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PubMed2002

The effect of bracing on proprioception of knees with anterior cruciate ligament injury.

This paper is a comprehensive review on the effect of bandaging, bracing, and neoprene sleeves on knee proprioception following anterior cruciate ligament (ACL) injury and reconstruction with a focus on studies that have measured joint position sense and threshold to detection of passive knee motion. Disruption of the ACL does not appear to alter joint position sense soon after injury, although there is evidence that in some subjects deterioration may occur over time. An ACL tear creates a deficit in the threshold to detection of passive knee motion soon after injury and in those with chronic tears. The magnitude of worsening is less then 1.0 degree of movement in flexion-extension and of questionable concern from a clinical and functional perspective. Application of a functional brace or neoprene sleeve to the ACL-deficient limb does not improve the threshold to detection of passive knee motion; however, application of an elastic bandage to a knee with an ACL tear improves joint position sense. Reconstruction of a torn ACL is associated with a deficit in the threshold to detection of passive knee motion, and during the first year of healing the use of a neoprene sleeve provides improvement. Two years following ACL reconstruction there is no deficit in the threshold to detection of passive knee motion and the use of a brace has no effect on this outcome.

Anterior Cruciate Ligament↗
PubMed1991

Basic studies of local adsorption in burn treatment.

The model of a full-thickness thermal burn in rats was used to demonstrate that the application of adsorptive dressings made of a fibrous activated carbon material (ACFM) after early excision of a burn crust exerts a considerable influence on the development of both local and general symptoms of burn disease. Three days after the excision a water content in underlying tissues falls from 84.81 +/- 0.62% to 54.47 +/- 4.2%, the wound surface area decreases by 10%, while this surface area under gauze bandages increases by 6.3%. The local adsorption results in lower activity of proteolytic serum enzymes and toxicity of blood serum in burned animals as well as in the positive dynamics of changes in functional activity of the immune system. By the 14th day the T-cell activity in animals with adsorptive carbon dressings was by 3.2 times higher than that in the animals with gauze bandages. The level of B-cell response if ACFM is applied exceeds normal values to a great extent, starting from the first days after the excision of a burn crust.

Animals↗
PubMed1989

Fixation not needed for undisplaced Colles' fracture.

A series of 68 undisplaced or minimally displaced Colles' fractures was randomized into two groups undergoing treatment with either a plaster cast or an elastic bandage. Pain, function, grip strength, and range of motion were evaluated 1 year later. There was a difference in the functional outcome in favor of the patients treated with an elastic bandage, who did not have more fracture redislocations than those treated with a plaster cast.

Adult↗
PubMed1996

Is prophylactic bracing of the ankle cost effective?

The ankle joints of 14 healthy volunteers and 16 patients with unstable ankle joints were tested for their functional and proprioceptive capabilities. All of them were active athletes. Three tests were used: the single-leg stance test, the single-leg jumping course test, and the angle-reproduction test. The influence of three stabilization devices--the lace-on brace (Mikros), the stirrup brace (Aircast), and taping--on the proprioceptivity of stable and unstable ankle joints was evaluated. The scores of the single-leg jumping course test without any stabilizing device ("standard" category) ranged between 8.06 and 13.68 (10.65 + 1.29). In the Mikros (9.95 + 0.99) and Aircast (9.99 + 1.14) brace categories, as well as the tape bandage (10.27 + 0.81) category, better scores were achieved. The differences between "standard vs Mikros" and "standard vs Aircast" revealed a significant reduction of the scores with the orthoses (P < .01). The error rate in the single-leg stance test was within the range of 0 to 16 (5.12 + 2.85) for the standard category. It was lower for the Mikros (3.65 + 2.65) and Aircast (4.17 + 2.59) categories. The error rate was highest in the tape bandage group (5.79 + 3.53). There was a significant difference between "standard vs Mikros" and "standard vs Aircast" regarding injured and non-injured ankle joints (P < .01). The angle-reproduction test showed higher values for the standard (2.36 degrees + 0.97) category than the Mikros (1.46 degrees + 0.72), Aircast (1.62 degrees + 0.91), and taping (1.84 degrees + 0.41) categories. In the standard category, the reproduction error was lower when non-injured ankle joints (2.30 degrees + 1.04) were tested than when unstable ankle joints (2.44 degrees + 0.81) were tested, whereas in all other categories the reproduction error was higher in the group of non-injured joints. According to the literature, applying a prophylactic brace can prevent an estimated 30 ankle sprains per 1000 athletic exposures.

