Renowned Canadian wound care experts Dr. Gary Sibbald and Pat Coutts led the webinar on low compression following the publication of the study in Advances in Skin & Wound on the Evaluation of Longitudinal and Tubular Compression Treatment for Lower Limb Edema. Here we recap on some of the poignant takeaways from the well-attended webinar. 

The webinar had three learning objectives;

  • to consider the use of audible handheld Doppler in the patient vascular assessment;
  • to assess the use of EdemaWear as a suitable compression product; and
  • to evaluate the new EdemaWear paper in Advances in Skin & Wound Care.

Audible Handheld Doppler

Dr. Sibbald reinforced the need to begin with a vascular assessment. These should be conducted in all cases and low arterial supply is an absolute contraindication to compression.

Many attendees at the webinar and wound care practitioners seek illustrations on Doppler sounds. This video by Dr. Mayer on Vascular Diagnosis: How to Exclude Peripheral Arterial Disease in the Community, is among the best at showing audible handheld Doppler waveforms.

EdemaWear comparative low compression study

This study evaluated two elasticized systems for the control of bilateral or unilateral lower limb edema; an elasticized longitudinal non-latex spandex (EdemaWear) stockinette and a latex containing elasticized tubular bandages. The crossover study evaluated edema control, pain and patient preference in patient with lower limb edema over 1 month, uncontrolled venous disease and ankle-brachial pressure index (ABI) 0.65-1.3. An elasticized longitudinal stockinette (ELS) and an elasticized tubular bandage (ETB) were evaluated for control of bilateral or unilateral lower limb edema in 25 patients. The majority of patients in this crossover study had an average body mass index of 40.1 kg/m2.

“The ELS (fuzzy wale stockinette) is a recent innovation and alternative clinical choice in the low-compression toolkit. Most patients found this device comfortable and relatively easy to apply.”

Study Conclusions

  1. Both ELSs and ETBs are alternatives to traditional circumferential elastic and inelastic systems for the control of leg edema are easy to apply and provide greater self-sufficiency for patients.
  2. These bandage systems have a relatively low cost compared with compression stockings.
  3. In this study, ELB was preferred over ETB by 72% of participants.
DOWNLOAD THE FULL PAPER HERE

To the best of our knowledge, this represents a milestone for EdemaWear as the first peer-reviewed study publication conducted in Canada. Dr. Sibbald is one of Canada’s foremost wound experts, who was among the architects of Wounds Canada as well as the Wound Bed Preparation concept and TIME acronym.

“Leg edema prevalence increasing as populations age.” Many patients with lower limb edema do not tolerate traditional higher-pressure compression devices and require alternative devices for edema control. The ELS was preferred by 78% surveyed participants stating that it was more comfortable and breathable, easier to put on, less painful than previous therapies, cooler while wearing and easier to accommodate in footwear. The two treatment options showed equivalency in edema control or pain.

Both systems were easy to apply and provided low compression without increased pain. ELS was preferred by more patients (78.3%) than ETB (21.7%).

“Adherence to compression therapy can be difficult for patients with painful leg edema … For patients who cannot tolerate optimal high compression because of pain, coexisting arterial disease, or irregular contours of the legs or who have difficulty applying compression devices, low compression that can facilitate edema control may be suitable long-term options.”

Application guide to low compression

Tubigrip and EdemaWear video with Pat Coutts courtesy of WoundPedia, Project ECHO Skin & Wound & IIWCC.

Our thanks to Dr. Sibbald, Pat Coutts and Andrew Mohan for supporting the webinar.

Reference

Sibbald, R.G., Elliott, J.A., Persaud-Jaimangal, R., Goodman, L., Armstrong, D.G., Harley, C., Coelho, S., et al. (2021). Wound Bed Preparation 2021, Advances in Skin & Wound Care: April 2021 – Volume 34 – Issue 4 – p 183-195 https://doi.org/10.1097/01.ASW.0000733724.87630.d6

Sibbald, R. G., Elliott, J. & Coutts, P., & Persaud-Jaimangal, R. (2020). Evaluation of Longitudinal and Tubular Compression Treatment for Lower Limb Edema. Advances in Skin & Wound Care. 33. 643-649. https://doi.org/10.1097/01.ASW.0000720264.41419.38

Alavi, A., Sibbald, R. G., Nabavizadeh, R., Valaei, F., Coutts, P., & Mayer, D. (2015). Audible handheld Doppler ultrasound determines reliable and inexpensive exclusion of significant peripheral arterial disease. Vascular, 23(6), 622–629. https://doi.org/10.1177/1708538114568703

O’Meara S, Cullum NA, Nelson EA. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000265. https://doi.org/10.1002/14651858.CD000265.pub2