Abstract
Compression is the mainstay of management of ambulatory venous hypertension, the most common sequel of which is venous leg ulceration. The logic for selecting compression is based on physical principles governing tension, pressure, volume as elegantly enshrined in the works of French mathematician philosophers Laplace and prior to him, Pascal. The application of Laplace’s law for using compression bandages to manage limb swelling consequent to unrelieved venous pressures and sequelae are described and used with Pascal’s law to comprehend the limitations of compression systems. While robust data from several reports endorse the concept of using compression, evidence also indicates the limitations of and difficulties encountered in practice of offering compression which involve, to a large part, changing position: from lying still to standing upright and being ambulant. The concept of measuring static stiffness index (SSI), described by Partsch, helps to explain these changes. SSI should be measured with the patient upstanding and at a specific point on the calf. This and guidance for offering compression for other clinical conditions are described in this chapter.
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References
Thomas S. The production and measurement of sub-bandage pressure: Laplace’s Law revisited. J Wound Care. 2014;23(5):234–6, 38–41.
Partsch H, Mosti G, Schuren J, Benigni JP. The static stiffness index: an important parameter to characterise compression therapy in vivo. J Wound Care. 2016;25(Suppl 9):S4–S10.
Partsch H. Compression for the management of venous leg ulcers: which material do we have? Phlebology. 2014;29(1 suppl):140–5.
Neumann HA, Partsch H, Mosti G, Flour M. Classification of compression stockings: report of the meeting of the International Compression Club,Copenhagen. Int Angiol. 2016;35(2):122–8.
Partsch H, Clark M, Bassez S, Benigni JP, Becker F, et al. Measurement of lower leg compression in vivo: recommendations for the performance of measurements of interface pressure and stiffness: consensus statement. Dermatol Surg. 2006;32(2):224–32.
Partsch H, Mosti G. Comparison of three portable instruments to measure compression pressure. Int Angiol. 2010;29(5):426–30.
Partsch H, Clark M, Mosti G, Steinlechner E, Schuren J, et al. Classification of compression bandages: practical aspects. Dermatol Surg. 2008;34(5):600–9.
Stolk R, Wegen van der-Franken CP, Neumann HA. A method for measuring the dynamic behavior of medical compression hosiery during walking. Dermatol Surg. 2004;30(5):729–36.
CEN. Comité Européen de Normalisation. 2001:1–40. Located at: European Prestandard. Medical compression hosiery. European Committee for Standardization, Brussels.
Partsch H. The use of pressure change on standing as a surrogate measure of the stiffness of a compression bandage. Eur J Vasc Endovasc Surg. 2005;30(4):415–21.
Sigel B, Edelstein AL, Savitch L, et al. Type of compression for reducing venous stasis. A study of lower extremities during inactive recumbency. Arch Surg. 1975;110:171–5.
Murthy G, Ballard RE, Breit GA, Watenpaugh DE, Hargens AR. Intramuscular pressures beneath elastic and inelastic leggings. Ann Vasc Surg. 1994;8(6):543–8.
Flour M, Clark M, Partsch H, Mosti G, Uhl JF, et al. Dogmas and controversies in compression therapy: report of an International Compression Club (ICC) meeting, Brussels, May 2011. Int Wound J. 2013;10(5):516–26.
Mosti G, Partsch H. Compression stockings with a negative pressure gradient have a more pronounced effect on venous pumping function than graduated elastic compression stockings. Eur J Vasc Endovasc Surg. 2011;42(2):261–6.
Mosti G, Partsch H. Improvement of venous pumping function by double progressive compression stockings: higher pressure over the calf is more important than a graduated pressure profile. Eur J Vasc Endovasc Surg. 2014;47(5):545–9.
Sippel K, Seifert B, Hafner J. Donning devices (foot slips and frames) enable elderly people with severe chronic venous insufficiency to put on compressionstockings. Eur J Vasc Endovasc Surg. 2015;49(2):221–9.
Luder C, Dziunycz P, Omid N, Radetzki AL, Lang C, Hübner M, Hafner J. A Compression Kit of a Stocking and Three Superimposed Leggings Is Easy to Don and Dose Adjustable. Eur J Vasc Endovasc Surg. 2016;51(3):434–40.
Heyer K, Protz K, Augustin M. Compression therapy—cross-sectional observational survey about knowledge and practical treatment of specialised and non-specialised nurses and therapists. Int Wound J. 2017;14(6):1148–53.
Zarchi K, Jemec GB. Delivery of compression therapy for venous leg ulcers. JAMA Dermatol. 2014;150(7):730–6.
Damstra RJ, Partsch H. Prospective, randomized, controlled trial comparing the effectiveness of adjustable compression Velcro wraps versus inelastic multicomponent compression bandages in the initial treatment of leg lymphedema. J Vasc Surg Venous Lymphat Disord. 2013;1(1):13–9.