Adult↗
PubMed1982

Retarding the uptake of "mock venom" in humans: comparison of three first-aid treatments.

We compared, for the first time in human subjects, first-aid measures to treat bites from Australian snakes using a "mock venom" (congruent to 0.2 mL of Na 131I at 7.4 kBq or 11.1 kBq (0.2 muCi/kg or 0.3 muCi/kg)) as a subcutaneous injection in the lateral aspect of the leg. After application of either a full-length lower-limb airsplint (inflated to 7.3 +/- 0.7 kPa (55 +/- 5 mmHg) pressure) or the currently recommended treatment (elastic bandages at 7.3 +/- 0.7 kPa (55 +/- 5 mmHg) pressure and supporting splint) the rate of appearance of the Na 131I in the peripheral blood was approximately the same as the ratio for the untreated controls. However, application of a large firm pad over the injection site and its immediate surrounds, retained by a non-elastic bandage (at least 9.3 kPa (70 mmHg) pressure over the injection site), completely prevented "mock venom" uptake until the pad was removed. Further investigations are proceeding.

Adult↗
PubMed1992

Management of a major box jellyfish (Chironex fleckeri) sting. Lessons from the first minutes and hours.

OBJECTIVE: To report the management of a serious box jellyfish (Chironex fleckeri) envenomation from the first minutes of bystander first aid and treatment by ambulance personnel to subsequent treatment in hospital. CLINICAL FEATURES: A 14-year-old girl sustained a serious Chironex fleckeri sting. There was no loss of consciousness, but the patient suffered severe pain, myocardial irritability, acute pulmonary oedema and mild systemic hypotension, due to the direct toxic effects of the venom. Thirst was a dominant symptom. INTERVENTION AND OUTCOME: Management involved rapid bystander action and call for ambulance assistance; and early intervention with oxygen/nitrous oxide administration, compression bandaging, antivenom administration and electrocardiographic monitoring at the site by ambulance personnel. Echocardiography in hospital three hours after the sting showed a normal myocardium. In hospital management resulted in recovery. Nocturnal itching of the sting persisted for six weeks. CONCLUSIONS: (i) Vinegar dousing may irritate freshly stung skin, but as a nematocyst inhibitor vinegar remains an essential part of the first aid treatment for cubozoan jellyfish stings. (ii) Compression/immobilisation bandaging was not associated with long-term harm to the sting area. (iii) The pain of an intramuscular antivenom injection may not be felt by a chirodropid sting victim, so safe injection protocols must be strictly observed. (iv) Ambulance services in other States whereas there is a risk of box jellyfish (Chironex fleckeri or Chiropsalmus quadrigatus) stings should be similarly trained and equipped to deal with serious jellyfish envenomations.

Acetates↗
PubMed1999

[Thrombophlebitis: bed rest or walking exercise?].

