So You Thought You Knew All So You Thought You Knew All the Answers About

Compression Therapy!Terry Treadwell, MD, FACS

Medical DirectorMedical DirectorInstitute for Advanced Wound Care

Montgomery, Alabama

Compression Questionsp Q1. Are all compression bandages the same?p g2. Can compression therapy be used in the patient with edema

and an ABI < 0.8? 3 Can compression therapy be used in the patient with edema 3. Can compression therapy be used in the patient with edema

and cellulitis? 4. Does compression therapy improve the skin of patients with

d titi ? venous dermatitis? 5. Can compression therapy be used in the patient with edema

and congestive heart failure? g6. Can compression therapy be used in the patient with edema

and acute deep venous thrombophlebitis?7 Do patients care which compression bandage is used?7. Do patients care which compression bandage is used?

Looking for the Evidence??Looking for the Evidence??

Are all compression bandages the same?

Compression Therapyp py• Short stretch or inelastic • Elastic

Si l l• Single layer• Multiple layersp y• High pressure

L • Low pressure

Working vs. Resting PressuresR l f C i M t i lRole of Compression Material

EmptyingEmptyingp y g

e(P

T)

Emptying

essu

reue

Pre

Tiss

u

TimeDr. HN Mayrovitz

Time

Can compression Can compression therapy be used in the therapy be used in the patient with edema pand an ABI < 0.8?

Arterial Flow Pulses

Control Leg Below Knee Blood Flow via Nuclear Magnetic Resonance

Treated LegControl Leg

BeforeBandage

ml/min

Treated Leg

Bandage

WithBandage

ml/min

Bandage

Dr. HN Mayrovitz, Univ of Miami

Compression Therapy and Circulationp py

ABI Bandage Sub-bandageABI Bandage Sub bandage pressure (mm Hg)

> 0.8 4-layer 35-400 8 aye 35 0

0.7 2-layer 17-25

0.6 2-layer 17-25

<0.5 Only with medical supervision

---

Moffatt C. www.worldwidewounds.com (12/5/09)

Compression and Arterial Insufficiency

• 15 patients suffering from peripheral arterial occlusive disease with an ankle brachial pressure index (ABPI) of 0.5-0.8

1) 5 patients with ABPI of ≥0.5 and ≤0.6 2) 4 patients with ABPI of >0.6 and ≤0.7 3) 6 patients with ABPI of >0 7 and ≤0 83) 6 patients with ABPI of >0.7 and ≤0.8

• All patients treated with 3M™ Coban™ 2 Layer Lite Compression System Compression System

• Bandage remained on the leg 1 to 4 days• Study stopped after 14 days• Study stopped after 14 days

Data on file – 3M

Results of 3M™Coban™ 2 Layer Lite Compression System Study

• An average supine subbandage pressure of ~ 28mmHg was measured just above the medial g jankle after bandage application

• No pressure-related skin damage occurred in patients No pressure related skin damage occurred in patients with reduced arterial perfusion

• No pain related to tissue hypoxia was detected

Data on file – 3M

Results of 3M™Coban™ 2 Layer Lite Compression S stem St d Lite Compression System Study

• Laser doppler fluxmetry demonstrated positive effects on pp y pmicrocirculation including:– Increased overall tissue microperfusion – Reduced respiratory reflux in limbs with venous

insufficiency– Maintained stable capillary perfusion

• Limb volume reduction (reduced edema) compared to baseline

• High wearing comfort

Data on file – 3M

Conclusions: 3M™Coban™ 2 Layer Lite Compression System Study

• Compression with Coban 2 Layer Lite Compression System is safe and well tolerated by patients with System is safe and well tolerated by patients with reduced peripheral arterial perfusion

• Results of the laser doppler fluxmetry measurements pp yindicate significant improvements of the dermal microcirculation under this compression therapy

Data on file – 3M

Venous UlcerVenous Ulcer99 year old lady with ulcer for 8 months

ABI - 0.45

Informed that BKInformed that BK amputation was the only therapy

Treated with lightTreated with light compression and bi-layered tissue engineered skin

Wound healed after 47 weeks

Can compression ptherapy be used in

the patient with d d edema and cellulitis?cellulitis?

Treadwell TA, Fowler E, Bates-Jensen BB. Management of Edema in Wound Care: A Collaborative Practice Manual for Health Professionals, 4th Edition, Ed. BB Bates-Jensen, in press

Edema and Compression Therapy in Cellulitis

1. Normal anti-Streptococcal properties of skin are inactivated by edema fluid

2. Compression therapy:• Removes protein-containing fluid from the p g

subcutaneous tissues• Increases blood flow to tissues • Increases antibiotic concentration in tissues

Cellulitis of LegCellulitis of Leg

Healed after10 days of

antibiotics andantibiotics and 5 weeks of

compression therapy

Does compression therapy improve

fthe skin of patients with venous with venous dermatitis?dermatitis?

