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PubMed1985

[Compression in vascular pathology. Practical applications].

A better use of the methods of compression in vascular disease would be based on a progression of the available techniques: fixed compression, elastic bandages, elastic stockings, so that one can pass from one degree to another, but only in the direction indicated, except in the case of regression of the disease, when treatment of the previous stage would be required. One should never replace elastic stockings by elastic bandages except in the case of regression, nor the bandage by the boot, except when the bandage fails. On the other hand, a favourable clinical evolution means that the boot can be replaced by the bandage, the bandage by the stocking, or directly from the boot to the stocking. The optimal choice of the method of compression is made from this progressive range on the basis of the evaluation of the severity of the vascular disorders.

Bandages↗

PubMed1987

Graduated compression and its relation to venous refilling time.

Graduated compression is important in improving venous function, but the pressure profiles of different brands of stockings in situ and effects on a direct measure of venous function have not been investigated. The pressure profiles of 15 different types of below knee compression stockings were established with a medical stocking tester in 13 healthy volunteers. Analysis of variance was performed for each stocking separately, considering the factors of size of stocking, site of measurement, and their interaction. The criteria used to define satisfactory function were that the stockings should have a significant linear trend with site--that is, graduation--and no other significant effects. Only five types of stockings met these standards. Venous function was then assessed by photoplethysmography in 19 patients with defined venous abnormalities. For each patient the effect on venous refilling time of three satisfactory and three unsatisfactory stockings was assessed. The three satisfactory stockings gave refilling times that were not significantly different from normal in patients with both superficial and deep vein incompetence, while refilling times with the three unsatisfactory stockings remained significantly below normal in all patients with deep vein incompetence; one stocking had no significant effect on refilling times in either group. Functional testing of compression hosiery should form part of future British Standards specifications.

Biometry↗

PubMed1985

The use of plastic face mask and silicone gloves and boots as alternative to compression suits for treating hypertrophic scars.

Prevention and treatment of hypertrophic scars and contractures is usually obtained by the use of compression suits. The compression hood for the burned face is unaesthetical and often refused by the child. A better compression can be obtained by the use of a clear transparent plastic mask. It offers a better view and looks better, thus increasing the cooperation of the patient. Compression gloves and stockings are difficult to adapt to. It is easier to make mittens and boots out of silicone. These two techniques meet the criteria of efficiency: early application of compression, good tolerance, splint support, individually moulded splints for optimum pressure and cooperation.

Burns↗

PubMedDate not supplied

[Varices in pregnant woman. Legs and vulva. Treatment].

All pregnancy varices should be treated by the "new" sigvaris elastic stockings, available since C. 1960, degressive, and of calculated compression. However, these elastic stockings are not enough in all cases, and they should in no way replace active therapy. Sclerosant injections enable the practitioner to treat varicose recidivism during the pregnancy of women already treated (by sclerotherapy or by surgery). Surgery may also be performed on the saphenous veins during pregnancy, if it is really necessary. This is rare; it should be used only in carefully-selected cases: E. Gr. saphenous thrombosis, or certain rapid developments on large saphenous vessels. After an account of the three methods, the author gives his reasons for a therapeutic option, and notes his observations, especially concerning 54 operations performed on varices during the course of pregnancy. Contrary to the teachings of many obstetricians, vulval varices may be treated rapidly, successfully, and safely by sclero-therapy. The author hopes that this reminder of certain theories and experiences will encourage younger phlebologists to practice these therapeutic methods.

Adult↗

PubMed1985

Management of stasis leg ulcers with Unna's boots versus elastic support stockings.

