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The aim of this overview is to discuss the role of thigh compression for the management of venous and lymphatic diseases. The most important indications for thigh compression are prevention and treatment of sequelae of superficial vein procedures (surgery or endovenous procedures), prevention and therapy of deep vein thrombosis (DVT), post-thrombotic syndrome and lymphoedema. The intended effects depend mainly on narrowing/occlusion of deep and superficial veins on which the body position and the applied pressure play a crucial role. While in the horizontal position thigh veins can be narrowed by the light pressure of a thromboprophylactic stocking, much higher pressure is needed to compress thigh veins effectively during standing and walking. This is shown by magnetic resonance imaging (MRI) performed in the supine and upright position. Using pads, rolls or specially designed devices, the local pressure under conventional compression garments or bandages over a treated vein can be increased considerably. In patients with deep valve incompetence, beneficial haemodynamic effects of strong thigh compression have been demonstrated, but clinical studies in this field are still lacking. Thigh compression reduces oedema in patients with DVT and lymphoedema.

BACKGROUND

Pressure loss under short-stretch bandages (SSBs) is a well-known phenomenon and is thought to be related to bandage relaxation and poor quality of application.

AIM

The aim was to demonstrate that therapeutically intended volume reduction of the compressed leg is the most important cause for the loss of bandage pressure.

DESIGN

This was an experimental, controlled comparative study.

METHODS

In 20 patients suffering from lymphedema of the lower extremities and in 9 healthy persons, lower leg volume was measured by water displacement. After application of a pressure measurement device (Kikuhime) at the B1 region, SSBs were applied on one leg according to a standard protocol. Volume and pressure measurements were performed at 0, 2, and 24 hours in supine as well as standing positions.

RESULTS

A significant reduction of leg volume is already achieved 2 hours after bandage application, both in lymphedema patients and in normal controls. A further volume decrease of the lymphedematous legs is observed in the following 24 hours after application of a new bandage (-290 mL). The volume reduction is associated with a significant loss of bandage pressure from initial values over 60 mmHg by 37 and 48% in controls and lymphedema patients, respectively.

CONCLUSIONS

Inelastic, multilayer, multicomponent compression bandages lead to an immediate reduction of leg volume, both in lymphedematous and in normal legs. This therapeutically intended volume reduction seems to be the main reason for the fast decrease of the subbandage pressure. This study was supported by Lohmann & Rauscher, Ltd. Germany.

Background: There is growing awareness surrounding the importance of wound pain, recognised by the publication of recent international studies (White, 2008). Wound pain has been identified as an outcome important to patients, in addition to physiological endpoints. It can be difficult to use randomised controlled trials to measure subjective outcomes such as pain, particularly with complex patients. An audit was therefore used to explore the effect of Actiform Cool on wound-related pain. Methods: Change in wound-related pain was assessed using a modified Short-Form McGill Pain Questionnaire pre- and post-application of Actiform Cool, and patients were asked to report on any changes in their pain experience, and the effects of this on their activities of daily living. Results: Results indicated that 12 patients reported an overall decrease in pain levels following use of the dressing. Four patients reduced their analgesia requirements with one discontinuing opiate analgesics. Five patients reported improvement in their sleep patterns and three reported improved mobility. Conclusion: The overall outcome reinforces that Actiform Cool has the potential to reduce pain in some patients when used as part of a pain management plan. Conflict of interest: This audit was funded by Activa Healthcare Ltd.