A comparison of multilayer bandage systems during rest, exercise, and over 2 days of wear time.

OBJECTIVE To study the interface pressure between the leg and 8 different multilayer bandage systems during postural changes, exercise (walking), and over 2 days of wear time. DESIGN Comparison of 8 different compression bandages under standardized conditions. SETTING Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland. PARTICIPANTS A series of 10 healthy volunteers, 5 females and 5 males, aged 26 to 65 years. INTERVENTION An electropneumatic device was used to measure interface pressure at 12 points of the leg. MAIN OUTCOME MEASURES (1) Pressure changes from the standing to the sitting and supine position at rest, (2) pressure amplitude during exercise (200-m treadmill walk at 3.2 m/s, 0 degrees incline), and (3) pressure decrease over 2 days of wear time. RESULTS Results are given as median with the 10% to 90% confidence intervals. Multilayer bandages of short and medium stretch showed a larger pressure decrease when the patient was supine (eg, 3 short stretch bandages: 18.0 mm Hg [reference range, 15.5-19.5 mm Hg]) than systems of medium and long stretch bandages (eg, 4-layer bandage, 6.0 mm Hg [reference range, 4.5-7.0 mm Hg]) (P=.005). The amplitude of pressure waves during exercise was comparable among most multilayer bandage systems. The pressure loss over time was the smallest in elastic bandages (eg, 4-layer bandage, 6.0 mm Hg [reference range, 0.0-10.5 mm Hg]), compared with short stretch bandages (eg, 3 short stretch bandages, 18.0 mm Hg [reference range, 16.5-20.5 mm Hg]) (P=.005). CONCLUSIONS Highly elastic multilayer bandage systems showed the smallest pressure loss over several days, but the small pressure decrease when the patient was supine makes them potentially hazardous to patients with arterial occlusive disease. Short stretch bandages and the Unna boot with an inelastic zinc plaster bandage generate large pressure waves while walking and showed a marked pressure decrease when the patient was supine, but they lose a lot of their pressure within the first hours of wear. Multilayer systems composed of short stretch and cohesive medium stretch bandages represent a good compromise between elastic and inelastic bandage systems (moderate pressure loss over time, large pressure decrease on lying down). The clinical effectiveness of the different types of compression still remains to be studied.

[1]  P. Hooper,et al.  Four-layer bandaging and healing rates of venous leg ulcers. , 1996, Journal of wound care.

[2]  H Partsch,et al.  Compression therapy of the legs. A review. , 1991, The Journal of dermatologic surgery and oncology.

[3]  C. Ruckley,et al.  Arterial disease in chronic leg ulceration: an underestimated hazard? Lothian and Forth Valley leg ulcer study. , 1987, British medical journal.

[4]  B. Stanton,et al.  A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications. , 1994, Journal of the American Academy of Dermatology.

[5]  F. Fowkes.  Epidemiology of Chronic Venous Insufficiency , 1996 .

[6]  F. Martin,et al.  Heel ulcers in patients with long‐standing diabetes who wear antiembolism stockings , 1986, The Medical journal of Australia.

[7]  H. Partsch.  Compression therapy of venous ulcers. , 1999, Current problems in dermatology.

[8]  C. McCollum,et al.  Community clinics for leg ulcers and impact on healing. , 1992, BMJ.

[9]  C. Ruckley,et al.  Hazards of compression treatment of the leg: an estimate from Scottish surgeons. , 1987, British medical journal.

[10]  Trevor A Sheldon,et al.  A systematic review of compression treatment for venous leg ulcers , 1997, BMJ.

[11]  A. Naylor,et al.  A prospective randomised trial of four-layer versus short stretch compression bandages for the treatment of venous leg ulcers. , 1998, Annals of the Royal College of Surgeons of England.

[12]  J. Marescaux,et al.  [Compression therapy of the lower extremities particularly with compression stockings]. , 1980, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.

[13]  C A Harries,et al.  Measuring pressure under burns pressure garments using the Oxford Pressure Monitor. , 1989, Burns : journal of the International Society for Burn Injuries.

[14]  H. Partsch,et al.  [Varicose ulcer: healing in conservative therapy. A prospective study]. , 1994, Wiener medizinische Wochenschrift.

[15]  A. Kinsella,et al.  Community leg ulcer clinics: a comparative study in two health authorities , 1996, BMJ.

[16]  A. Mostbeck,et al.  Inelastic leg compression is more effective to reduce deep venous refluxes than elastic bandages. , 1999, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[17]  S. Baker,et al.  Aetiology of chronic leg ulcers. , 1992, European journal of vascular surgery.

[18]  A D Chant,et al.  Sustained compression and healing of chronic venous ulcers. , 1989, BMJ.

[19]  L. Konradsen,et al.  Chronic critical leg ischaemia must include leg ulcers. , 1996, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[20]  R. Prescott,et al.  Effect of Time and Posture on Pressure Profiles Obtained by Three Different Types of Compression , 1991 .

[21]  T. Raj,et al.  How long do compression bandages maintain their pressure during ambulatory treatment of varicose veins? , 1980, The British journal of surgery.