It is a common tradition to admit patients with deep vein thrombosis (DVT) to the hospital and put them to bed for several days because of fear from pulmonary embolism, even if they are mobile. Between May 1994 and December 1997 929 patients were admitted to our department who were treated by subcutaneous injections of low-molecular-weight heparin (mainly 200 IU dalteparin per kilogram body-weight per 24 hours), got firm compression bandages and were encouraged to walk as much as possible. On admission DVT propagated into the pelvis in 268 patients, into the thigh in 480 and below the popliteal level in 181 patients. V/Q-lung scans were performed at baseline and repeated after 10 days on average. In these three groups primary pulmonary embolism was diagnosed in 49.4%, 50% and 34% respectively, new emboli after 10 days were found in 6.1%, 5.7% and 3.9%. Only one third of the patients with embolism on admission and 5 from 50 patients who developed new emboli showed some dyspnoea. 12 patients died and underwent autopsy, 3 fatal events were caused by pulmonary embolism. With out management the incidence of thromboembolic complications is statistically significantly lower than data from the literature. Preliminary results from an ongoing randomised trial comparing bed-rest, compression bandages and compression stockings in the acute phase of proximal DVT demonstrate faster improvement of swelling and of pain in the compression-groups. Low-molecular-weight heparin has greatly facilitated therapy of DVT since effective anticoagulation can be obtained by subcutaneous injections of fixed doses without the need of laboratory monitoring. For the future development of conservative management mechanical prophylaxis of thrombus extension by acceleration of venous flow using leg compression and walking will probably become as important as exact anticoagulation.

Adolescent↗
PubMed2000

[Manual lymphatic drainage].

Manual physiotherapy of lymphoedema is the best treatment for chronic venous and lymphatic stasis of the lower limbs. It consists in handlings of the limb for the appeal and the resorption of the lymph but it cannot be used alone. It must be associated with other techniques: defibrosing, skin care, compressive bandages, muscular exercise. Contensive and compressive bandagings prolong the action of lymphatic drainage. The main indication of manual physiotherapy is primary or secondary lymphoedema but also chronic venous disease, and in some selected cases acute venous thrombosis and traumatic or post-traumatic pains.

Bandages↗
PubMedDate not supplied

[Physical methods in the treatment and prevention of deep phlebitis of the leg].

By the term "physical methods" the author envisages primarily walking, wearing an elastic support, and rest with the legs raised. Physical methods for the prevention and cure of phlebitis were worked out by two French surgeons between the two wars but have been rapidly replaced by coagulant treatment. Now these methods have been reduced, in most cases, simply to a "fight against haemostasis" by means of verbal instructions and with no relation to the original methods : in many cases the methods are not known to the younger generation of physicians because they have not been taught them. Several factors are leading to renewed interest in these methods : on the one hand the undeniable dissatisfaction with anticoagulant therapy, and on the other hand the many experiments that, in the last 15 years, have led to an understanding of the mode of action of the physical methods. These experiments are reviewed in the present article. From the practical point of view, improvements in materials have led to improvements in the range of bandaging techniques. The authors looked back at the original publications, that is to say to the publications of Chalier and of Nard, who described methods, which have been much referred to, that were quite exacting. The different types of bandaging for the prevention and cure of thrombosis are illustrated by numerous pictures. In the curative treatment of phlebitis, there are three essential indications for the use of physical methods : contraindications for anticoagulants, their failure, and the prevention of sequelae. In the prevention of phlebitis, the raising of the legs when seated, a factor in a quasi-experimental stasis, must give way to mobilization - very early and very frequent walking. It is the opinion of specialists in phlebitis, who have used these methods over many years, that the physical methods, which are also physiological, are a valuable complement to biological methods. Their effectiveness is, however, a function of the rigour with which they are applied : --as regards degree : the support must be applied in the correct dosage, as, for example, must heparin and digitalin ; --as regards staff : the patient and his associates must collaborate closely, and nursing staff are indispensable ; --as regards skill : the faith of the physician alone can overcome the doubts or scepticism of others.

Bandages↗
PubMed2001

[Conservative therapy in varicose symptom complex].