Ludbrook J. Aspects of venous function in the lower limbs. Springfield, IL: Charles C. Thomas; 1968.
Partsch B, Partsch H. Calf compression pressure required to achieve venous closure from supine to standing positions. J Vasc Surg. 2005;42(4):734–8.
Partsch H. Improving the venous pumping function in chronic venous insufficiency by compression as dependent on pressure and material. Vasa. 1984;13(1):58–64.
Partsch B, Mayer W, Partsch H. Improvement of ambulatory venous hypertension by Narrowing of the Femoral Vein in Congenital Absence of Venous Valves. Phlebology. 1992;7:101–4.
Mayrovitz HN, Larsen PB. Effects of compression bandaging on leg pulsatile blood flow. Clin Physiol. 1997;17(1):105–17.
Jünger M, Haase H, Schwenke L, Bichel J, Schuren J, Ladwig A. Macro- and microperfusion during application of a new compression system, designed for patients with leg ulcer and concomitant peripheral arterial occlusive disease. Clin Hemorheol Microcirc. 2013;53(3):281–93.
Mosti G, Iabichella ML, Partsch H. Compression therapy in mixed ulcers increases venous output and arterial perfusion. J Vasc Surg. 2012;55(1):122–8.
Zaki M, Elsherif M, Tawfick W, El Sharkawy M, Hynes N, Sultan S. The role of sequential pneumatic compression in limb salvage in non- reconstructable critical limb ischemia. Eur J Vasc Endovasc Surg. 2016;51(4):565–71.
Buschmann EE, Brix M, Li L, Doreen J, Zietzer A, Li M, Buschmann I, Hillmeister P. Adaptation of external counterpulsation based on individual shear rate therapy improves endothelial function and claudication distance in peripheral artery disease. Vasa. 2016;45(4):317–24.
Chen AH, Frangos SG, Kilaru S, Sumpio BE. Intermittent pneumatic compression devices – physiological mechanisms of action. Eur J Vasc Endovasc Surg. 2001 May;21(5):383–92.
Mani R. Transcutaneous measurements of oxygen tension in venous ulcer disease. Vasc Med Rev. 1995;6:121–31.
Bollinger A, Fagrell B. Clinical capillaroscopy. Toronto: Hofgreve & Huber Publishers; 1990.
Abu-Own A, Cheatle T, Scurr JH, Coleridge Smith PD. Effects of intermittent pneumatic compression of the foot on the microcirculatory function in arterial disease. Eur J Vasc Surg. 1993;7(5):488–92.
Barnes M, Mani R, Barrett DF, White JE. Changes in skin microcirculation at periulcerous sites in patients with chronic venous ulcers during leg elevation. Phlebology. 1992;7:36–9.
Bakker K, Apelqvist JAP, Schaper NC. Practical guidelines on the management and prevention of the diabetic foot. Diabetes Metab Res Rev. 2012;28(S1):30–5.
Mathieu D. Mani R. A review of the clinical significance of tissue hypoxia measurements in lower extremity wound management. Int J Low Extremity. Wounds. 2007;6(4):273–83.
Olszewski WL, Engeset A. Intrinsic contractility of prenodal lymph vessels and lymph flow in human leg. Am J Phys. 1980;239(6):H775–83.
Olszewski WL. Contractility patterns of normal and pathologically changed human lymphatics. Ann N Y Acad Sci. 2002;979:52–63.
Breslin JW. Mechanical forces and lymphatic transport. Microvasc Res. 2014;96:46–54.
Lahtinen T, Seppälä J, Viren T, Johansson K. Experimental and analytical comparisons of tissue dielectric constant (TDC) and bioimpedance spectroscopy (BIS) in assessment of early arm lymphedema in breast cancer patients after axillary surgery and radiotherapy. Lymphat Res Biol. 2015;13(3):176–85.
Zaleska M, Olszewski WL, Cakala M, Cwikla J, Budlewski T. Intermittent pneumatic compression enhances formation of edema tissue fluid channels in lymphedema of lower limbs. Lymphat Res Biol. 2015;13(2):146–53.
Zaleska M, Olszewski WL, Durlik M, Kaczmarek M. A novel clinical test for setting intermittent pneumatic compression parameters based on edema fluid hydromechanics in the lymphedematous Calf. Lymphat Res Biol. 2015;13(3):208–14.
Kakkar VV. A physiological study of elastic compression stockings in venous disorders of the leg. Phlebologie. 1982;35(1):101–6.
Partsch H. Compression therapy: clinical and experimental evidence. Ann Vasc Dis. 2012;5(4):416–22.
Downie SP, Raynor SM, Firmin DN, Wood NB, Thom SA, et al. Effects of elastic compression stockings on wall shear stress in deep and superficial veins of the calf. Am J Physiol Heart Circ Physiol. 2008;294(5):H2112–20.
