Controlled, Comparative Study of Relation between Volume Changes and Interface Pressure under Short-Stretch Bandages in Leg Lymphedema Patients

Abstract

BACKGROUND Pressure loss under short‐stretch bandages (SSBs) is a well‐known phenomenon and is thought to be related to bandage relaxation and poor quality of application. AIM The aim was to demonstrate that therapeutically intended volume reduction of the compressed leg is the most important cause for the loss of bandage pressure. DESIGN This was an experimental, controlled comparative study. METHODS In 20 patients suffering from lymphedema of the lower extremities and in 9 healthy persons, lower leg volume was measured by water displacement. After application of a pressure measurement device (Kikuhime) at the B1 region, SSBs were applied on one leg according to a standard protocol. Volume and pressure measurements were performed at 0, 2, and 24 hours in supine as well as standing positions. RESULTS A significant reduction of leg volume is already achieved 2 hours after bandage application, both in lymphedema patients and in normal controls. A further volume decrease of the lymphedematous legs is observed in the following 24 hours after application of a new bandage (−290 mL). The volume reduction is associated with a significant loss of bandage pressure from initial values over 60 mmHg by 37 and 48% in controls and lymphedema patients, respectively. CONCLUSIONS Inelastic, multilayer, multicomponent compression bandages lead to an immediate reduction of leg volume, both in lymphedematous and in normal legs. This therapeutically intended volume reduction seems to be the main reason for the fast decrease of the subbandage pressure.

Adjustable Velcro® Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial

“…As shown in a previous study, the pressure loss under the IBs is mainly due to a volume reduction of the leg. 3 The consistently higher pressure exerted over time by the AVCDs compared with the IBs might explain its greater effectiveness.…”

“…This bandage loosening is due to a reduction in edema, which is most pronounced immediately after bandage application. 3 The renewal of the bandage after 1 day seems to be an appropriate regime, as at that time the pressure will have already dropped to more than half. However, the optimal timing for renewing bandages needs further investigation.…”

“…1,2 The disadvantages of IBs are that they lose pressure quickly following application and need to be reapplied by specialized staff. 3,4 Elastic stockings, and particularly elastic kits, have been shown to be effective, even in the therapy phase, achieving similar edema reduction as IBs. 5,6 However, stockings may be difficult to apply and are often not well tolerated during the night.…”

The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy

“…17 On the other hand, there are many published articles stressing that inelastic materials provide better hemodynamic and clinical outcome on VLU healing compared to elastic material. 18,19 Despite the drop in the interface pressure, Partsch 20 demonstrated that in patients with deep venous incompetence, "inelastic" material achieves better control of venous reflux than "elastic" bandages applied at the same interface pressure. Therefore, it is clear that material plays a decisive role influencing the efficacy of the compression system.…”

Compression therapy in breast cancer-related lymphedema: A randomized, controlled comparative study of relation between volume and interface pressure changes

“…2 Only recently we reported the sub-bandage pressure measurements for leg LE. 3 Studies to measure the pressure in arm LE have rarely been performed before: thus, the compression pressure required to obtain the highest volume reduction per unit of time is unknown. In a pilot study, we found interface pressure values between 30-40 mm Hg exist after routine bandaging.…”