Recherche de publication

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.

INTRODUCTION

Chronic venous insufficiency (CVI) is a venous disorder in the lower extremities associated with changes in the skin and subcutaneous tissue. Treatment with short-stretch compression bandages is highly recommended for advanced stages of CVI.

METHODS

The compression systems Rosidal Sys, Porelast, Coban, and Proguide were evaluated in 4 groups of mobile and active patients (n = 18) with CVI stage II or III. Sub-bandage pressures at point B1 were measured in the upright and supine positions 30 min and 12 h after the bandage was applied. Average pressures and values of the static stiffness index (SSI) were calculated for each group.

RESULTS

The Porelast, Rosidal Sys and Coban systems had SSI values in excess of 10 mmHg, 30 min and 12 h after application. The corresponding values for Proguide were below 10 mmHg.

CONCLUSION

Porelast, Rosidal Sys and Coban are very stiff systems, whereas Proguide is more similar to long-stretch compression bandages with a lower degree of stiffness.

AIM

To investigate the influence of compression bandages, manufactured using materials with different elastic properties, on the impaired venous pumping function in patients with venous insufficiency.

METHODS

Ejection volume (EV) and ejection fraction (EF) were measured using strain gauge plethysmography distal from the patella without and with elastic and inelastic compression bandages in a total of 30 patients with major venous reflux in the great saphenous vein. The interface pressure of the bandages was measured simultaneously in the medial gaiter area. Normal values of EV and EF were obtained from 15 healthy controls.

RESULTS

Patients with venous insufficiency showed a statistically significant reduction of EV and EF compared to controls. Elastic bandages with an average pressure of 42 mm Hg in the supine position achieved a moderate increase of EV and a significant improvement of EF (p < .01), while inelastic bandages applied with comparable resting pressure (41 mm Hg) raised EV and EF into a normal range (p < .001). The improvement of the ejection fraction correlates well with the pressure differences between standing and lying (Static Stiffness Index) and between muscle systole and diastole during exercise (Pearson r = 0.69 and 0.74 respectively, p < .001). Elastic bandages applied with high stretch in order to achieve standing pressures comparable to those of inelastic bandages (>60 mm Hg) led only to a minor improvement of the venous pumping function.

CONCLUSIONS

Ejected volume and ejection fraction, which are severely reduced in venous insufficiency, can be increased by compression therapy. Inelastic compression is much more effective than elastic bandages, and is able to normalize venous pumping function. With elastic bandages EV and EF always remain below the normal range even when applied with high stretch producing a resting pressure that is barely tolerable.

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.