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PubMed1999

Effects of microwave heating on systemic and local infiltrating lymphocytes in patients with chronic limb lymphedema.

OBJECTIVES: To observe the characteristics of lymphocyte phenotypes in systemic and local skin and to evaluate the effects of microwave heating and bandaging treatment on chronic limb lymphedema. METHODS: Totally 27 patients with lymphedema and 10 normal subjects were examined with alkaline phosphatase-anti-alkaline phosphatase (APAAP) and avidin-biotin-peroxidase (ABC) immunohistochemistry for the observation of systemic lymphocyte phenotypes and inflammatory cell infiltration of skin tissues. RESULTS: In the peripheral blood of patients with chronic limb lymphedema, the number of CD4 T lymphocytes and the ratio of CD4/CD8 decreased, while the number of CD8 T lymphocytes increased. Obvious dermal perivascular infiltration of T lymphocytes was also observed. After two courses of microwave heating and bandaging treatment, the number of CD4 T lymphocytes augmented and the decreased CD4/CD8 ratio returned to normal, and the number of CD8 T lymphocytes reduced. The perivascular T lymphocyte infiltration in the dermis resolved and the number of macrophages elevated. CONCLUSION: Microwave heating and bandaging treatment can regulate the imbalance of systemic and local immunity in patients with chronic lymphedema.

Adolescent↗
PubMed2001

Cost-effectiveness of Apligraf in the treatment of venous leg ulcers.

Venous ulcers are the most common chronic wounds of the lower leg. Skin substitutes recently have been introduced to stimulate nonhealing wounds. To conduct an incremental cost-effectiveness analysis, a model was developed to compare the four-layer bandage system, with and without one application of skin substitute, for the outpatient treatment of venous leg ulcers. The model estimated the costs and consequences of treatment with and without the skin substitute application. Two analytic horizons were explored: 3 months and 6 months. Determined by seven physicians, data and assumptions for the 3-month model were based on information from a clinical trial, published studies, and clinical experience. Data for the 6-month model were extrapolated from the shorter model. The model results indicate that over 3 months, the use of the skin substitute provided a benefit of 22 ulcer days averted per patient at an incremental cost of $304 (societal). The incremental cost-effectiveness ratio was $14 per ulcer day averted. Over 6 months, the incremental cost-effectiveness ratio was less than $5 per ulcer-day averted. The skin substitute plus a four-layer bandage was more costly and more effective than the four-layer bandage alone. The skin substitute is increasingly cost-effective over a longer analytic horizon and in a subgroup of patients with ulcers of long duration (greater than 1-year duration at baseline). The results come from a model that is based on a series of estimates and assumptions, and accordingly, confirmation of this finding in a prospective study is encouraged.

Aged↗
PubMed2003

Leg compression and ambulation is better than bed rest for the treatment of acute deep venous thrombosis.

AIM: Treatment of acute deep venous thrombosis (DVT) with low-molecular-weight heparin and vitamin K-antagonists reduces the risk of thrombus progression and pulmonary embolism but has no immediate effect on signs and symptoms. We addressed the question whether adding compression and walking would lead to a more rapid clinical improvement than bed rest. METHODS: Fifty-three symptomatic outpatients with proximal DVT were randomly treated, in addition to dalteparin and phenprocoumon, with either firm inelastic bandages (n=18), elastic compression stockings (n=18), both combined with immediate deliberate ambulation, or bed rest without any compression (n=17). We assessed daily walking distance, well-being, quality of life, pain, swelling and clinical scores over a period of 9 days. Lung scans and ultrasound of the leg were performed on days 0 and 9. RESULTS: In the compression groups the walking distance increased with time to 4 km/day on average. Improvement of well-being and DVT-related quality of life was significantly faster and more pronounced with compression than with bed rest (p<0.05 for stockings, p<0.001 for bandages). Pain monitored by visual analogue scale decreased with time in a linear pattern in all groups (p<0.001). There was a significant difference between the groups (p<0.01), the best effect being achieved with bandages. Pain assessed by a provocation test was reduced by half on day 3 with bed rest but remained constantly present over the subsequent 6 days. With compression it was reduced to near baseline on day 3. Swelling was almost completely removed with compression and clinical scores also improved more than with bed rest (p<0.001). Thrombus progression, as studied with ultrasound, was less frequent and less pronounced in the compression groups than with bed rest. There was no difference of new pulmonary embolism on repeat lung scans. CONCLUSION: Leg compression combined with walking is the better alternative to bed rest for the treatment of symptomatic outpatients with proximal DVT.