This article deals with the conservative management of light and severe forms of varicosities as well as chronic venous insufficiency along with subjective symptoms and trophic skin changes. Approximately 40% of the population shows minor forms and another 10% shows major forms of varicosities. The prevalence of advanced stages of chronic venous insufficiency is approximately 3%. Compression therapy represents the mainstay of anti-edema treatment. Elastic bandages are mainly used during the acute phase, and compression stockings are rather recommended to maintain the result. The differences of short stretch and long stretch bandages, as well as the classes of compression therapy are discussed. Physical therapy, such as joint mobilization, ambulation exercises, and lymph drainage may further support edema reduction in severe cases. Edema-protective drugs can be justified as adjuvant treatment. The pharmacology and action of these substances has been further elucidated by both laboratory and clinical studies. It has been shown that the continuous use of these substances during 8-12 weeks can reach the anti-edematous effect of class II-stockings. Sclerotherapy is especially useful in the treatment of smaller caliper reticular varicosities and teleangiectatic veins. The development of new vascular lasers with a long pulse duration has added to the options in the treatment of leg teleangiectasias, although these expensive techniques cannot be regarded a standard therapy. Advanced stages of chronic venous insufficiency are also amenable to conservative treatment. In these cases, an exact vascular examination is highly recommended. Interventional treatment of relevant peripheral arterial disease and of superficial venous insufficiency can impressively improve the quality of life of these patients, even at an elderly age. Moreover, the role and differential indication of synthetic dressings in the local therapy of chronic leg ulcers is explained in-depth.

Bandages↗
PubMedDate not supplied

[Chronic venous insufficiency and compression therapy].

INTRODUCTION: Disorders of venous circulation are among most frequent diseases in the human population. During recent years there has been increased interest in physiopathology of chronic venous insufficiency (CVI), due to development of more accurate diagnostic methods and new therapeutic techniques. Considering patophysiology of CVI and its consequences the crucial points are stasis and reflux of blood flow, with increase of intravascular pressure. CLASSIFICATION AND THERAPY OF CVI: Empirical experience and theoretical models suggest that progression of the disease can be stopped or reverted by correction of stasis. Today, this is the main direction in all therapeutic approaches. Compression therapy represents the most successful conservative technique. In this article we are presenting basic principles of the compression therapy of CVI. Evidence for the physiologic effect of compression therapy are decrease of edema, softening of lipodermatosclerosis, acceleration of venous flow, decrease in venous volume, blood shift into central compartments, reduction of venous refluxes, influence on arterial flow and improvement of microcirculation and lymph drainage. There are several types of compression devices: elastic stockings, elastic bandages, inelastic bandages, intermittent pneumatic compression devices. Other advantages of compression therapy are decrease of hospital treatment and better quality of life for patients with CVI.

Bandages↗
PubMedDate not supplied

[General surgeon's approach to deep phlebitis of the leg].

The therapeutic problems of the general surgeon, faced with a case of deep phlebitis of the lower limbs, differ according to whether it is diagnosed before or after surgery. If possible, pre-surgical phlebitis should be treated before the operation. Heparinotherapy remains the basic treatment. But there are numerous arguments against, or for the modification of, its use : old age, haemorrhagic lesions, haemorrhagic risks during surgery, or simply great operational urgency. In all these cases, an elastic bandage is invaluable. Treatment of post-operative phlebitis is also based on the heparins, combined if necessary with antibiotics and corticoids, but these products can result in iatrogenic complications (ulcers, haemorrhage). It is often difficult to choose between embolic and haemorrhagic risks ; it is always easy to apply an elastic bandage which suffices in most cases to remove the inflammatory signs of the phlebitis. This problem is not so frequent since systematic prevention has made post-operative phlebitis more rare. The use of anticoagulants in vascular surgery seems to the authors to be not so much an effective therapeutic method as a method to be feaved close surveillance of coagulation is indispensable during treatment.

Aged↗
PubMedDate not supplied

Rehabilitation protocol in upper limb lymphedema.

