake or spider envenomation. SETTING: The nuclear medicine department of a major teaching hospital. PARTICIPANTS AND DESIGN: Twenty-four subjects received either intradermal or subcutaneous injections of 99mtechnetium antimony sulfur colloid (0.1 mL) in both hands/forearms and feet/legs. This simulated a snake or spider bite. Fifteen of the subjects had first-aid in the form of firm bandages and splints applied to an upper and a lower limb immediately after injection. MAIN OUTCOME MEASURES: The progress of the radiotracer was followed with a large field of view gamma camera. If no egress of radiotracer was seen in the bandaged limbs, the subject walked until radioactivity was detected. RESULTS: The mean (+/- SEM) periphery-to-systemic circulation transit time after subcutaneous injection was 58 (+/- 7) minutes. The first-aid was found to be very effective when applied with bandage pressures ranging from 40 to 70 mmHg (5.3-9.3 kPa) in the upper limb and 55 to 70 mmHg (7.3-9.3 kPa) in the lower limb. Lower and higher bandage pressures were ineffective. However, despite first-aid measures, egress of radiotracer, even in the upper limbs, was seen in all subjects who walked for 10 minutes or more. CONCLUSIONS: Firm pressure bandaging is an effective means of restricting the lymphatic flow of toxins after envenomation, provided the bandage is applied within the defined pressure range. Strict limb immobilisation is necessary to minimise lymphatic flow, and walking after upper or lower limb envenomation will inevitably result in systemic envenomation despite first-aid measures.

Adult↗
PubMed1994

[Compression therapy in post-thrombotic syndrome].

The most important aim of compression therapy in postthrombotic legs is prevention of dermatosclerosis and ulcus cruris. For the acute stage of leg swelling and for venous ulceration we prefer compression bandages ("therapy phase"). The effect of compression therapy with bandages depend on the material of the used bandages (short or long-stretch bandages), the stretching the bandages are applied with, the number of layers, the local pads and on well done application of the bandages. After removal of oedema compression therapy should be continued with medical compression stockings ("maintenance phase"). Compression stockings should be fit on carefully and be checked from time to time to guarantee their application by the patient.

Bandages↗
PubMed1999

[Modified moisture chamber].

BACKGROUND: Moisture chambers can protect the eye in corneal lubrication or eyelid closure disorders. However, in cases with protrusio bulbi or pronounced chemosis conjunctivae direct damaging contact of the cornea or conjunctiva on the one hand and the inside of the moisture-chamber-bandage on the other hand are possible. Since commercial moisture-chamber-bandages are not available with different internal radii, new methods are necessary to increase the distance between the bandage and the eye. MATERIAL AND METHODS: A special pressure relieving foam dressing used in the therapy and prophylaxis of decubitus was prepared in such a way that a periocular attachment was enabled and an opening for the eye was left blank. This central opening was covered with a commercial moisture-chamber-bandage. Five test persons and two ventilated patients with protrusio bulbi and manifest lagophthalmus were treated with the modified moisture chamber. The relative humidity within the bandage was measured. RESULTS: The modified moisture chamber allows an individual adaptation to the periocular shape of the face and rises the level of the monoculus for about 7 mm. The internal relative humidity was for eight hours at 98% in both test persons and patients. All test persons felt more comfortable with the modified moisture chamber on their skin. CONCLUSIONS: The presented modified moisture chamber is a derivative of the commercial monoculus bandage for patients with sensitive protrusio bulbi.

Adult↗
PubMed2004

Effectiveness of microporous polysaccharide hemospheres for achieving hemostasis in mohs micrographic surgery.