Acute Disease↗
PubMed2005

Radionuclide assessment of the treatment by compression of patients with chronic venous insufficiency.

A study was made of the efficacy of the compression medical tricot in the treatment of chronic venous insufficiency (CVI). To evaluate the treatment by compression, the authors, in addition to the clinical examination, used radionuclide techniques such as examination of the regional blood volumes and phleboscintigraphy. The results of the given work have shown that the compression products under test are effective agents for the treatment of CVI by compression which improves venous return and the patients' quality of life. The data obtained point out that in addition to the lowering of blood filling, the medical tricot influences the interstitial element of the edematous syndrome, leading to the elimination of the latter one. The use of elastic bandages creates the known difficulties (the necessity of the patient training in bandaging, complexity of creating an adequate bandage, quick depreciation). In view of this fact the use of the compression tricot which possesses the fixed grade of compression for a concrete form and stage of CVI is preferable in the therapy of chronic venous diseases.

Adult↗
PubMed1985

Varicose veins: optimum compression following sclerotherapy.

There is uncertainty regarding the most satisfactory technique of lower limb compression following sclerotherapy for varicose veins. We have compared a standard bandaging technique with a high pressure compression stocking in a randomised trial. Efficacy was judged on the success of injections, complications of the treatment and patient satisfaction. In the stockinged legs 144 of 156 injections were successful, compared with 117 of 147 in the bandaged group (P less than 0.001) (Chi squared). The incidence of superficial thrombophlebitis was also reduced in the stocking group. In addition, the stocking technique costs less in materials than conventional bandaging. We would recommend compression stockings for evaluation in sclerotherapy of varicose veins.

Adult↗
PubMed1982

[Dynamics of the morphological changes in a burn wound during treatment in a controlled abacterial environment].

Histological and histochemical research methods were used to examine the healing of burn wounds treated under bandage and in monitored abacterial environment (open type treatment). Biopsies of burn wounds were investigated in 40 patients. It was shown that upon the treatment in abacterial environment the wound heal 10-12 days more rapidly as compared to those treated under bandage. Upon open type treatment there was an early appearance of fine granulations with marked macrophagal and fibroblast reactions, whereas under bandage there formed edematic granulations with high content of lymphoid and plasma cells.

Antisepsis↗
PubMed1994

[Compression stockings in treatment of lower leg venous ulcer].

AIM: of the study was to evaluate the efficiency of medical compression stockings, which do not require special application techniques, compared with short stretch bandages for treating leg-ulcers. STUDY-DESIGN AND PATIENTS: Prospective trial on a total of 50 out-patients with leg-ulcers randomly allocated into two therapy-groups: 25 patients got firm compression bandages using short stretch material (Rosidal K), 25 patients were treated by medical compression stockings (Thrombo+Sigvaris 503). Due to the statistically significantly lower mean age and longer duration of the ulcers in the Sigvaris-group only restricted comparison of the treatment groups is possible. Local dressings in both groups consisted of a nonadherent, absorbing material (Vliwin) with an individually modelled rubber foam pad on top. The end-point was complete ulcer-healing, in a period of 3 months. METHODS: The following parameters were measured: area of ulceration, compression-pressure, tcPO2 and Laser-Doppler-Fluxmetry at the ulcer border before and after 3 minutes of arterial occlusion, venous volume and venous filling index by air plethysmography (APG) with and without compression. RESULTS: After 3 months 21 cases (84%) were healed in the Sigvaris-group and 13 (52)% in the Rosidal-group. This significant difference may be partly explained by the more favorable starting condition of the stocking-patients. However, one major advantage of stockings over short stretch bandages is the maintenance of an adequate pressure if they are not renewed for several days. CONCLUSION: Therapy of venous ulcers by medical compression stockings may be an effective approach for fit and cooperative patients.

Adult↗
PubMedDate not supplied

Wrapping of the legs reduces the decrease in blood pressure following spinal anesthesia. A study in men undergoing urologic procedures.

