Page 52 - VOL 26 N. 72 - 2015

June 4, 2015 - Auditoire A. Tissot
WORKSHOP 1 (English)
COMPRESSION IN LYMPHOEDEMA MANAGEMENT
DECISION MAKING IN COMPRESSION THERAPY
Emeritus Professor of Dermatology, Medical University of Vienna, Austria
PARTSCH H.
Compression is the most effective and indispensable measure to reduce lymphedema among the classical components of decongestive lymphatic therapy (DLT).
Important variables deciding the effectivity of compression using bandages and stockings are the exerted pressure and the elastic properties of the material. For intermittent pneumatic compression pumps the sequence and duration of inflating the chambers need to be considered in addition. There is still a lack of comparative clinical studies trying to optimize compression therapy in lymphedema. Some facts based on experimental clinical work will be outlined:
Stiff, non-yielding bandages applied with sufficient pressure, are the treatment of choice in the initial treatment phase. These bandages stay day and night and work especially in combination with exercises.
Multicomponent bandages exerting a tolerable resting pressure and a high working pressure are preferred.
The application of good inelastic bandages resembles a sculptor’s work and should be performed by well-trained staff. The use of pressure measuring probes may be helpful for training courses.
In ISL stage II lymphedema the resting pressure after application should not exceed 30 mmHg on the upper and 50-60 mmHg on the lower extremity. Inelastic material will lead to pressure peaks of up to 100 mmHg during walking corresponding to a “massaging effect”.
There is an immediate pressure loss after application due to instant oedema reduction. This has important implications on the timing of bandage renewal.
The use of inelastic Velcro wraps which can be applied and readjusted by the patients are a valuable alternative, especially for self- management.
Maintenance phase of lymphedema treatment starts when no more volume reduction of the oedematous extremity can be achieved. Self-management with compression stockings, preferably using flat knitted made to measure hosiery, or with Velcro wraps are the methods of choice.
Positive patients’ experience with compression in the therapy phase is the most convincing way to achieve good concordance with compression hosiery in the maintenance phase.
Intermittent pneumatic pressure pumps should only be used in addition to sustained compression and not as a single method. Hybrid systems combining sustained and intermittent compression could become an interesting alternative.
COMPRESSION GARMENT: CUSTOM VS OVER-THE-COUNTER
Division of Angiology, Lausanne University Hospital, CHUV, Switzerland
The most important characteristics of medical elastic compression stockings (MECS) are elasticity, hysteresis, and stiffness.
Each type of MECS has its own characteristics depending on material, type of knit (flat-knitted or round-knitted), and knitting method. One should be familiar with all available garments in order to choose the right one for the right patient.
All garments are available either as ready-made or custom-made. A good balance between comfort and effectiveness makes MECS acceptable for patients.
In the future, we hope to obtain an international consensus for MECS labeling concerning pressure and stiffness.
LESSERT C.
PRESCRIBING AND FITTING GARMENTS FOR CHILDREN
VOLLMER A.
Germany
June 4, 2015 - Auditoire A. Yersin
WORKSHOP 1 (French) ICG_FLUOROSCOPIE: ASPECTS PRATIQUES
ICG_FLUOROSCOPIE: ASPECTS PRATIQUES
BELGRADO J.-P.
Belgium
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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