Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation

Domeij-Arverud, Erica; Labruto, Fausto; Latifi, Ali; Nilsson, Gunnar; Edman, Gunnar; Ackermann, Paul W.

doi:10.1302/0301-620x.97b5.34581

Cited by 63 publications

(139 citation statements)

References 28 publications

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“…11 At 2 weeks, all patients who returned for follow-up were mobilised with an orthosis (Aircast XP Walker, DJO LLC, Vista, California, USA (n=23) or VACOped, OPED Gmbh, Germany (n=42)), and were instructed to start bearing their full weight. At 6 weeks, the brace was removed.…”

Section: Methodsmentioning

confidence: 99%

Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

Alim

Svedman

Edman³

et al. 2016

BMJ Open Sport Exerc Med

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ObjectivePatients who sustain acute Achilles tendon rupture (ATR) exhibit variable and mostly impaired long-term functional, and patient-reported outcomes. However, there exists a lack of early predictive markers of long-term outcomes to facilitate the development of improved treatment methods. The aim of this study was to assess markers of tendon callus production in patients with ATR in terms of outcome, pain, and fatigue.Study design and settingProspective cohort study; level of evidence 2. Outpatient orthopaedic/sports medicine department.PatientsA total of 65 patients (57 men, 8 women; mean age 41±7 years) with ATR were prospectively assessed.AssessmentsMarkers of tendon callus production, procollagen type I N-terminal propeptide (PINP) and procollagen type III N-terminal propeptide (PIIINP), were assessed 2 weeks postoperatively using microdialysis followed by enzymatic quantification. Normalised procollagen levels (n-PINP and n-PIIINP) were calculated as the ratio of procollagen to total protein content. Pain and fatigue were assessed at 1 year using reliable questionnaires Achilles tendon Total Rupture Score (ATRS).ResultsPatients exhibited fatigue (77.6%) and pain (44.1%) to some extent. Higher levels of n-PINP (R=0.38, p=0.016) and n-PIIINP (R=0.33, p=0.046) were significantly associated with less pain in the limb. Increased concentrations of PINP (R=−0.47, p=0.002) and PIIINP (R=−0.37, p=0.024) were related to more self-reported fatigue in the leg. The results were corroborated by multiple linear regression analyses.ConclusionsAssessment of procollagen markers in early tendon healing can predict long-term patient-reported outcomes after ATR. These novel findings suggest that procollagen markers could be used to facilitate the development of improved treatment methods in patients who sustain ATR.Trial registration numbersNCT01317160: Results. NCT02318472: Pre-results.

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Section: Methodsmentioning

confidence: 99%

Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

Alim

Svedman

Edman³

et al. 2016

BMJ Open Sport Exerc Med

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“…Although long-term bedrest (>14 days) would be beneficial for the success rate, it may increase the risks of disuse and deep vein thrombosis. [8][9][10] There was a significant difference between success rates of SG in patients who underwent immediate reconstruction and those who underwent delayed reconstruction. The purpose of delayed reconstruction is preparation of the wound bed and obtaining a more exact histopathological diagnosis of the resected tumor before reconstruction.…”

Section: Discussionmentioning

confidence: 95%

Retrospective evaluation of factors influencing successful skin grafting for patients with skin cancer of the foot

Goto

Yoshikawa

Mori

et al. 2017

The Journal of Dermatology

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Skin grafting is a simple method for reconstruction of a large defect on the foot. Although skin grafting on the foot sometimes fails, it is not clear what factors influence the success rate of skin grafting. We analyzed data for 71 patients with skin cancer of the foot who underwent reconstruction of defects with skin grafting. The factors we evaluated were success rate of skin grafting, weight-bearing or non-weight-bearing area, immediate or delayed reconstruction, and whether a tie-over bolster was used or not. The success rates were higher in patients with lesions in non-weight-bearing areas than in patients with lesions in weight-bearing areas and in patients who underwent delayed reconstruction than in patients who received immediate reconstruction. On the other hand, the use of a tie-over bolster did not improve the success rate. In conclusion, delayed reconstruction is desirable if the lesion is located in a weight-bearing area.

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“…Earlier studies examined the incidence of DVT at 2 weeks post-operatively as primary outcome [8, 9]. Adjuvant IPC was shown to be an effective method to reduce the risk of DVT during leg immobilization of ATR patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recently however, adjuvant intermittent pneumatic compression (IPC), which increases blood circulation during leg immobilization, was demonstrated to increase metabolism [10] and to reduce the risk of DVT after ATR [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis

Alim

Domeij-Arverud

Nilsson

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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Purpose and hypothesisAdjuvant intermittent pneumatic compression (IPC) during leg immobilization following Achilles tendon rupture (ATR) has been shown to reduce the risk of deep venous thrombosis. The purpose of this study was to investigate whether IPC can also promote tendon healing.MethodsOne hundred and fifty patients with surgical repair of acute ATR were post-operatively leg immobilized and prospectively randomized. Patients were allocated for 2 weeks of either adjuvant IPC treatment (n = 74) or treatment-as-usual (n = 74) in a plaster cast without IPC. The IPC group received 6 h daily bilateral calf IPC applied under an orthosis on the injured side. At 2 weeks post-operatively, tendon healing was assessed using microdialysis followed by enzymatic quantification of tendon callus production, procollagen type I (PINP) and type III (PIIINP) N-terminal propeptide, and total protein content. 14 IPC and 19 cast patients (control group) consented to undergo microdialysis. During weeks 3–6, all subjects were leg-immobilized in an orthosis without IPC. At 3 and 12 months, patient-reported outcome was assessed using reliable questionnaires (ATRS and EQ-5D). At 12 months, functional outcome was measured using the validated heel-rise test.ResultsAt 2 weeks post-rupture, the IPC-treated patients exhibited 69% higher levels of PINP in the ruptured Achilles tendon (AT) compared to the control group (p = 0.001). Interestingly, the IPC-treated contralateral, intact AT also demonstrated 49% higher concentrations of PINP compared to the non-treated intact AT of the plaster cast group (p = 0.002). There were no adverse events observed associated with IPC. At 3 and 12 months, no significant (n.s.) differences between the two treatments were observed using patient-reported and functional outcome measures.ConclusionsAdjuvant IPC during limb immobilization in patients with ATR seems to effectively enhance the early healing response by upregulation of collagen type I synthesis, without any adverse effects. Whether prolonged IPC application during the whole immobilization period can also lead to improved long-term clinical healing response should be further investigated. The healing process during leg immobilization in patients with Achilles tendon rupture can be improved through adjuvant IPC therapy, which additionally prevents deep venous thrombosis.Level of evidenceRandomized controlled trial, Level I.Electronic supplementary materialThe online version of this article (doi:10.1007/s00167-017-4621-8) contains supplementary material, which is available to authorized users.

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Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation

Cited by 63 publications

References 28 publications

Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

Retrospective evaluation of factors influencing successful skin grafting for patients with skin cancer of the foot

Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis

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