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Aim:

In The Netherlands health-insurance companies aim to reduce costs for complex wound and oedema treatment. For this purpose an adjustable short-stretch compression device (ACD) may be used [1,2]. Some of the available long-stretch systems have caused skin damage [1]. The objective of this care series was to stimulate self-management of fragile elderly patients with oedema and/or a venous leg ulcer using an easy and safe to apply short-stretch wrap-on compression1 device, which was selected for patients in our region [1,2].

Method:

Twenty out-patients with oedema and a venous leg ulcer received the ACD1 and were followed during the treatment and maintenance phase. Scabs and sloughy tissue were removed using a monofilament debridement pad2 after which the ulcer was covered with a superabsorbent pad3. Those with fragile skin conditions, prone to skin lesions received a “silk”stocking4 applied under the ACD1 which provided an additional 10 mmHg and skin protection.

Results:

Many patients requiring compression treatment are elderly and fragile. Self-management is often not an option. When using traditional compression bandages correct application and an optimal pressure level is not always achieved. The 20 patients treated with ACD1 achieved ulcer closure and oedema reduction in a comfortable fashion, stimulating self-management. Within 2 weeks often more than 3 cm ankle circumference reduction was achieved. It was easy to select the correct size and colour coding enabled a correct overlap upon application. From 2015 onwards, since education on compression was put in place for physicians and nurses throughout the care-chain in our region, the number of adverse events has reduced and quality of care has improved.

Conclusion:

It is important to select a suitable and effective compression system for especially frail elderly patients. Although the general practitioners (GP) take time to getting used to ACD1, collaboration with leg measurement sites and training GPs may enable choosing and applying suitable compression. The tested ACD1 enabled effective and safe compression. Complete ulcer closure was achieved in a comfortable fashion that suited the individual needs of the patients.

Aim:

Improving Quality of life should be paramount to every patient’s care-pathway. Many quantitative tools are available but rarely capture the individuals true goal. Individual goal setting however difficult to achieve, should always be considered. A selection of compression devices available and applied in a novel way were adapted to improve one lady’s quality of life and achieve her goal.

Method:

A 48-year-old lady with unilateral lymphoedema of her left leg, secondary to surgery for endometriosis was referred for Decongestive Lymphoedema Treatment (DLT). DLT consisted of compression bandaging using a foam roll and cohesive inelastic bandages* and lymphatic drainage using a hand-held negative pressure device**, for 6 sessions over 10 days. Following DLT a class IV flat-knit compression stocking was fitted with a below-knee velcro wrap system over the top of the stocking to prevent ‘rebound’ oedema. Individual aims were set by the patient – to ride her horse again.

Results / Discussion:

Limb volumes reduced following DLT and maintained with monthly lymph drainage, compression stocking and velcro wrap system. Sub-bandage pressures were measured to indicate pressure and stiffness of combined treatment.

Conclusion:

Combining existing products available on the market to achieve known pressures from scientific research has resulted in preventing rebound oedema post DLT. Most importantly the patient’s individual goals were achieved and she can ride her horse again. This is possible by understanding the tissue density, material properties and the combined prescription of compression used, without causing physical and functional restriction.