BACKGROUND AND OBJECTIVES: Hypotension after induction of spinal anesthesia remains a common and a potentially serious complication despite acute expansion of intravascular volume. The current study evaluated the role of leg wrapping as an adjunct to acute volume expansion. METHODS: Twenty-four men undergoing elective urologic procedures were randomly assigned to two groups. Patients in the experimental group had their legs wrapped tightly while those in the control group had their legs wrapped loosely with elastic bandages immediately following spinal anesthesia. Significant hypotension was defined as a decrease in mean arterial pressure to less than 65 mm Hg. RESULTS: Systolic blood pressure was significantly lower (P < .05) in the control group at 4, 5, 7, 9, 10, 12.5, and 15 minutes following spinal injection. Diastolic blood pressure was significantly lower (P < .05) in control subjects at 7, 8, 10, and 15 minutes following the block. None of the patients in either group became hypotensive following removal of the elasticized bandages. CONCLUSIONS: Tightly wrapping the legs with elastic bandages immediately after placing spinal anesthesia in mature men is a safe and efficient adjunct in preventing hypotension.

Aged↗
PubMed1996

Approaches to venous leg ulcer care within the community: compression, pinch skin grafts and simple venous surgery.

The traditional approach to leg ulcer care is both expensive and achieves poor outcomes. The outcome of treatment for patients with venous ulceration has been improved using a more scientific and research-based approach to patient assessment, adequate compression bandaging, use of other procedures such as pinch skin grafting and simple venous surgery, and the delivery of these innovations in patient care to the community as a whole. Multi-layer compression bandaging is superior to standard (one-layer) bandaging because it can easily be adapted to a wide range of ankle circumferences and leg sizes to provide sustained, graduated compression. Pinch skin grafting is cost-effective, accelerates healing, and, following adequate training, may be performed by specialist nurses in the community. Simple venous surgery may be offered under local anaesthesia when only the superficial veins are incompetent; however, deep venous surgery has yet to prove itself in clinical practice. Implementation of dedicated community leg ulcer clinics using these research-based findings will result in a substantially reduced prevalence of venous leg ulceration.

Ambulatory Care↗
PubMed1998

Manual lymphatic drainage for chronic post-mastectomy lymphoedema treatment.

BACKGROUND: The authors evaluated the chronic post-mastectomy lymphoedematous tissue and the effects of manual lymphatic drainage (Leduc method) with and without compressive bandage. METHODS: The arms were measured before and after physical therapy and the results were expressed as a percentage decrease. Physical therapy was performed first by manual lymphatic drainage only and after by manual lymphatic drainage plus compressive bandage. RESULTS: We observed that during manual lymphatic drainage plus compressive bandage the total percentage decrease of whole limb was the highest: 41.1 +/- 12.2% versus 30.4 +/- 15.8% (p < 0.05). Clinical and physiopathological implication are discussed.

Adult↗
PubMed1998

Objective roentgenologic measurements of the influence of ankle braces on pathologic joint mobility. A comparison of 9 braces.

The stabilizing effect of external support (taping and nine different ankle braces) was tested in a total of 220 functionally unstable ankles. A standard surface EMG controlled stress Roentgen test protocol was used, measuring talar tilt (TT) without support and with tape bandage or brace. Different levels of TT restraining by external support could be identified. Tape bandage and two braces had a highly significant influence on the talar tilt. The mean TT without support was decreased by using from 13.4 degrees to 4.9 degrees, by using one brace to 4.8 degrees and by using another brace to 5.9 degrees. These two braces are effective for protection during functional treatment. A classification into three grades of effectiveness is proposed. It is concluded that the stabilizing influence offered by bandages and braces should be measured before using the external support as a treatment device for acute ankle sprain and as a reliable protection against sprain injuries in daily living and sports.

Activities of Daily Living↗
PubMed1996

Overcorrection after excimer laser treatment of myopia and myopic astigmatism. Melbourne Excimer Laser Group.

OBJECTIVE: To study the incidence and associations of overcorrection after excimer laser treatment of myopia and myopic astigmatism. METHODS: The study cohort consisted of 645 patients who had photorefractive or photoastigmatic refractive keratectomy done by an excimer laser during a 2-year period. Patients were assessed 1,3,6, and 12 months postoperatively. The variables evaluated were visual acuity, refraction, keratometry, and corneal clarity. RESULTS: At 1 month, overcorrection of more than +1 diopter spherical equivalent (SEQ) was seen in 22% of the eyes. This progressively regressed so that only 8.6% of the 140 eyes that were overcorrected at 1 month were overcorrected at 1 year. Overall, 2.2% of eyes were overcorrected at 1 year. The magnitude of attempted correction and use of topical nonsteroidal anti-inflammatory drugs disclosed a notable association with occurrence of overcorrection at 1, 3, and 6 months. The use of bandage contact lenses also was associated with overcorrection at 1 and 3 months. After controlling for myopia and use of contact lenses, the odds of overcorrection for use of topical nonsteroidal anti-inflammatory drugs at 1,3, and 6 months were 2.21 (95% confidence limits [CL]=1.49, 3.44), 1.69 (95% CL=0.88, 3.24), and 2.01 (95% CL=0.88, 4.56), respectively. The odds of overcorrection with bandage contact lenses were 1.79 (95% CL=1.05, 3.05) at 1 month and 2.42 (95% CL=1.23, 4.75) at the end of 3 months. No associations were seen between overcorrection and age, gender, surgical technique, or simultaneous astigmatic corrections. CONCLUSIONS: Overcorrection is common during the early postlaser treatment period and is associated with degree of myopia, use of nonsteroidal anti-inflammatory drugs, and bandage contact lens wear.

