The Effects of Graduated Compression Stockings on Cutaneous Surface Pressure Along the Path of Main Superficial Veins of Lower Limbs
Abstract: Background. The superficial venous system is most often affected by varicose veins. Graduated compression stockings (GCSs) are a recognized effective nonsurgical option to prevent and treat lower limb varicose veins. Objective. The objective of the present study was to investigate the cutaneous surface pressure exerted by GCSs along the courses of main superficial veins of the lower limb. Methods and materials. Cutaneous surface pressures along the paths of long and short saphenous veins applied by different kinds of GCSs were examined by using pressure sensors (Tekscan, Inc., Boston, Mass) and a multichannel monitoring system in 6 healthy women tested in 7 different body postures. Results. Tested location, body posture, and types of compression stocking significantly influenced the cutaneous pressure along the main superficial veins (P < 0.001). Cutaneous pressure along the short saphenous veins had better pressure gradient performance when subjects were standing. The pressures applied at the popliteal fossa and Achilles tendon were significantly influenced by body postures (P < 0.001). Insufficient pressure and reversed pressure gradients were exerted on the regions along the long saphenous veins. Flexion exercise of the joints and muscle activity of the lower limbs helped provide more support and compression on the superficial venous system. Conclusion. Graduated compression stockings exerted significant influences on the cutaneous pressure distribution and magnitudes along the path of main superficial veins. Different testing locations and body postures induced variations on the pressure performances. Proper lower limb exercises are still recommended when wearing compression stockings.
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May 2004 Product News
May 2004 Product News Product News: May 2004 Product News - Juzo Introduces Silver Compression Stockings Juzo announces the arrival of Juzo Silver Compression Stockings. Juzo Silver Compression Stockings are knitted with 23-percent X-STATIC® silver threads. These added benefits make Juzo Silver Compression Stockings the ideal compression therapy solution for wound care patients by extending the antimicrobial shield beyond the wound dressing.
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February 2005
February 2005 Product News: February 2005 - Compression Stockings for the Fashion Conscious Sigvaris Inc. (Peachtree City, Ga) announces the launch of the Sigvaris® 773 Truly Transparent medical compression stockings. E-mail sunita.pargass@ganzoni.com or call 770-632-2932 for more information. Easy Air features and benefits include: ?
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Efficacy and Safety of Recombinant Human Platelet-Derived Growth Factor-BB (Becaplermin) in Patients with Chronic Venous Ulcers: A Pilot Study
Abstract: Objective: Two randomized, placebo-controlled, pilot studies were conducted to evaluate the efficacy and safety of becaplermin gel 100mg/g (rhPDGF-BB; Regranex® 0.01%, Johnson & Johnson Wound Management Worldwide, Somerville, New Jersey) in patients >=18 years of age with chronic venous ulcers. Methods: Patients were treated with becaplermin gel 100mg/g (Study 1, n = 35; Study 2, n = 32) or placebo gel (Study 1, n = 36; Study 2, n = 32) for a maximum of 16 weeks or until ulcers were completely healed, whichever came first. Study medication was applied to the ulcers daily (in Study 1) or twice weekly (Study 2), and the ulcers were covered with nonadherent dressing with or without gauze. All patients received a standardized regimen of good wound care, including sharp debridement, compression therapy, and infection control. Efficacy measures included the incidence of and time to complete healing. The incidence of adverse events was used to evaluate safety. Results: In Study 1, complete healing occurred in 36 percent (12/35) of patients treated with becaplermin gel compared with 34 percent (12/36) of patients treated with placebo gel. In Study 2, complete healing was noted in 56 percent (18/32) of patients treated with becaplermin gel compared with 44 percent (14/32) of patients treated with placebo. Further analysis showed that becaplermin gel was of greater benefit in patients with baseline ulcer size of >=5cm2. The incidence of adverse events (overall and treatment-emergent, wound-related) was generally comparable for both treatment groups in each study. Conclusion: These results suggest that becaplermin gel 100mg/g in conjunction with good wound care that includes compression therapy at 30 to 40mmHg appears safe and may be beneficial in the treatment of patients with chronic venous leg ulcers, whether used daily or twice weekly. An additional large-scale study will be necessary for conclusive determination of efficacy.