Edema of the upper limb is, frequently, very invalidating. The physical treatment for edema of the upper limb consists on a combination of different therapies: manual lymphatic drainage (MLD), intermittent sequential pressotherapy (IPP) with a very low intensity, multilayer bandages (MLB), and compression sleeves. Patients are not hospitalized. In the first step of physical treatment, the patients are treated daily during 2 or 3 weeks with different therapies (MLD, IPP and MLB). During the second step, bandages are no more used. The compression garments are applied after this 2 or 3 weeks period. The physical treatment consist now in: manual lynphatic drainage and intermittent sequential pressotherapy (with low intensity). The frequency of the physical treatment is progressively decreased.

Arm↗
PubMed2004

Understanding venous leg ulcer pain: results of a longitudinal study.

Venous leg ulcer pain experienced during compression bandaging is poorly understood. A prospective, pilot cohort study was initiated to determine the feasibility of conducting a large-scale, repeated measures cohort study of venous leg ulcer pain and to document and describe the venous leg ulcer pain experience during the first 5 weeks of treatment with compression bandages. Eligible individuals admitted to a nurse-led community leg ulcer service in one Canadian community were recruited for the 5-week study. Pain assessment tools (ie, numerical rating scale and short form McGill Pain Questionnaire) were evaluated by 20 venous ulcer patients (mean age = 73.7 years) and their nurses for ease of use during one baseline and five weekly follow-up visits. Health-related quality of life (HRQL) information was obtained. Nurses reported on ease of integrating pain data collection into regular clinical care. Each pain assessment tool was audited for completion. Most participants found the pain assessment tools easy to use, but nurses reported lengthened visit times with some participants as a result of tool administration difficulties, particularly the visual analogue scale (VAS). Overall completeness of pain assessment tools ranged from 85.0% (visual analogue scale) to 96.3% (present pain intensity and word descriptor list). The vast majority of patients (18) reported ulcer pain at baseline. Total mean scores for all pain assessment tools used decreased over time, but most patients reported pain throughout the study. The most common pain descriptors used were "aching," "stabbing," "sharp," "tender," and "tiring." Health-related quality of life was low and did not change during the 5-week study. The results of this study suggest that the vast majority of venous ulcer patients experience pain and that it is feasible to examine this pain in individuals receiving care in the community over time.

Activities of Daily Living↗
PubMed2004

Ultrasound-guided compression repair of femoral pseudoaneurysms complicating cardiac catheterization.

BACKGROUND: Femoral pseudoaneurysms complicate cardiac catheterizations in up to 3.2% of cases. Ultrasound-guided compression repair (UGCR) is a known valid alternative therapy to surgical and percutaneous repair. We evaluated its safety and efficacy in a series of patients. METHODS: Patients with clinical findings suggesting pseudoaneurysm after cardiac catheterization, underwent echo-color and duplex studies. When a pseudoaneurysm was diagnosed, the patient underwent UGCR until closure or for 50 min. A groin compression bandage was applied after the procedure and patients were put on bed rest for 12-18 hours; a new ultrasound study was performed the day after the procedure: when the UGCR procedure failed, patients were referred to a vascular surgeon or interventional radiologist. When possible, a third ultrasound study was performed 1 month after the procedure. RESULTS: Between January 2001 and June 2003, 15 pseudoaneurysms were diagnosed and treated by means of UGCR. The UGCR procedure (UGCR followed by groin bandage) was successful in 13 cases (87%); 1 patient underwent surgical repair and 1 patient underwent percutaneous repair. No local or systemic complications were observed following UGCR. CONCLUSIONS: Pseudoaneurysm UGCR constitutes a safe and valid procedure; it is less invasive and easier to perform than percutaneous and surgical repair.

Adult↗
PubMed2004

Comparing a foam composite to a hydrocellular foam dressing in the management of venous leg ulcers: a controlled clinical study.