Adult↗
PubMed1999

Total, subtotal, and partial surgical removal of cervicofacial lymphangiomas.

OBJECTIVES: To compare different surgical interventions for the treatment of extensive cervicofacial lymphangiomas and to define the minimal extent of surgery necessary to control disease. DESIGN: Retrospective study. Mean +/- SD follow-up was 31+/-4 months after surgery. Surgical procedures were grouped as follows: (1) total removal, (2) subtotal removal (all cystic structures removed, small plaques of cyst walls left attached to vital structures), (3) partial removal (major cysts removed, some partially resected cystic structures left in place), and (4) incision and aspiration with subsequent compression bandage. Control of disease was defined as no recurrent or residual tumor or as recurrent or residual tumor less than 10% of initial tumor size without evidence of growth on several postoperative examinations and without clinical symptoms or aesthetic disfigurement. PATIENTS: Twenty-one patients with cervicofacial lymphangiomas (>3 cm in maximum diameter) without thoracic involvement were evaluated. Fifteen patients were 6 years or younger and 6 were older than 6 years. No surgery was yet performed in 3 patients, for a total of 24 surgical interventions in 18 patients. SETTING: Hospitalized care in 2 referral centers. RESULTS: After total removal, disease was controlled in 5 of 5 cases; after subtotal removal, in 8 of 9 cases; after partial removal, in 1 of 7 cases; and after incision and aspiration with subsequent compression bandage, in 0 of 3 cases. Two complications were encountered-1 fully reversible paresis of the marginal branch of the facial nerve and 1 secondary healing. CONCLUSIONS: Surgical removal of cervicofacial lymphangiomas is a safe treatment modality. Disease control can be achieved if all cystic structures are removed. Small plaques of cyst walls attached to vital structures may be left in place. If small cystic extensions of lymphangiomas are only opened and left in place or if lymphangiomas are only drained following compression bandage, symptomatic residual tumor or recurrence is frequent.

Child↗
PubMed2000

Skin grafting for venous leg ulcers.

BACKGROUND: Venous leg ulceration is a common, recurring, disabling condition affecting up to 1% of adults. Treatment is aimed at healing with simple dressings and compression bandages / stockings. Unfortunately in some cases this treatment is unsuccessful with ulcers remaining open for months or years. In order to stimulate healing, some clinicians use skin grafts. These skin grafts may be taken from the patients own uninjured skin (e.g. thigh), may be grown from the patient's skin cells into a dressing, (both known as autografts) or applied as a sheet of bioengineered skin grown from a donor cells (known as an allograft). Preserved skin from other animals, e.g. pigs, have also been used and these are known as xerografts. OBJECTIVES: To assess the effectiveness of skin grafts in the treatment of venous leg ulcers. SEARCH STRATEGY: We searched the Cochrane Wounds Groups specialised register (date of search October 1999), and reference lists of relevant articles. We hand searched relevant journals and conference proceedings, and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials evaluating skin grafts in the treatment of venous leg ulcers. There was no restriction on articles based on language or publication status. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality was undertaken by two reviewers independently. Trials with similar patients, comparisons, and outcomes were pooled. MAIN RESULTS: Seven RCTs of skin grafts for venous leg ulcers were identified. In 6 trials patients also received compression bandaging. Two trials (98 patients) evaluated split thickness autografts, three trials (92 patients) evaluated cultured keratinocyte allografts, one compared tissue engineered skin (artificial skin) with a dressing (309 patients) and one compared it with a split thickness skin graft (7 patients, 13 ulcers). The trials comparing artificial skin with a dressing reported a significantly higher proportion of ulcers healing with artificial skin. There was insufficient evidence from the remaining trials to determine whether other types of skin grafting increased the healing of venous ulcers. REVIEWER'S CONCLUSIONS: There is limited evidence that artificial skin used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared to compression alone. Further research is needed to assess whether other forms of skin grafts increase ulcer healing.

