Timescaled monitoring to manage venous leg ulcers and chronic oedema.

Venous leg ulcers and chronic oedema including lymphoedema are lifelong conditions that cause great distress to sufferers due to psychophysical symptoms. Time and resources spent on managing chronic wounds place an economic burden on healthcare providers, particularly with an anticipated increase in an ageing population and diminishing numbers of those providing long-term care. Resources are further challenged if wounds remain unhealed.

Three wound types: common challenges with exudate, gaps and anatomical positioning.

Complex wounds require combinations of technologies and regimes to match laboratory tests and address challenges of physiological processes, body contours, movement and ease of use during life-long self-management. Wound management for vascular and lymphatic disorders incorporate wound dressings, skin care and compression to address local wound needs and underlying pathologies, while allowing functionality for movement. In a similar manner, acute inflammatory conditions that become chronic require skin care and local conformable and absorbent wound management, but with simple, atraumatic retention methods without compression.

24-hour interval compression: a plan to balance effectiveness and tolerability for chronic oedema.

As one of the mainstays for the management of chronic oedema, compression is unquestionably an efficacious and important element in treatment pathways during the intensive acute, transition and maintenance phases. Despite the variety of compression technologies on the market, devices to aid application and innovative methods employed by caregivers to encourage adherence to treatment, concordance remain a challenge. Balancing clinical effectiveness and patient comfort, the 24-hour interval plan considers wearer lifestyle and treatment options to tailor types of compression and times during the day and night when compression is worn.

The 24-hour interval compression plan: part 2-lifestyle and therapeutic regimens to manage chronic oedema case series.

Objective: The aim of this case series was to retrospectively assess the impact on volume control and patients' quality of life (QOL) when a night-time garment was added to their previous compression regimen for a full 24-hour interval compression plan.

Method: Patients who had a history of chronic oedema presented to one of two oedema management centres in the US for treatment for oedema exacerbation and/or suboptimal performance of their current garments. Objective data examined were circumferential limb volume (cm) measurements and QOL measured with the Lymphoedema QOL Tool (LYMQOL-Leg and LYMQOL-Arm).

A 24-hour interval compression plan for managing chronic oedema: part 1-the science and theory behind the concept.

Compression, skin care, manual lymph drainage and exercise form the mainstays of treatment of chronic limb oedema. The compression aspect of the regimen is often prescribed and used without conscious concern for the patient's ability for self-adjustment and skin hygiene. This article will focus on the action of compression therapy using a new concept of encouraging patients to apply and reapply an adjustable compression garment or multiple garment types during a 24-hour interval.

Compression hosiery for venous disorders and oedema: a question of balance.

Compression therapy for venous and lymphatic conditions may be delivered via a range of treatment modalities using many different technologies, depending on the patient's condition and needs. Clinical decision-making relies on accurate assessment of the patient, their presenting and underlying clinical condition, skill and training of the applier and the available resources. However, changes in the patient's condition or lifestyle may necessitate re-evaluation of the treatment pathway.

Interface pressures with compression systems: relevance to clinical practice.

Interface pressures with compression depend on many factors relating to the science of measurement and intrinsic, patient-related factors, including limb size and tissue texture. While it is important for manufacturers of compression devices to measure pressures, it may not always be relevant to clinical practice where application methods and oedematous limbs may affect final pressures. Accurate performance of any compression system relies on the use of the right technology for the right condition and patient lifestyle.

Intermittent pressures in compression bandaging for oedema management.

Chronic oedema is an increasing problem requiring higher levels of knowledge and research. With improvements in education and specialist products, management of patients with uncomplicated oedema can be undertaken by non specialist practitioners. Despite recent advances there remains a paucity of research that provides information to link science and theory to clinical practice.

Short-stretch compression bandages and the foot pump.

Short-stretch compression bandages have been shown to be as cost-effective and efficient as other compression systems in healing venous ulcers, independent of associated factors (Scriven et al, 1998; Nelson, 1996). However, as they do not contract around a limb they do not exert pressure during inactivity (resting pressure) (Klose Norton, 2003). But their stability creates a high resistance to stretch when pressure is applied through internal muscle contraction and joint movement (working pressure) (Tuckwood, 1996).