BACKGROUND: Microporous polysaccharide hemospheres consist of controlled-porosity spherical particles manufactured from bioinert plant polysaccharide. Microporous polysaccharide hemospheres facilitate hemostasis by rapidly absorbing the fluid component of blood, concentrating platelets and clotting factors to accelerate blood clotting. OBJECTIVE: The objective was to compare a microporous polysaccharide hemosphere bandage and electrocautery in achieving hemostasis. METHODS: Twenty-four patients with a total of 48 stages of Mohs micrographic surgery were included. Patients were stratified by whether or not they were taking anticoagulant medications. Within each group, patients were randomized to receive either the microporous polysaccharide hemosphere bandage or electrocautery. Outcomes included bleeding through the dressing (early time point) and active bleeding upon dressing removal (late time point). RESULTS: Nineteen patients not taking anticoagulants had 40 stages, of which 18 received the study bandage and 22 received electrocautery. The remaining 5 patients on anticoagulants had 8 stages, of which 4 received the study bandage and 4 received electrocautery. In both total and subgroup analysis, there was a higher incidence of bleeding through the dressing with the study bandage (p<0.05), but no increase in the incidence of active bleeding upon dressing removal (p>0.05). CONCLUSION: The microporous polysaccharide hemosphere study bandage had an increased incidence of bleeding through the dressing compared to electrocautery, but did not have an increased incidence of active bleeding upon dressing removal.

Aged↗
PubMed2002

Injection sclerotherapy for varicose veins.

BACKGROUND: Injection sclerotherapy for varicose veins has been used widely since 1963, following popularisation of the technique by Fegan. The treatment aims to obliterate the lumen of varicose veins or thread veins, however, there is limited evidence regarding its efficacy. OBJECTIVES: To determine whether sclerotherapy is effective in terms of symptomatic improvement and cosmetic appearance; has an acceptable complication rate; and to define rates of symptomatic or cosmetic varicose vein recurrence following sclerotherapy. SEARCH STRATEGY: Publications describing randomised controlled trials (RCTs) of injection sclerotherapy for varicose veins (excluding comparisons with surgery) were sought through EMBASE and MEDLINE (from inception to March 2001) and hand-searching relevant journals, using the search strategy described by the Cochrane Peripheral Vascular Diseases Review Group. Bibliographies of papers identified were examined for further RCTs. Manufacturers of sclerosants were contacted for further trial information. SELECTION CRITERIA: RCTs of injection sclerotherapy versus graduated compression stockings or 'observation', or comparing different sclerosants, doses and post-compression bandaging techniques on patients with symptomatic and/or cosmetic varicose veins or thread veins were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Ten studies were included in the analysis. These compared: sodium tetradecyl sulphate (STD) versus an alternative sclerosant; sclerosant with or without local anaesthetic; application of Molefoam versus Sorbo pads to injection sites; elastic compression bandaging versus conventional bandaging; and short-term bandaging versus standard bandaging. Data were abstracted by both authors. MAIN RESULTS: No RCTs compared sclerotherapy to graduated compression stockings or other non-surgical treatments. Two studies compared STD to alternative sclerosants and found no significant differences in outcome or complication rates. Adding local anaesthetic to sclerosant reduced the pain from injection (one study) but had no other effects. Comparison of Molefoam and Sorbo pad pressure dressings found no difference in outcome for erythema (redness) or successful sclerosis. The degree and duration of elastic compression had no significant effect on varicose vein recurrence rates, cosmetic appearance or symptomatic improvement. Increased compression prevented slipping of dressings but caused increased discomfort, as did increasing duration of compression. REVIEWER'S CONCLUSIONS: Evidence from RCTs suggests that type of sclerosant, local pressure dressing, degree and length of compression have no significant effect on the efficacy of sclerotherapy for varicose veins. This supports the current place of sclerotherapy in modern clinical practice, which is usually limited to treatment of recurrent varicose veins following surgery, and thread veins. A comparison of surgery versus sclerotherapy would be valuable.

Bandages↗
PubMed2005

Over-the-counter topical antimicrobials: effective treatments?

There are many over-the-counter (OTC) bandage products available. In addition to their direct purchase by the public, many physicians provide OTC bandages to their patents after minor surgeries. The aim of this study was to evaluate in a well established porcine model the efficacy against Staphylococcus aureus of four OTC antimicrobial containing bandages as compared to two OTC ointments. Multiple partial thickness wounds were made on the backs of four pigs. The wounds were treated within 20 min after S. aureus inoculation. The wounds were cultured quantitatively at 24 and 48 h. Only one of the antibiotic bandages and one of the topical ointments were effective in reducing S. aureus proliferation in partial thickness wounds. The two treatments that were effective were the only treatments that contained neomycin. Although many OTC bandages and ointments contain antimicrobials, they may not be effective at reducing bacteria in wounds.