Twenty-one patients with stasis leg ulcers were randomly assigned to two groups. The first group was treated with Unna's boots, while the second was treated with elastic support stockings with graded compression from 24 mm/Hg pressure at the ankle to 16 mm/Hg pressure at the calf. The ulcers on seven of ten legs (70%) treated with Unna's boots and on 10 of 14 legs (71%) treated with elastic support stocking healed. Although the two groups were small, there was no statistically significant difference between their success rate in healing stasis leg ulcers (p = 0.9394). Both treatment groups showed significant changes in lower limb volume, calf circumference, and ankle circumference, although there was no statistically significant difference between the two groups. If healing times are calculated, however, the average healing time in the Unna boot-treated group was 7.3 weeks, while patients treated with support stockings took an average of 18.4 weeks. If one patient whose ulcerations almost encircled her calves and took 78 weeks to heal is excluded, patients treated with support stockings had an average healing time of 11.8 weeks.

Adult↗

PubMed1986

Photo-reflex-rheographical method in the evaluation of elastocompression.

The importance of a "compression-mobilization" association in order to attain a correct therapeutical procedure is stressed. The authors then report the results of a study conducted on patients affected by varices to establish the efficacy of a treatment by means of elastic stockings with graduated compressive pressure and the efficacy of reflex-rheography as a noninvasive, economical and easy-to-use method for the assessment of the variations in venous return flow produced by the association of muscular activity and elastocompression.

Adult↗

PubMed2006

A review of the microcirculation in skin in patients with chronic venous insufficiency: the problem and the evidence available for therapeutic options.

Impairment of the cutaneous microcirculation is a major predisposing factor in inflammation and ulceration in patients with chronic venous insufficiency (CVI). Increase of capillary filtration rate predisposes to the formation of edema. Local lymphedema is a complication of CVI, often underdiagnosed. This review is focused on CVI but excludes the complication of ulceration. Treatment of microcirculatory dysfunction can be done by pharmacologic intervention or compression therapy or using a combination of both. This review is focused on drugs that have been evaluated by randomized prospective controlled trials. The following compounds are discussed: horse chestnut seed extracts, flavonoids, red vine leaves extracts, total triterpenic fraction of Centella asiatica (L), prociadins, calcium dobesilate, and pentoxifylline. The microcirculatory effects of compression therapy using bandages or stockings are also reviewed. The major microcirculatory effects that have been shown are the reduction of capillary filtration rate and improvements in levels of transcutaneous partial pressures of oxygen and carbon dioxide (TcPO(2) and TcPCO(2)). Available data suggest that a combination of pharmacologic and compression therapy may have some additive effects.

Chronic Disease↗

PubMed2005

Skin grafting for venous leg ulcers.

BACKGROUND: Venous leg ulceration is a common and disabling condition which often recurs. It affects up to one in 100 adults at some time. The usual treatments are simple dressings and compression bandages or stockings. Unfortunately, in some cases this treatment is unsuccessful, with ulcers remaining open for months or years. Sometimes skin grafts are used to stimulate healing. These skin grafts may be taken from the patient's own uninjured skin, may be grown from the patient's skin cells into a dressing (autografts), or applied as a sheet of bioengineered skin grown from donor cells (allograft). Preserved skin from other animals, such as pigs, has also been used; these grafts are known as xerografts. OBJECTIVES: To assess the effect of skin grafts for treating venous leg ulcers. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (June 2004) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2004). SELECTION CRITERIA: Randomised controlled trials (RCTs) of skin grafts in the treatment of venous leg ulcers. DATA COLLECTION AND ANALYSIS: Two reviewers independently undertook data extraction and assessment of study quality. MAIN RESULTS: Nine trials of skin grafts for venous leg ulcers were identified, involving 579 participants. The trials were generally of poor methodological quality. In eight trials participants also received compression bandaging. Two trials (98 participants) evaluated split thickness autografts (one against a dressing and one against a xerograft), four trials (119 participants) evaluated cultured keratinocyte grafts (3 allografts and 1 autograft) , two compared tissue engineered skin (bilayer artificial skin) with a dressing (345 participants), and one compared it with a split thickness skin graft (7 participants, 13 ulcers). The trials comparing bilayer artificial skin with a dressing reported a significantly higher proportion of ulcers healing with artificial skin. There was not enough evidence from the other trials to determine whether other types of skin grafting increased the healing of venous ulcers. AUTHORS' CONCLUSIONS: There is evidence that a bilayer artificial skin, used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared with compression and a simple dressing. Further research is needed to assess whether other forms of skin grafts increase ulcer healing.