Partsch H, Mosti G, Mosti F. Narrowing of leg veins under compression demonstrated by magnetic resonance imaging (MRI). Int Angiol. 2010;29(5):408–10.
Dennis M, Sandercot PA, Reid J, et al. The CLOTS Trials Collaboration. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet. 2009;373:1958–65.
Nicolaides AN, Breddin HK, Carpenter P, Coccheri S, Conard J, et al. Thrombophilia and venous thromboembolism. International consensus statement. Guidelines according to scientific evidence. Int Angiol. 2005;24(1):1–26.
El-Sheikha J, Nandhra S, Carradice D, Acey C, Smith GE, et al. Compression regimes after endovenous ablation for superficial venous insufficiency – a survey of members of the Vascular Society of Great Britain and Ireland. Phlebology. 2016;31(1):16–22.
Lugli M, Cogo A, Guerzoni S, Petti A, Maleti O. Effects of eccentric compression by a crossed-tape technique after endovenous laser ablation of thegreat saphenous vein: a randomized study. Phlebology. 2009;24(4):151–6.
Mosti G, Mattaliano V, Arleo S, Partsch H. Thigh compression after great saphenous surgery is more effective with high pressure. Int Angiol. 2009;28(4):274–80.
Rabe E, Partsch H, Hafner J, Lattimer C, Mosti G, et al. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology. 2018;33(3):163–84.
Mosti G, Mattaliano V, Partsch H. Inelastic compression increases venous ejection fraction more than elastic bandages in patients with superficial venous reflux. Phlebology. 2008;23(6):287–94.
Lattimer CR, Ligi D, Mannello F, Kalodiki E. Effect of compression and lying down on local MMPs from the dependent leg in healthy subjects & varicose vein patients. Presentation at the 30thAnnual Meeting of the AVF, Tucson AZ Feb 20–23. J Vasc Surg. In press.
Murphy MA, Joyce WP, Condron C, Bouchier-Hayes D. A reduction in serum cytokine levels parallels healing of venous ulcers in patients undergoing compression therapy. Eur J Endovasc Surg. 2002;23:349–52.
Beidler SK, Douillet CD, Berndt DF, Keagy BA, Rich PB, Marston WA. Inflammatory cytokine levels in chronic venous insufficiency ulcer tissue before and after compression therapy. J Vasc Surg. 2009;49(4):1013–20.
Ten Cate-Hoek AJ, Amin EE, Bouman AC, Meijer K, Tick LW, et al. IDEAL DVT investigators. Individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL DVT): a multicentre, randomised, single-blind, allocation- concealed, non-inferiority trial. Lancet Haematol 2018;5(1):e25–33.
Partsch H. The role of leg compression in the treatment of deep vein thrombosis. Phlebology. 2014;29(1 suppl):66–70. Epub 2014 May 19.
Cinderella indications for compression - International Compression Club (ICC) Meeting, 2015. http://www.pagepressjournals.org/index.php/vl/issue/view/414.
Partsch H, Winiger J, Lun B. Compression stockings reduce occupational leg swelling. Dermatol Surg. 2004;30(5):737–43.
Levick JR. Revision of the Starling principle: new views of tissue fluid balance. J Physiol. 2004;557(Pt 3):704.
Galm O, Jansen-Genzel W, von Helden J, Wienert V. Plasma human atrial natriuretic peptide under compression therapy in patients with chronic venous insufficiency with or without cardiac insufficiency. Vasa. 1996;25(1):48–53.
O’Donnell TF Jr, Passman MA, Marston WA, Ennis WJ, Dalsing M, et al. Society for Vascular Surgery; AmericanVenous Forum. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg. 2014;60(2 Suppl):3S–59S.
Földi M, Földi E, Kubik S. Textbook of lymphology. München: Urban & Fischer; 2003.
International Lymph network position Document: best practice for the management of lymphoedema, 2nd ed. https://www.lympho.org/wp-content/uploads/2016/03/Compression-bandaging-final.pdf.
Lee BB, Rockson SG, Bergan J, editors. Lymphedema A concise compendium of theory and practice. New York: Springer; 2018.
Partsch H, Damstra RJ, Mosti G. Dose finding for an optimal compression pressure to reduce chronic edema of the extremities. Int Angiol. 2011;30(6):527–33.
Position Statement of the National Lymphedema Network. http://www.strengthandcourage.net/pdfs/Lymphedema%20and%20Exercise.pdf.
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Partsch, H., Mani, R. (2019). Physics of Using Compression to Treat Venous Leg Ulcers and Other Conditions of the Lower Extremities. In: Mani, R., Rerkasem, K., Nair, H., Shukla, V. (eds) Compression and Chronic Wound Management. Springer, Cham. https://doi.org/10.1007/978-3-030-01195-6_2
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