Evidenz der Kompressionstherapie

Konschake, Wolfgang; Valesky, Eva Maria; Stege, Helger; Jünger, Michael

doi:10.1007/s00105-017-3999-z

Cited by 22 publications

(15 citation statements)

References 39 publications

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“…Currently, no data exist on the effects of compression in lipoedema. However, studies in phlebology and sports medicine have shown that compression has an impressive effect on the inflammatory processes in subcutaneous tissue [51,52]. Confocal laser scanning microscopy has been used to show a significant reduction in pro-inflammatory cytokines and a simultaneous rise in anti-inflammatory mediators in the compressed tissue of patients with venous disease [53].…”

Section: Compression Therapymentioning

confidence: 99%

Lipoedema – myths and facts, Part 5

Bertsch¹,

Erbacher²,

Corda³

et al. 2020

Phlebologie

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The four previous articles in this series addressed the myths and facts surrounding lipoedema. We have shown that there is no scientific evidence at all for the key statements made about lipoedema – which are published time and time again. The main result of this “misunderstanding” of lipoedema is a therapeutic concept that misses the mark. The patient’s real problems are overlooked.The national and especially the international response to the series, which can be read in both German and English, has been immense and has exceeded all our expectations. The numerous reactions to our articles make it clear that in other countries, too, the fallacies regarding lipoedema have led to an increasing discrepancy between the experience of healthcare workers and the perspective of patients and self-help groups, based on misinformation mostly generated by the medical profession.Parts 1 to 4 in this series of articles on the myths surrounding lipoedema have made it clear that we have to radically change the view of lipoedema that has been held for decades. Changing our perspective means getting away from the idea of “oedema in lipoedema” – and hence away from the dogma that decongestion is absolutely necessary – and towards the actual problems faced by our patients with lipoedema. Such a paradigm shift in a disease that has been described in the same way for decades cannot be left to individuals but must be put on a much broader footing. For this reason, the lead author of this series of articles invited renowned lipoedema experts from various European countries to discussions on the subject. Experts from seven different countries took part in the two European Lipoedema Forums, with the goal of establishing a consensus. The consensus reflects the experts’ shared view on the disease, having scrutinized the available literature, and having taken into account the many years of clinical practice with this particular patient group. Appropriate to the clinical complexity of lipoedema, participants from different specialties provided an interdisciplinary approach. Nearly all of the participants in the European Lipoedema Forum had already published work on lipoedema, had been involved in drawing up their national lipoedema guidelines, or were on the executive board of their respective specialty society.In this fifth and final part of our series on lipoedema, we will summarise the relevant findings of this consensus, emphasising the treatment of lipoedema as we now recommend it. As the next step, the actual consensus paper “European Best Practice of Lipoedema” will be issued as an international publication.Instead of looking at the treatment of oedema, the consensus paper will focus on treatment of the soft tissue pain, as well as the psychological vulnerability of patients with lipoedema. The relationship between pain perception and the patient’s mental health is recognised and dealt with specifically. The consensus also addresses the problem of self-acceptance, and this plays a prominent role in the new therapeutic concept. The treatment of obesity provides a further pillar of treatment. Obesity is recognised as being the most common comorbid condition by far and an important trigger of lipoedema. Bariatric surgery should therefore also be considered for patients with lipoedema who are morbidly obese. The expert group upgraded the importance of compression therapy and appropriate physical activity, as the demonstrated anti-inflammatory effects directly improve the patients’ symptoms. Patients will be provided with tools for personalised self-management in order to sustain sucessful treatment. Should conservative therapy fail to improve the symptoms, liposuction may be considered in strictly defined circumstances.The change in the view of lipoedema that we describe here brings the patients’ actual symptoms to the forefront. This approach allows us to focus on more comprehensive treatment that is not only more effective but also more sustainable than focusing on the removal of non-existent oedema.