Adult↗

PubMed2003

[Therapy of ulcus cruris venosum].

Wound healing in venous leg ulcers is a highly complex, dynamic process that is influenced by a number of factors. The primary task of local therapy is to support this natural healing process. While a number of therapeutic agents are available, in most cases their efficacy has yet to be established in controlled prospective studies in the sense of evidence-based medicine. Thus, the physician is left with the task of drawing up individual therapy plans for each patient according to the state of the wound. Compression bandages or stockings form the mainstay of treatment, generally in combination with moist dressings for chronic wounds.

Anti-Infective Agents, Local↗

PubMed2003

Prevention of venous thromboembolism in critically ill medical patients: a Franco-Canadian cross-sectional study.

BACKGROUND: Medical intensive care unit (ICU) patients are at moderate risk of venous thromboembolism (VTE) and prophylaxis against VTE is recommended. OBJECTIVES: To observe the range and frequency of VTE prophylaxis administered to medical ICU patients and to determine factors associated with different strategies in French and Canadian ICUs. DESIGN: Prospective cross-sectional observational study. RESULTS: 113/251 (45.0%) French and 29/30 (96.6%) Canadian ICUs agreed to participate. Of 1,222 critically ill medical patients, most were mechanically ventilated (62.5%). Overall, heparin VTE prophylaxis was administered to 63.9% patients, similarly between the 2 countries. Excluding patients with contraindications to heparin and those receiving therapeutic anticoagulation, 91.7% of medical ICU patients appropriately received either low dose unfractionated heparin (UFH) or low molecular weight heparin (LMWH) prophylaxis. Independent predictors of heparin prophylaxis were invasive mechanical ventilation (odds ratio [OR]; 95%CI, 2.4 (1.4-4.3) and obesity (OR 3.1; 1.1-8.8). LMWH was less likely to be prescribed for patients with renal failure (OR 0.1; 0.0009-0.9), or receiving antiembolic stockings (OR 0.4, 0.1-0.9), and much more likely to be prescribed in French ICUs (OR 9.2; 5.0-16.9); however, among patients receiving LMWH, high doses were more likely to be prescribed in Canadian ICUs (OR 8.7; 2.0-37.6). Patients who were pregnant or postpartum (OR 7.7, 1.3-44.3), had neurologic failure (OR 2.1, 1.3-3.4), or were Canadian (OR 3.0, 2.1-4.4) were most likely to receive mechanical VTE prophylaxis (with antiembolic stockings or pneumatic compression devices), whereas those who were already receiving heparin were less likely to receive mechanical prophylaxis (OR 0.5, 0.3-0.7). CONCLUSIONS: In this binational cross-sectional observational study of medical ICU patients, we found that 92% of eligible patients received either UFH or LWMH for VTE prophylaxis. Differences in prescribing between countries include significantly greater use of LMWH in France, but use of lower doses than in Canada, and greater use of mechanical VTE prophylaxis in Canada. More randomized trials of VTE prophylaxis in critically ill medical patients would better inform practice.

Anticoagulants↗

PubMed2001

Use of venous thromboembolism prophylaxis for surgical patients: a multicentre analysis of practice in Spain.

