Compression Beyond Edema Management | webinar summary
Compression is a recognized cornerstone of management of the venous system, Dr. Suzie Ehmann explores how the different compressions systems positively impact the venous, arterial, and lymphatic systems. Much of the literature explores the role of compression on the venous system. This webinar looked at how compression pressure in textile dependent, influenced by gradient and the distribution of pressure across the tissue.
If we look at compression in a 3D perspective, it opens a whole new way of looking at this idea of therapeutic compression: it’s not just the millimetres of mercury at the ankle, or the distribution of pressure from top to bottom but also across the tissue, or across the wound … is there a way to use compression to stimulate lymphatics in the superficial tissue?
The educational webinar Therapeutic Compression: More than a number in conjunction with NSWOCC and WOC Institute had the following educational objectives:
- describe the impact of compression modalities on edema, lymphedema, and lower extremity wounds
- illustrate impact of different compression textiles on therapeutic outcomes; and
- utilize compression science to formulate optimal compression options to maximize patient compliance.
Looking at compression in 3D
In a 2015 scholarly review, Partsch & Mortimer provide a good exploration of compression therapy in leg ulcers, including how it works and the four parameters determining the quality of compression bandages, represented by P.La.C.E.
P – Pressure is dependent on the force with which the bandage is applied
La – Layers–increase the number of layers, increased pressure (increased stiffness)
C – Components–multi-layer system composed of different materials fulfilling different functions
- Distribution of compression pressure across the tissue
- Directionally mobilize fluid (lymph channels)
- Prevent slipping
- Containment (even distribution of pressure)
E – Elastic property/stiffness–different layers of elastic material are applied over each other, the final bandage becomes stiff – stiff, non-yielding material produces high-pressure peaks
What does compression look like on the skin? Dr. Ehmann described how the fuzzy wales of EdemaWear make the product a 3D compression system. She reiterated the need for knowing your patient’s vascular status, medical status and social status. Dr. Ehmann described a number of case studies using EdemaWear in conjunction with multi-layer compression systems. She encourages those working with patients to learn more about 3D compression and join a revolution.
Positive pressure wound therapy (PPWT) was one of several new concepts introduced together with lymphedema alternating pressure profile (LAPP) and PLaCE.
Positive Pressure Wound Therapy (PPWT) is the application of a compression textile, which produces a varied or alternating level of pressure distribution and which has an impact on both the vessels (arterial, veins and lymphatics) and the tissue (cellular deformation triggering biophysical response).
In the case of EdemaWear, see a vertical distribution of compression along the sensor with alternating areas of little or no compression. It has been clinically observed that the inclusion of EdemaWear produces better edema management and wound edge migration that mirrors the vertical pressure distribution observed in the in vitro pressure studies. This varied pressure profile has a positive impact on wound healing and integument health restoration.
Compression is 3D
- Dosage (mmHg) is not everything
- Distribution of pressure
- PPWT (positive pressure wound therapy)
- LAPP (lymphedema alternating pressure profile)
Successful application with EdemaWear
- Pressure ‘under wales’ is elevated
- Patients on anticoagulation may develop small area of petechia
- Be mindful when applying compression to not ‘strap’ (pull excessively)
- Protect areas of high friction
- Anterior tibialis tendon
- Single non-woven gauze
- Dorsum of foot if excessively bony
The popularity of the webinar reflects the interest in compression and the calibre of Dr. Ehmann. This summary cannot do justice to the science and clinical application shared by Dr. Ehmann, including the Q&A that followed through her perspective as a lymphedema therapist. Check the recording.
A full list of references from the webinar is available here as a download formatted to Vancouver style.
Thank you to Dr. Ehmann and NSWOCC. We look forward to bringing your further webinars exploring compression in 2022
Partsch H, Mortimer P. Compression for leg wounds. British Journal of Dermatology. 2015 Aug;173(2):359-69. https://doi.org/10.1111/bjd.13851