Venous leg ulcers are the most prevalent form of chronic wounds in the Western world. The principles of moist wound healing coupled with the use of graduated compression bandaging have become the cornerstone of treatment for venous leg ulcers but not all moist dressings are alike. To compare the attributes of a foam composite dressing with those of a hydrocellular foam dressing in the management of venous leg ulcers, a prospective, randomized, comparative 12-week study was conducted in 15 centers in the US, Canada, France, Germany, and the UK. Dressings were changed and compression bandages applied per manufacturer recommendations and dressing performance was assessed at every dressing change and at the final evaluation. Patients with venous ulcers were randomized to treatment for 12 weeks with either hydrocellular foam (n = 52) or foam composite (n = 55) dressing. Healing differences between the groups were not statistically significant, with 36% of patients using foam composite dressing healed in a mean of 66 days and 39% of patients using hydrocellular foam dressing healed in a mean of 73 days. However, the foam composite dressing performed significantly better than the hydrocellular foam dressing with regard to condition of the periwound skin - 55% of patients in the foam composite group having healed or markedly improved surrounding skin compared to 37% of patients using hydrocellular foam (P = 0.03). The foam composite dressing was rated significantly better than the hydrocellular foam dressing ("very good" to "excellent") in level of satisfaction with conformability (87% and 75%, respectively, P = 0.05); being non-sensitizing (73% and 52%, respectively, P = 0.02); and ease of application (93% and 81%, respectively, P = 0.01). The findings reported in this study suggest that the foam composite dressing offers significant improvements in the quality of life of patients with venous leg ulcers as well as for their caregivers.

Adult↗
PubMed2004

Immediate mobilisation in acute vein thrombosis reduces post-thrombotic syndrome.

AIM: To investigate the effect of compression and immediate ambulation in the acute stage of deep vein thrombosis (DVT) on the development of postthrombotic syndrome (PTS). METHODS DESIGN: follow-up study of patients who previously have been enrolled in a randomized controlled trial. SETTING: outpatient department of a municipial hospital. SUBJECTS AND INTERVENTIONS: a follow-up was performed 2 years after 53 patients with acute proximal DVT had been enrolled into a randomized controlled trial, comparing bed rest and no compression (n=17), Unna boot bandages plus walking (n=18) and compression stockings plus walking (n=18). Telephone interviews could be conducted with 11 patients, 37 patients could be reinvestigated by independent observers (11 from the bed-rest group, 13 from the bandage group and 13 from the stocking group). Compression stockings up to the time of the follow-up were worn by 8/11 (73%) of the bed-rest patients and by 13/26 (50%) of the mobile patients. MAIN OUTCOME MEASURES: clinical and venous duplex investigation, pain assessment using visual analogue scale and Lowenberg test, leg circumference, clinical ''PTS-score'' combining 5 subjective symptoms with 6 objective signs (Villalta-Prandoni-scale). RESULTS: Duplex investigation of the deep veins and pain assessment by visual analogue scale showed no significant differences between the groups. Nine out of 11 patients after bed rest, but only 16/26 in the mobile groups showed a larger calf circumference on the diseased leg (n.s.). Judged by the Villalta-Prandoni-scale a significantly better outcome could be found in the mobile group (mean score 5.1) than in the bed-rest group (mean score 8.2), (p<0.01). (''Mild PTS'' = score 5-14, ''severe PTS'' score = or > 15). Eighteen out of 26 mobile patients, but only 2/11 bed-rest patients had a score = or < 5 (''no PTS''). CONCLUSIONS: Immediate mobilisation with compression in the acute stage of DVT reduces the incidence and the severity of PTS.

Acute Disease↗
PubMedDate not supplied

[Manual lymph drainage of post-mastectomy "big arm"].

We estimate the effectiveness of the manual lymphodrainage in the patients with post-mastectomy lymphedema of the upper limb associated to axillary lymphnodes dissection of the ipsilateral arm. The best results were found in the patients with soft and recent lymphedema (which means that was seen within one year); the worst were found in the chronic hard lymphedema. An important psychological assistance and physiotherapy were required to complete the rehabilitation. However, the physiotherapy was very effective when associated to pressed bandage of the arm, at the end of the LDM therapy. Furthermore, the muscle contraction in the bandage had reinforced the lymphoematic pump effect.

Adult↗