Textile-based compression therapy in managing chronic oedema: Complex interactions

Abstract

Background Compression is a common therapy for management of chronic disease, including oedema of the lower limb. Modern compression interventions exert pressure on the lower limb through use of one or more materials which exert pressure against the limb over time. Where these materials are textiles, they range from elastic to inelastic, and are produced using knitting, weaving, or other textile technologies which can be manipulated to control performance properties. Thus, understanding of both the materials/textiles and the human body is needed if the most appropriate compression device and treatment strategy is to be used. Neither is independent of the other. This review aims to enhance understanding of critical textile performance properties and how selection of textiles may affect treatment efficacy when managing chronic oedema of the lower limb. Method Relevant papers for review were identified via PubMed Central® library, and Google Scholar using keywords associated with textile-based treatments of the oedematous lower limb and wider interdisciplinary factors. Results Assessment of the disorder, the severity of oedema, and location of fluid accumulation are required to inform treatment of chronic oedema. While the need to understand the patient is well established (e.g. age, sex, body mass index, skin thickness and colour, patient compliance with treatment), information about preferred compression systems and material structures, and inherent properties of these, is generally lacking. Conclusion Greater detail about materials used (e.g. fabric structure, number and order of layers, fibre content) and patient diagnosis (e.g. underlying cause, severity, location of oedema; patient age and sex; evidence of compliance with treatment; pressure exerted; lower leg shape, size, and properties of the tissue) is needed to facilitate advances in efficacy of compression treatment. Reduced limb swelling with a textile-based treatment occurs simultaneously with changes to the textile itself. Textiles cannot be considered inert.

Material, structure, and design of textile-based compression devices for managing chronic edema

“…Properties critical to selection of materials and their performance are that they are light in weight, puncture resistant (in case of PCDs), sufficiently flexible to allow conformation to the body shape, air and water-vapor permeable, and that they exhibit low thermal and water-vapor resistance. 13,58,69 Other factors include presence of frictional properties and response to repeated cycle without wrinkles occurring. A further requirement is that compression devices must not abrade the affected or adjacent skin.…”

“…176,177 A compression device should accommodate the 3-dimensional shape of the leg. 13 Wearing a compression device that does not fit the patient's leg characteristics may enhance the severity of edema. A compression device that is too tight may cause tissue damage and discomfort for patients.…”

Thermal and moisture behavior of a multi-layered assembly in a pneumatic compression device

“…This paper explores selected factors affecting performance of the device which influence that environment, with the aim of improving compression products. 5…”

“…1,2 Investigation into effects of these pneumatic devices as part of sustained compression therapy has led to the conclusion that compression treatment does indeed offer benefits, 3 although some participants have been shown to resist or abandon compression treatments due to discomfort and low sensorial acceptability. 4,5 For example, five of 16 participants dropped out of a trial by Rowland et al: 6 of the five, two were using a compression bandage and three a pneumatic device. In another study, four participants from each treatment group (high, low pneumatic compression) withdrew due to discomfort.…”

“…This paper explores selected factors affecting performance of the device which Materials Science and Technology, University of Otago, New Zealand influence that environment, with the aim of improving compression products. 5 The bladder of an air pneumatic compression device is typically fabricated by joining two sheets of air impervious materials (e.g. polyurethane, polyethylene, silicone).…”