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Efficacy of a Ready-Made Tubular Compression Device Versus Short-Stretch Compression Bandages in the Treatment of Venous Leg Ulcers
Abstract: Background: Conventional compression therapy of venous leg ulcers consists of applying pressure bandages; this operation is not simple and requires training. A heelless open-toed elastic compression device knitted in tubular form (Tubulcus®, Laboratoires Innothéra, Arcueil, France) represents a valuable alternative. It provides graduated compression with a value of 30?40mmHg at the ankle. Appropriate pressure is exerted regardless of the skill of the fitter (who may even be the patient), and fitting of the device is facilitated by the use of a specific positioner. The aim of this trial was to compare the efficacy and tolerability of the new compression device and a short-stretch compression bandage (Rosidal® K, Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany) for 12 weeks in patients with venous leg ulcers. Materials and methods: This was an open, randomized, comparative, international multicenter trial in two parallel groups in France, Germany, Austria, and Switzerland. Study patients had venous ulcers for less than three months, and ulcers measured no more than 5cm in diameter. Ulcer area was assessed by a physician by means of computerized planimetry each week or on premature discontinuation of treatment. The per-protocol (PP) population comprised 88 patients treated with the tubular device (50 in France/Switzerland, 38 in Germany/Austria) and 90 treated with bandages (52 in France/Switzerland, 38 in Germany/Austria). Results: Complete healing was observed in 58 percent of patients in the tubular compression device group and in 56.7 percent in the bandage group. The difference between the two treatment groups was ?1.3 percent, and the 90-percent confidence interval (?13.5%?10.9%) was within the limits of noninferiority specified in the protocol, i.e., Δ=15%. These results show that the efficacy of the tubular device was not inferior to that of bandages and that neither treatment was superior in efficacy to the other. The surface area of ulcers not
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An Analysis of the Effectiveness of Skin Grafting to Treat Chronic Venous Leg Ulcers
Aim. This study assessed the effectiveness of skin autografting at 6 months post treatment. Materials and Methods. A prospective analysis of the disease course and treatment of 2 groups of patients (group S contained patients who have been treated by performing the surgery of skin autografting, group C contained patients who have been treated only by nonoperative means of treatment) after 6 months who were treated from January 2001 to June 2005 at the Department of Plastic Surgery and Burns and at the Clinic of Skin and Venereal Diseases of Kaunas Medical University Hospital was performed. The analysis evaluated the influence on the speed of epithelization (healing) of ulcers by performing surgical skin autografting and conservative treatment. The speed of epithelization (the decrement of an area of an ulcer within 6 months) for the treatment of large chronic leg ulcers after the first 6-month period was also analyzed. Results. Seventy-one patients (group S, n = 40; group C, n = 31) participated in the 6-month study period. Ulcers did not heal completely in any patients in group C (100%)?ulcer size increased in 17 patients and decreased in 14 patients. The average area of ulcers for group C was 171.12 cm2 (range = 8 cm2?720 cm2). Compared to the area before treatment (m = 182.29 cm2), the reduction in average area was not significant (P > 0.5). The contamination of ulcers did not change much in either group over the course of the study. Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly found pathogens. In group S, the skin epithelized completely in 27 cases (67.5%) and did not epithelize in 13 cases (32.5%). The average ulcer area was 16 cm2 (range = 6 cm2?52 cm2). In comparison with the previous area (m = 279 cm2), the current area was rather small and did not (or was insignificant) influence patient quality of life. Conclusion. According to the data from all factors that were analyzed, age was the only influence on the origination of large chronic venous leg ulcers (CVLUs, P < 0.05). Larg
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Editorial Message
Editorial Message Editor's Message: Editorial Message - David T. Rovee, PhD June, 2006Dear Readers,The first article in this issue of the journal describes the uncommon disease, hidradenitis suppurativa (HS), which involves the chronic infection of apocrine glands. The authors find this technique to be particularly useful in dressing grafts on highly mobile areas, such as the buttock, hip joint, or shoulder joint.A case series by Humburg et al (Negative pressure wound therapy in post-...
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Compression of Venous Insufficiency Ulcers
Compression of Venous Insufficiency Ulcers Evidence Corner: Compression of Venous Insufficiency Ulcers - Laura L. Bolton, PhD This month the Evidence Corner brings you evidence on compression of venous insufficiency ulcers. Objective: Assess effectiveness and cost effectiveness of compression bandages and stockings in treating venous leg ulcers. Conclusions: Compression increases venous leg ulcer healing rates, high compression is more effective than low compression, and multilayered ...
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Nonhyperparathyroid Wound Calcifications: Two Case Presentations and Literature Review
Abstract: We present two case studies in which subcutaneous tissue calcifications are noted and reported in detail. Treatment in both cases included aggressive surgical debridement of calcium deposits. Though the etiologies differ, the two patients had similar symptoms and pathologic findings. A review of the literature reveals several etiologies of cutaneous and subcutaneous calcification. Physiologic regulation of body calcium is discussed as well as diagnostic tools and treatment plans.
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Does Bilayered Extracellular Matrix Technology Hasten Wound Healing in Venous Stasis Ulcers? A Retrospective Study
Abstract: The clinical management of venous ulcers is debatable; however, a better understanding of the physiology has led to development of new treatment modalities. At the authors? center, bilayered extracellular matrix (ECM) technology (OASIS® Wound Matrix, Healthpoint, Ltd., Fort Worth, Tex) has been used to treat various lower-extremity wounds. In this retrospective study, the authors attempted to determine if ECM with a classic Unna boot method of compression was more effective at healing venous stasis ulcers than traditional Unna compression dressing supplemented by a wound drainage controlling agent alone. Thirty-three randomized outpatients diagnosed with venous insufficiency and venous leg ulcers were recruited to the study. The patients were divided into 2 groups based on type of dressing applied. Group A was treated with the commercially available ECM and application of a classic Unna boot method of compression. Group B was treated with the classic Unna boot method. The complete healing rates were found to be 76.56% (13/18) in Group A and 74.46% (11/15) in Group B at the end of 12 weeks. The tri-weekly wound surface reduction (cm2) was 2.78±0.32 for Group A and 2.34±0.21 for Group B. The comparison of both groups according to the complete healing rates showed no significant difference (p>0.05).
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