Adult↗
PubMed2005

Skin grafting for venous leg ulcers.

BACKGROUND: Venous leg ulceration is a common and disabling condition which often recurs. It affects up to one in 100 adults at some time. The usual treatments are simple dressings and compression bandages or stockings. Unfortunately, in some cases this treatment is unsuccessful, with ulcers remaining open for months or years. Sometimes skin grafts are used to stimulate healing. These skin grafts may be taken from the patient's own uninjured skin, may be grown from the patient's skin cells into a dressing (autografts), or applied as a sheet of bioengineered skin grown from donor cells (allograft). Preserved skin from other animals, such as pigs, has also been used; these grafts are known as xerografts. OBJECTIVES: To assess the effect of skin grafts for treating venous leg ulcers. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (June 2004) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2004). SELECTION CRITERIA: Randomised controlled trials (RCTs) of skin grafts in the treatment of venous leg ulcers. DATA COLLECTION AND ANALYSIS: Two reviewers independently undertook data extraction and assessment of study quality. MAIN RESULTS: Nine trials of skin grafts for venous leg ulcers were identified, involving 579 participants. The trials were generally of poor methodological quality. In eight trials participants also received compression bandaging. Two trials (98 participants) evaluated split thickness autografts (one against a dressing and one against a xerograft), four trials (119 participants) evaluated cultured keratinocyte grafts (3 allografts and 1 autograft) , two compared tissue engineered skin (bilayer artificial skin) with a dressing (345 participants), and one compared it with a split thickness skin graft (7 participants, 13 ulcers). The trials comparing bilayer artificial skin with a dressing reported a significantly higher proportion of ulcers healing with artificial skin. There was not enough evidence from the other trials to determine whether other types of skin grafting increased the healing of venous ulcers. AUTHORS' CONCLUSIONS: There is evidence that a bilayer artificial skin, used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared with compression and a simple dressing. Further research is needed to assess whether other forms of skin grafts increase ulcer healing.

Adult↗
PubMed1997

[Proprioceptive deficits of the knee joint after rupture of the medial meniscus].

We assessed knee joint proprioception in 23 patients with an isolated lesion of the medial meniscus. Thirteen patients were tested prior to their arthroscopic operation, and 10 patients were examined after partial arthroscopic resection of the injured meniscus. As a control group we evaluated 30 healthy volunteers with clinically inconspicious knee joints. For documentation of the proprioceptive capabilities we performed an angle reproduction test. Additionally the subjects were tested with and without an elastic knee bandage, to test the influence of such a bandage on knee joint proprioception. Our results showed that preoperatively proprioception was significantly less good than in the control group. We found no influence of the knee bandage on the proprioception of the injured knee. The postoperative group of patients showed significantly better proprioceptive capability than the preoperative patients. The postoperative results did not differ significantly from those of the control group.

Adult↗
PubMed2005

The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery.

BACKGROUND: The aim of this study was to compare two different physiotherapy methods in the treatment of lymphedema after breast surgery. METHODS: This study was performed on 53 patients who had developed unilateral lymphedema after the breast cancer treatment. Twenty-seven patients served as the experimental group and were treated with complex decongestive physiotherapy (CDP) applications including lymph drainage, multi layer compression bandage, elevation, remedial exercises and skin care. Twenty-six patients in the control group were treated with standard physiotherapy (SP) applications including bandage, elevation, head-neck and shoulder exercises and skin care. Both groups were recommended a home program consisting of compression bandage exercises, skin care and walking. Patients were taken to a therapy program once a day; 3 days a week for 4 weeks. The range of motion, circumferential measurement, and volumetric measurement were assessed before and after treatment. RESULTS: The overall improving in the CDP group was shown to be greater than the SP group but when the evaluation results of both groups were compared before and after treatment, a significant statistical difference in edema according to circumferential and volumetric measurements results was found in favor of the CDP group (p < 0.05). CONCLUSION: In the patients with upper extremity lymphedema, the shoulder mobility can be increased and edema can be decreased by the use of complex physiotherapy programs.

Adult↗
PubMed1988

Hands up? A preliminary study on the effect of post-operative hand elevation.

Intra-compartmental pressures of up to 30 mmHg may be generated by compression bandaging following upper limb surgery. Compression bandaging and hand elevation are both shown to diminish skin blood-flow as measured by transcutaneous oxygen pressures. Hand elevation following post-operative compression bandaging is potentially hazardous.

Hand↗