Administration, Topical↗
PubMed1997

Management of 219 consecutive cases of postcatheterization pseudoaneurysm.

OBJECTIVES: We attempted to evaluate nonsurgical methods of treating postcatheterization pseudoaneurysm. BACKGROUND: The value of reapplication of a compression bandage, ultrasound-guided compression repair (UGCR) and awaiting spontaneous thrombosis in the treatment of postcatheterization pseudoaneurysms is unsettled. METHODS: We followed a stepwise treatment strategy of primarily conservative management using 1) reapplication of a compression bandage, followed by 2) UGCR, if needed, and 3) observation of the natural course. Surgical repair was reserved for patients with a rapidly expanding or complicated lesion. RESULTS: Reapplication of a compression bandage was performed in 128 patients and was successful in 32%. The success rate correlated inversely with anticoagulant therapy and the size of the aneurysm. In case of failure this pretreatment with a compression bandage significantly enhanced the success rate of subsequent UGCR (p = 0.04). UGCR was performed in 124 cases with a success rate of 84%. In 54 patients with a stable lesion, refraining from any (further) active measures resulted in spontaneous thrombosis of the aneurysm in 50 patients (93%) after 1 to 180 days (median 40 days). The course of the remaining four femoral artery aneurysms was uneventful. Definitive repair by operation or collagen plug implantation was required in only 20 patients (9%). CONCLUSIONS: The first measure performed in the treatment of pseudoaneurysms should be reapplication of a compression bandage, followed, if necessary, by UGCR. After failure of UGCR, spontaneous healing occurs in the majority of patients. Operation can be reserved for progressive and complicated lesions.

Adult↗
PubMed2000

Pressure support and elevation following the removal of a radial artery for coronary artery bypass grafting.

The saphenous vein was once the standard coronary artery bypass graft. Alternate grafts, primarily the radial artery and the internal mammary artery are now being utilised for revascularisation of the heart. However, the radial artery graft site can be at risk of oedema and the development of haematoma during the post-operative period. Also tension on the suture line may compromise circulation and create functional problems for the patient. The aim of this study was to assess the effect of pressure support (elastic support bandage) and elevation in reducing swelling and arm discomfort in the harvest arm. The patients in the study undergoing coronary artery bypass grafts were randomly assigned to one of three groups: elastic support bandage, collar and cuff sling and elevation on two pillows. There were 30 patients in each group. The circumference at three locations on the forearm was measured pre-operatively and on post-operative days 3 and 5. Pain was measured on a visual pain scale, which went from 1-10, with 10 being the most painful. The patients were also asked whether their arm movement felt restricted. The study found that there was no statistically significant difference (at the 0.05 level) between the three groups in the amount of swelling witnessed at the different forearm locations. There was, however, a significant decrease in swelling for all groups between days 3-5, but no difference in pain scores between the groups. Moreover, the collar and cuff sling group reported movement restriction, which was not apparent in the other two groups. In view of the findings, the researchers advocate the elastic support bandage. Patient compliance has practical implications when applying treatment and this is enhanced by the non cumbersome elastic support bandage. This can be compared to the collar and cuff sling and pillow elevation groups where the patient's daily activities affects compliance with these two treatments. It is recommended that future research be conducted comparing the effects of the elastic support bandage with a control group.

Activities of Daily Living↗
PubMed2001

An octyl-2-cyanoacrylate formulation speeds healing of partial-thickness wounds.

BACKGROUND: Occlusive dressings have been known to accelerate the rate of healing. Every year new dressings are being introduced in the marketplace. OBJECTIVE: The purpose of this study was to evaluate the effect of a new octyl-2-cyanoacrylate liquid dressing as compared to two over-the-counter bandages on partial-thickness wounds. Performance parameters were epithelialization, erythema, scab formation, material adherence, hemostasis, and infection. METHOD: Eight pigs with a total of 645 partial-thickness wounds were assigned to one of the following treatments: liquid dressing, standard bandage, hydrocolloid bandage, or untreated air exposed. RESULT: The liquid bandage enhanced the rate of epithelialization and was the only treatment to provide complete hemostasis, reduced scab formation, and did not induce an irritant response (erythema) or infection. CONCLUSION: The liquid bandage is an easy to use material that stops bleeding (instantaneous hemostasis) while enhancing healing of partial-thickness wounds.