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Section: Compression Therapymentioning

confidence: 99%

Lipoedema – myths and facts, Part 5

Bertsch¹,

Erbacher²,

Corda³

et al. 2020

Phlebologie

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“…Compressive bandages reduce the exudate and the inflammation and are particularly important during the inflammatory phase. There is some evidence that the compression reduces the inflammation in inflammatory ulcers such as PG and vasculitis 33 . NPWT can be used in the noninflammatory phase of PG to reduce the size of the lesion and to control the exudate 34 .…”

Section: Discussionmentioning

confidence: 99%

PG‐TIME : A practical approach to the clinical management of pyoderma gangrenosum

Janowska

Oranges

Fissi

et al. 2020

Dermatologic Therapy

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Pyoderma gangrenosum (PG) is a neutrophilic dermatosis which may be rapidly progressive. Standard guidelines for local treatment are lacking. Through our experience, we suggested a local treatment algorithm based on the tissue, infection, moisture balance, and epithelization (TIME) concept. The clinical and histopathological features of 52 patients with PG, the duration, and the evolution of the lesions were retrospectively evaluated. Systemic therapies, local treatments, and standard wound treatments were reported. We observed ulcerative PG in the majority of the patients (82.6%), followed by the pustular form (9.6%), the peristomal type (3.8%), the vegetative form (1.9%), and the bullous type (1.9%). The lower leg was the most commonly area affected (90.4% of cases). Pathergy was reported in 15.3% of cases. The first‐line treatment was the use of oral glucocorticosteroids (GCSs). We observed healing after 3 weeks of GCS in 17.3% of cases. In 25% of all cases, we obtained complete healing with long‐term low doses (<0.5 mg/kg) of GCS in the range of 2 to 6 months. We used second‐line treatments in 57.6% of patients. Local, systemic treatment, and correct wound management can be associated with better clinical results. We suggest a new local therapeutic algorithm in both the inflammatory and noninflammatory healing phases.

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“…В таких случаях истина всегда находится где-то посередине. Так, большинство специалистов, активно практикующих склеротерапию, указывают на пользу 7-14-дневной компрессии и целесообразности ее пролонгации в зависимости от риска или появления нежелательных побочных явлений, таких как гиперпигментация и флебит [15][16][17].…”

Section: эстетическая флебологияunclassified

Sclerotherapy: step by step – liquid sclerotherapy

Богачев

Лобанов²

2020

Ambulatornaya khirurgiya

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Classic sclerotherapy using drugs in the native (liquid) state is almost the oldest method of minimally invasive treatment of various forms of varicose veins of lower extremities and not only. Despite more than 300 years of development of the sclerotherapy methodology, enormous international experience and almost thorough study of its mechanisms, the development of new sclerosing drugs and technologies of their delivery to the lumen of the target vein continues. Measures aimed at reducing the frequency of undesirable side effects after sclerotherapy and improving the quality of life of patients during treatment and after its completion are discussed separately. Currently, there are several guidelines that regulate phlebosclerosing treatment in various clinical situations in terms of evidence-based medicine. This publication provides a brief historical background on the formation of sclerotherapy technology, presents basic principles for liquid sclerotherapy based on the analysis of international and Russian recommendations for the treatment of chronic venous diseases. Indications, contraindications and the basic methods of carrying out sclerotherapy with the use of officinal, registered in the Russian Federation phlebosclerosing detergent agents are presented, their actual physical and chemical properties, similarities and distinctions, and also optimal concentrations and doses are discussed. The classic sclerotherapy technique which has become known as “empty vein technique” is described in detail and illustrated.In addition, current clinical examples demonstrating successful use of compression sclerotherapy are presented. Again, the authors conclude that liquid sclerotherapy with the use of modern phlebosclerosing agents such as lauromacrogol 400 and sodium tetradecyl sulfate, performed according to the classical “empty vein” technology, demonstrates high efficiency and safety regarding large varicose veins of various localizations.

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Evidenz der Kompressionstherapie

Cited by 22 publications

References 39 publications

Lipoedema – myths and facts, Part 5

Lipoedema – myths and facts, Part 5

PG‐TIME : A practical approach to the clinical management of pyoderma gangrenosum

Sclerotherapy: step by step – liquid sclerotherapy

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