OBJECTIVE: To assess the use of venous thromboembolism prophylaxis in surgical patients. DESIGN: Retrospective multicentre study. SETTING: Eight acute-care teaching hospitals with more than 400 beds, Spain. PATIENTS: Medical records of all consecutive patients undergoing operations in the general surgical and trauma and orthopaedic services during the month of April, 1997, were randomly selected. INTERVENTION: The sample size for each type of operation (general, trauma-orthopaedic) was calculated from the number of operations done at each hospital (with an absolute precision of 5%, and an alpha error of 5%) and the prevalence of the use of venous thromboembolism prophylaxis obtained from a random sample of 50 records (25 from patients in general surgery and 25 from patients in orthopaedic surgery) from each centre. MAIN OUTCOME MEASURES: Appropriate and inappropriate pharmacological prophylaxis defined according to a combination of risk categories for venous thromboembolism, doses of antithrombotic agents given, time of starting prophylaxis, and its duration. RESULTS: A total of 1848 medical records (general surgery, n = 1025; trauma-orthopaedic surgery, n = 823) were included. Physical methods (elastic stockings, intermittent pneumatic compression) were used in only 0.3% of patients. Pharmacological prophylaxis consisted of low molecular weight heparin in 99% of cases. The percentage given heparin-based prophylaxis was 54%. Overall, appropriate prophylaxis was given in 1175 patients (64%). Use of thromboprophylaxis ranged from 27% to 70% among the participating hospitals. Prophylaxis was more likely to be appropriate in orthopaedic patients (577, 70%) than in general surgical patients (598, 58%) in both the high and moderate risk categories. CONCLUSIONS: Given the large variability between the participating hospitals, more specific protocols and recommendations about prophylaxis of thromboembolism in surgical patients are needed.

Adolescent↗

PubMed2004

Minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema: is it effective for stage III and IV?

This is the first report on the effectiveness of minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema. Fifty-two patients (age: 15 to 78 years old; 8 males, 44 females) were treated with lymphaticovenular anastomoses under local anesthesia and by postoperative compression using elastic stockings. The average duration of edema of these patients before treatment was 5.3 +/- 5.0 years. The average number of anastomosis in each patient was 2.1 +/- 1.2 (1-5). The patients were followed for an average of 14.5 +/- 10.2 months, and the result were considered effective (82.5%) even for the patients with stage III (progressive edema with acute lymphangitis) and IV (fibrolymphedema), but others showed no improvement. Among these cases, 17 patients showed reduction of over 4 cm in the circumference of the lower leg. The average decrease in the circumference excluding edema in bilateral legs was 41.8 +/- 31.2% of the preoperative excess length. These results indicate that minimal invasive lymphaticovenular anastomosis under a local anesthesia is valuable instead of general anesthesia.

Adolescent↗

PubMedDate not supplied

From skin disorders to venous leg ulcers: pathophysiology and efficacy of Daflon 500 mg in ulcer healing.

The standard treatments for venous diseases of the lower limb include compression bandaging and stockings as well as surgical removal of varicose veins. There are a number of conditions in which these conventional treatments are ineffective, particularly in the management of leg ulceration. Drug treatments for healing venous leg ulcers have yet to be developed to the stage of good clinical efficacy, but these may assist in the management of patients. Flavonoid drugs have been widely used in the management of the symptoms of venous disease for many years and have recently been studied in some detail to assess their effects on the microcirculation. Work in animal models of ischemia-reperfusion show that MPFF (micronized purified flavonoid fraction) modulates leukocyte adhesion and prevents endothelial damage. Similar biochemical effects have been observed in patients with venous disease and may explain the efficacy of this drug in the management of edema and other symptoms of venous disease. There is clinical evidence that MPFF modifies venous leg ulcer healing.

Animals↗

PubMed1994

Optimal treatment of venous (stasis) ulcers in elderly patients.

In elderly patients, even those with a typical venous (stasis) ulcer, coexisting conditions like peripheral arterial insufficiency and diabetes are very common. Therefore, all elderly patients with leg ulcers should have a complete medical assessment. The mainstay of treatment for venous ulcers is compression therapy, exercise and leg elevation at rest. Long term treatment with double bandages (zinc paste bandages and elastic compression), changed once weekly, is the recommended standard treatment in the elderly. Hydrocolloid dressings are also suitable for long term treatment in clean ulcers, and should be changed once or twice weekly and combined with compression. Sloughy, exudating ulcers might need redressing daily with a desloughing agent for a short period of time. The risk of sensitising patients with chronic leg ulcers is high and few topical preparations, with low antigenicity, should be used. Infection and ulcerated skin cancers should be ruled out in nonhealing ulcers if the patient complies with compression therapy. After healing, the patient should be advised to continue compression therapy with stockings to prevent recurrences. New noninvasive techniques for investigation of venous insufficiency can select patients suitable for venous surgery, but many elderly patients are not interested in surgery or have other ailments that prevent surgery.