Animals↗
PubMed2003

Functional treatments for acute ruptures of the lateral ankle ligament: a systematic review.

Our aim with this systematic review was to assess the effectiveness of various functional treatments for acute ruptures of the lateral ankle ligament in adults. We performed an electronic database search using MEDLINE, EMBASE, COCHRANE CONTROLLED TRIAL REGISTER and CURRENT CONTENTS. We evaluated randomized clinical trials describing skeletally mature subjects with an acute rupture of the lateral ankle ligament and compared functional treatments for inclusion in this study. 9 trials met our inclusion criteria. Two reviewers independently assessed the quality of these trials and extracted relevant data on treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcome and (weighted) mean differences (W)MD) for continuous outcome measures with 95% confidence intervals (95% CI). Heterogeneity between the trials was tested using a standard chi-square test. Persistent swelling at short-term follow-up was less with lace-up ankle support than with semi-rigid ankle support (RR 4.2 95% CI 1.3-14), an elastic bandage (RR 5.5; 95% CI 1.7-18) and tape (RR 4.1; 95% CI 1.2-14). A semi-rigid ankle support required a shorter period for return to work than an elastic bandage (WMD 4.2; 95% CI 2.4-6.1) (p = 0.7). One trial reported better results for subjective instability using the semi-rigid ankle support than the elastic bandage (RR 8.0; 95% CI 1.0-62). Treatment with tape resulted in more complications, mostly skin problems, than that with an elastic bandage (RR 0.1; 95% CI 0.0-0.8). We found no other statistically significant differences. We conclude that an elastic bandage is a less effective functional treatment. Lace-up supports seem better, but the data are insufficient as a basis for definite conclusions.

Bandages↗
PubMed2000

[Aftercare of malleolar fractures in Denmark. A questionnaire study].

A questionnaire was sent out to 59 orthopaedic departments. Seventy-eight percent returned the questionnaire. Four thousand two hundred ankle fractures are treated annually. Fifty percent are operated on (range 12.5-83%). Large departments are on average more surgically active than smaller ones. The noticeable difference, however, in surgical frequency is not connected to size, function or location of orthopaedic department. All fractures are usually immobilized with a circular plaster bandage. Thirty percent use dynamic bandages for some stable ankle fractures. Eighty-five percent bandage for six weeks, 15% for up to eight weeks. Very few allow early mobilization of surgically treated fractures (6%). The rest do not allow mobilization until at least three weeks after surgery. Stable fractures are more frequently permitted immediate mobilization. Several randomized studies recommend that all ankle fractures should be mobilized immediately, surgically treated in a circular plaster bandage, stable fractures in dynamic bandages.

Aftercare↗
PubMed1985

Intractable postphlebitic ulceration of the leg.

A new regimen for the successful treatment of intractable postphlebitic ulceration of the leg is described. It is based on preliminary culture of organisms in the ulcers followed by sensitivity tests to ascertain the appropriate antibiotics or antibacterials to be used. Patients with Pseudomonas infection are hospitalized and receive: intramuscular injections of amikacin sulphate 500 mg twice daily for 7 days; a once-daily spraying of antibiotic powder on the ulcer for 7 days; and a topical gentian violet regimen once daily for a further 2 days to encourage adhesion of a dressing to the ulcer bed. After discharge the patients are treated in the consulting rooms. Ulcers without Pseudomonas infection but from which organisms have been cultured are treated in the consulting rooms with drugs indicated by the results of sensitivity tests, and topical gentian violet. Patients from whom organisms have not been cultured are treated with co-trimoxazole and topical gentian violet. Patients are taught correct bandaging of the calf with a 150 mm wide crêpe bandage and a Rowden Foote elastic bandage. Firm bandaging prevents calf oedema, the factor predisposing to ulceration. Patients are initially seen daily and then, as the dressing becomes adherent, at decreasing intervals until it is shed. Both bandages are worn until the affected tissues heal. The patient is then fitted with a below-knee heavy-duty elastic stocking.

Adult↗