Properties of Edema Fluid

1. Edema fluid inhibits mitogenic activity and DNA g ysynthesis

2. Cytokine environment in edema fluid is more yproinflammatory

3. Protease activity is higher in edema fluidy g4. Growth factor levels are decreased in edema fluid

Proteases and Compression TherapyRelative MMP Levels in Healthy and Ulcer Tissue

Before and After Compression Therapyp py

500

600 HealthyBefore TXAfter TXro

tein N=21

200

300

400

µg to

tal pr

0100200pg

/

Marston WA, Beider S, Davies S, Berndt DF. Protease and Cytokine Levels in Non-Healing Venous Leg Ulcers Before and After Compression Therapy. Presented at Symposium on Advanced Wound Care/Wound

Healing Society Meeting, San Diego, CA. April 25, 2008

Inflammatory Cytokines and Compression Therapy

Interleukins

0 0060.008

0.010.0120.0140.0160.018

0.02

0.1

0.15

0.2

0.25

0.3

Interleukins

810

121416

Il-80.080.1

0.120.140.160.18

Il-1b

normal before after0

0.0020.0040.006

Normal Before Afternormal before after0

0.05

0.1

normal before afternormal before after024

6

normal tissue ulcer before Rx ulcer after Rx\normal tissue ulcer before RX ulcer after RX

1.4

1.6

1.8

00.020.040.060.08

normal before Afternormal before after

normal before after

TNF-alpha IFN-gamma

0

0.2

0.4

0.6

0.8

1

1.2

norm al before after

IL12p40

normal before after

Marston WA, Beider S, Davies S, Berndt DF. Protease and Cytokine Levels in Non-Healing Venous Leg Ulcers Before and After Compression Therapy Presented at Symposium onVenous Leg Ulcers Before and After Compression Therapy. Presented at Symposium on Advanced Wound Care/Wound Healing Society Meeting, San Diego, CA. April 25, 2008

Effect of Compression TherapyEffect of Compression Therapy

1 Week of Compression

Stasis Dermatitis Stasis Dermatitis

Improvement after 22

weeks ofweeks of compression

therapy

Can compression therapy Can compression therapy be used in the patient with p

edema and congestive heart failure?

Massive Edema and CHFMassive Edema and CHF

Photo used with permission

Congestive Heart Failure and Compression Therapy

• No acute pulmonary edemaO t t t t t d ith • Once treatment started with cardiostimulatory medications and diureticsdiuretics

Treadwell TA Fowler E Bates Jensen BB Management of Edema in Wound Care:Treadwell TA, Fowler E, Bates-Jensen BB. Management of Edema in Wound Care: A Collaborative Practice Manual for Health Professionals, 4th Edition, Ed. BB Bates-Jensen, in press

Can compression therapy be used in the patient with edema and patient with edema and

acute deep venous pthrombophlebitis?

Compression Therapy and Acute Deep Venous Thrombophlebitis

• Increases venous flow• Prevents further clotting• Prevents further clotting• Occludes superficial veins that could clot• Does not cause an increase in pulmonary

embolism

Dale AW. The Swollen Limb. Current Problems in Surgery, Year Book Medical Publishers, Inc., USA 1973 (September) p 18USA. 1973 (September), p 18

Treadwell TA, Fowler E, Bates-Jensen BB. Management of Edema in Wound Care: A Collaborative Practice Manual for Health Professionals, 4th Edition, Ed. BB Bates-Jensen, in press

Contraindication to Compression in A t D V Th b hl bitiAcute Deep Venous Thrombophlebitis

Leg so painful that compression cannot be toleratedLeg so painful that compression cannot be tolerated.

Dale AW. The Swollen Limb. Current Problems in Surgery, Year Book Medical Publishers, Inc., USA. 1973 (September), p 18

Do patients care which i b d compression bandage

is used?is used?

Fact: Patients don’t like i b d !compression bandages!

• Only 48 8% of patients wore their compression bandages *Only 48.8% of patients wore their compression bandages

• May be as high as 80% *

• Determinants for NOT wearing compression bandages:a. Ageb. Pain c. Wound sized Wound depthd. Wound depth

* Miller C, Kapp S, Newell N, et al. Predicting Concordance with Multilayer Compression Bandaging. Jour Wound Care 2011;20(3):101-112

Is this comfortable?Is this comfortable?

9

10Slippage in cm: after 24 and 48 hours

actico k-two profore profore lite proguide short stretch long stretch rosidal sys coban 2 layer coban 2 lite

After 48 hours of wear

6

7

8

After 48 hours of wear

3

4

5

0

1

2

actico k-two profore profore lite proguide short stretch long stretch rosidal sys coban 2 layer coban 2 lite

Patient Preference for C i ThCompression Therapy

• 72% of patients preferred Coban 2 Layer Compression System over Profore when treated with both for venous yulcer

• Coban 2 Layer Compression System showed less slippage than Profore

• Quality of Life assessments were better with Coban 2 Layer Compression System than with Profore (p<0.05)

Moffatt CJ Edwards L Collier M Treadwell T Miller M Shafer L Sibbald G Brassard A McIntosh AMoffatt CJ, Edwards L, Collier M, Treadwell T, Miller M, Shafer L, Sibbald G, Brassard A, McIntosh A, Ryzelman A, Price P, Kraus SM, Walters SA, Harding K. Randomized Controlled 8-Week Crossover Clinical Evaluation of the 3M Coban 2 Layer Compression System Versus Profore to Evaluate the Product performance in Patients with Venous Leg Ulcers. Int Wound Journal 2008; 5:267-279.

Compression Questions

1. Are all compression bandages the same? NOp g2. Can compression therapy be used in the patient with edema and

an ABI < 0.8? YES3 Can compression therapy be used in the patient with edema and 3. Can compression therapy be used in the patient with edema and

cellulitis? YES 4. Does compression therapy improve the skin of patients with venous

d titi ? YESdermatitis? YES5. Can compression therapy be used in the patient with edema and

congestive heart failure? YESg6. Can compression therapy be used in the patient with edema and

acute deep venous thrombophlebitis? YES7 Do patients care which compression bandage is used? YES7. Do patients care which compression bandage is used? YES

“It is the individual patient who we treat, not the disease. It is the patient who recovers or dies, not the illness.”James Peck, MD, Am. Jour. Surg. 2004;187:569-574

Sponsored by an educational grant from 3M

For more information on 3M Compression Therapy visit

www.3m.com/coban2layer

or contact us or contact us 1-800-228-3957