Aged↗

PubMed2000

Micronized purified flavonoid fraction and the treatment of chronic venous insufficiency: microcirculatory mechanisms.

The standard treatments for venous diseases of the lower limb include compression bandaging and stockings as well as surgical removal of varicose veins. There is a number of conditions in which these conventional treatments are ineffective, particularly in the management of leg ulceration. Drug treatments for healing venous leg ulcers have yet to be developed to the stage of good clinical efficacy, but may assist in the management of patients. Flavonoid drugs have been widely used in the management of the symptoms of venous disease for many years and have recently been studied in some detail to assess their effects on the microcirculation. Work in animal models of ischemia/reperfusion (I/R) show that micronized purified flavonoid fraction (MPFF) modulates leukocyte adhesion and prevents endothelial damage. Similar biochemical effects have been observed in patients with venous disease and may explain the efficacy of this drug in the management of edema and other symptoms of venous disease. There is some evidence that MPFF promotes venous leg ulcer healing.

Animals↗

PubMed2001

[Perioperative management for radical esophagectomy in a patient with polycythemia vera].

We experienced perioperative management of a 75 year-old patient with polycythemia vera (PV) who underwent transthoracic esophagectomy. After treatment for 14 days of ranimustine and hydroxycarbamid, the preoperative hemoglobin, hematocrit values and platelet count were 17.9 g.dl-1, 58% and 54 x 10(4).mm-3 respectively. During the perioperative period, phlebotomy, elastic stockings, intermittent pneumatic compression, infusion of nafamostat, and early extubation (the day of operation) were performed to prevent deep venous thrombosis. The postoperative course was uneventful and the patient was discharged 34 days after the operation.

Aged↗

PubMedDate not supplied

Surgical correction of recurrent venous ulcer.

Seventy-six limbs from 46 patients with comparable superficial and deep venous valve incompetence underwent surgical correction for recurrent venous ulcers of the leg that were refractory to various modes of nonsurgical and surgical treatments. A follow-up of 10 to 73 months (mean = 37 months), revealed the venous ulcer healed with perforator ligation and saphenous vein stripping in 14 of 33 (44%), stripping plus valvuloplasty 17 of 21 (80%), stripping plus vein transposition 11 of 14 (78%) and stripping plus valve transplantation 6 of 8 (75%). In patients with incompetent deep venous valve and perforators, the disassociation of the superficial from the deep venous system (stripping) plus correction of the deep venous valvular incompetence (valvuloplasty, transposition or valve transplant) produced superior results in the treatment of recurrent venous ulcer when compared to perforator ligation and saphenous vein stripping alone (p less than 0.005). Adjunctive usage of elastic stockings and intermittent compression pneumatic boots in the perioperative period was helpful in controlling leg swelling and promoting wound healing.

Bandages↗

PubMedDate not supplied

Comparison of surgical modalities in the treatment of recurrent venous ulcer.

Recurrent leg ulcer secondary to superficial and deep venous valve incompetence that are refractory to non-surgical treatment can be healed with the following surgical modalities. Perforator ligation and saphenous vein stripping (PLSVS) healed 4/16 (25%) of the ulcer. PLSVS and correction of deep venous valve incompetence healed 14/16 (87.5%) of the ulcer (p less than 0.005). The mean follow-up was 32 months (8-62 mon). This prospective comparison of the 2 surgical treatments (PLSVS versus PLSVS and correction of deep venous valve) demonstrated that disassociation of the superficial from the deep venous system with PLSVS and correction of the deep valve (valvuloplasty, transposition or valve transplant) produced promising results in the treatment of recurrent venous ulcer. Adjunctive usage of elastic stocking and intermittent compression pneumatic boot to reduce swelling in the paraoperative period improved long term result in venous reconstructive surgery.

Adult↗