Clinical Newsletter
Regular updates on our latest clinical studies.
Our research and development teams operate at a global level and generate synergies from our collective expertise and by drawing on related disciplines. We are also constantly exchanging information at an international level with independent technical institutions, key opinion leaders and multipliers in order to be able to ensure cooperation and knowledge management of the highest order. As part of this process, we also conduct extensive research, the results of which we continually present in workshops, at conferences and symposiums - either in documentation or talks given by our cooperation partners - and also publish in renowned scientific journals. This database contains a large number of these evidence-based scientific articles, most of which have been evaluated by independent assessors:
BACKGROUND
The efficacy of compression therapy depends mainly on the exerted pressure and on the stiffness of the material.
OBJECTIVE
To propose a simple method by which pressure and stiffness can be assessed in the individual patient.
MATERIAL AND METHODS
Using a pressure transducer (Kikuhime small probe, MediTrade, Soro, Denmark) the sub-bandage pressure is measured on the medial aspect of the lower leg at the transition of the gastrocnemius muscle into the Achilles' tendon. The pressure difference between active standing and lying is defined as the static stiffness index (SSI).
RESULTS
The accuracy and precision of the probe are good. Unna boot bandages (Lohmann-Rauscher, Vienna, Austria) and multilayer short-stretch bandages show a significantly higher SSI than long-stretch bandages and round-knitted class II stockings. The SSI values are lower than 10 mm Hg for elastic, long-stretch material and higher than 10 mm Hg for inelastic, short-stretch material.
CONCLUSION
In future compression trials, pressure and stiffness measured in vivo should be declared.
OBJECTIVES
To measure interface pressure and stiffness of short-stretch and long-stretch bandages applied with variable strength. These parameters have a deciding influence on the efficacy of compression therapy in chronic venous disease.
DESIGN
Prospective experimental study.
MATERIALS AND METHODS
Compression bandages constructed of different materials were applied with light, moderate and high pressure. Interface pressure was measured over the medial aspect of leg in 12 healthy individuals. Long-stretch bandages were compared to short-stretch bandages. The difference between standing and supine pressure was used to characterise stiffness.
RESULTS
In the low pressure range the median pressure of the final bandage in the supine position was between 18 and 30 mmHg for the long-stretch and 25-33.5 mmHg for the short-stretch bandages (p<0.01, Mann-Whitney U-test). The median differences between standing and supine pressure were between 2.0 and 8.5 for the long-stretch and 6.0-10.5 mmHg for the short-stretch material. In the group of moderate pressure the median values in the supine position were in a range 33.0-58.0 mmHg, for long-stretch and 39.0-49.5 mmHg for short-stretch bandages, with an increase after standing of 6.0-7.0 mmHg with long-stretch, and 14.0-21.0 mmHg with short-stretch bandages (p<0.01, Mann-Whitney U-test). The median supine pressure values in the high pressure group were between 52.0 and 67.0 mmHg for long-stretch and 59.5-67.0 mmHg for short-stretch material. The median increase during standing ranged between 8.5 and 14.5 mmHg in the elastic group and 23.0-33.0 in the inelastic group (p<0.01, Mann-Whitney U-test).
CONCLUSION
A bandage applied with light pressure corresponds to the moderate pressure category of stockings. The difference between the sub-bandage pressure from supine to standing can be used to characterise the stiffness of a bandage.
Leg Clubs have been established to empower patients to become stakeholders in their own treatment. This case report describes how attendance at a Leg Club resulted in healing in a patient who previously was non-concordant with treatment.
Die Kompressionsbehandlung venöser Unterschenkelgeschwüre sollte an die Schwere des Krankheitsbildes angepasst werden. Länger bestehende, große Ulzera werden vorwiegend mit festen, mehrschichtigen Kurzzugbandagen behandelt ("Therapiephase"). Derartige Verbände können die ambulatorische venöse Hypertonie senken und 70 Prozent der Geschwüre in zwölf Wochen heilen. Danach ist es entscheidend, das Auftreten von Rezidiven mit guten medizinischen Kompressionsstrümpfen zu verhindern ("Erhaltungsphase"). Nach einer kurzen Darstellung der Ursachen des venösen Unterschenkel-Geschwürs wird auf Details der Therapie unter Verwendung von Bandagen unterschiedlicher Steifigkeit (Stiffness) eingegangen.
Diabetische Fußulzera gehören weltweit zu den häufigsten Ursachen für Amputationen im Bereich der unteren Extremitäten. Alleine in Deutschland sind nach Schätzungen der AOK für das Jahr 2001 ca. 29.000 Diabetiker betroffen, das entspricht fast 70% aller nicht-traumatischen Amputationen. Säulen der Therapie dieser diabetesbedingten Läsionen sind ein fachgerecht ausgeführtes Wunddebridement und die Entfernung avitalen Gewebes, eine adäquate lokale Wundversorgung und eine effektive Druckentlastung. Insbesondere der Druckentlastung kommt in diesem Behandlungsschema eine ganz entscheidende Rolle zu. Nur so können die Druckspitzen in den betroffenen Fußregionen wirkungsvoll minimiert und wundfördernde Scherkräfte vermieden werden. Während bisher in Deutschland zur Druckentlastung vorrangig therapeutisches Schuhwer (z.B. Vorfußentlastungsschuhe) eingesetzt werden, wird in anderen Ländern, beispielsweise in den USA, die Druckentlastung mittels vollflächigem Gips- oder Castverband (Total Contact Cast) bereits über 20 Jahre praktiziert2, 3 . Die in der Literatur beschriebenen Heilungsraten dieser Behandlungsmethode sind überzeugend, dennoch ist dieses Prinzip in Deutschland bisher
noch wenig verbreitet. Zur Testung der Effektivität einer Druckentlastung durch individuell angepasste, gepolsterte Cast-Schuhe, ähnlich dem Prinzip des „Total Contact Cast“, wurde diese Pilotstudie initiiert. Die Durchführung erfolgte in der Chirurgischen Ambulanz des DRK-Krankenhauses in Hachenburg in Zusammenarbeit mit einer diabetologisch qualifizierten Allgemeinarztpraxis. Zusätzlich zur Druckentlastung wurde die Wundheilung mit Produkten der Modernen Wundversorgung unterstützt.