Full Leg Application of a 2 Layer Cohesive Short Stretch Compression System for Rapid Limb Volume Reduction and Chronic Edema Management

J d W PT CWS CLT LANA

IntroductionCompression of the lower extremities is recognized as the industry gold standard in

Jody Wong, PT, CWS, CLT – LANALegacy Village Rehabilitation, Layton Utah

Application over knee details Case studies showing product versatility

p g y gproviding treatment for the majority of venous related lower extremity wounds as well as chronic secondary lymphedema and edema of many etiologies. In many patients; lower leg compression wrapping only tends to push fluid up into the knee and thigh where it is very difficult to mobilize and dissipate. When edema occurs above the knee, few bandage options besides traditional short stretch bandages are available. Providing appropriate, maintainable compression above the knee can prove difficult Apply comfort layer to lower limb Figure 8 at knee care not to Spiral up thigh to gluteal foldg pp p p peven for the trained lymphedema clinician. A cohesive, 2 layer compression system* has been successfully used and is well known to manage lower leg edema. My plan was to evaluate its effectiveness in managing edema of the full leg.

Patients and clinicians alike who try to manage edema issues involving the knee, proximal thigh, groin, or the entire lower extremity often express frustration and

Apply comfort layer to lower limb. Figure 8 at knee – care not to leave edges at popliteal fossa.

Spiral up thigh to gluteal fold.

A hip spica application is useful to: • maintain a full leg bandage position without rolling

Post surgical wound dehiscence in her distal quadrant with localized edema about the wound in the p g , g , y p

extreme difficulty with attempts to maintain compression above the knee. Common complaints are slippage, rolling and “bunching” of the bandage especially at the knee. Patients’ report becoming discouraged when the bandages loosen and with the difficulty of rewrapping their bandages, especially above the knee.

As a PT,CWS,CLT, I provide both wound and lymphedema treatment and regularly

maintain a full leg bandage position without rolling• provide compression to inguinal area • mobilize fluid up through the trunk to help prevent

fluid stagnation, congestion, and obstruction.

quadrant with localized edema about the wound, in the inguinal fold, and groin. The 2 layer bandage provided appropriate, prolonged compression to the area, helped reduce her edema and promoted wound closure in 5 clinic visits over16 days.

Case: , , , p y p g yutilize the single use 2 layer short stretch compression system to achieve significant and rapid edema reduction in order to promote wound closure, shut down drainage and/or lymphorrhea, and help prevent reoccurrence of ulceration.

Methods & Results

Apply compression layer to lower leg.

Figure 8 at the knee Spiral up to groin with 50% overlapping layers

Case: Patient with unilateral, 3+ pitting edema with non-pitting fibrosis at proximal thigh and through the adductor canal.• Start of care 10/21/11: 41% difference between extremities • Visit 1 at 4 days: 26% (719.39 ml’s) reduction• 7 days later: 18% (390.94 ml’s) reduction (measured for

garment)Methods & ResultsSix patients diagnosed with Stage II Secondary Lymphedema of the entire lower extremity due to a variety of etiologies were treated with standardized edema management techniques including the application of the 2 layer bandages adapted to fit the entire limb from the foot to the upper thigh. Patients were seen twice weekly with routine circumferential measurements and limb volume calculations completed regularly. Each of the patients exhibited significant limb volume reduction,

Case Series Graphical Volumetric Data – (Key: 236.59 ml’s ~ 1 cup of fluid)garment)

• 6 days later: 7% (63.26ml’s) reduction• Last visit and discharge 1/18/11: 15% (111.82 ml's)

reductionTotal Reduction: 1285.42 ml's from start of care to discharge.Follow-up call 2/15/2012: Doing well, with no rebound edema. 10/21/201110/21/201110/21/2011 12/02/201212/02/201212/02/2012

regularly. Each of the patients exhibited significant limb volume reduction, improvement in tissue quality and good skin tolerance. Comparison circumferential measurements were taken and limb volume calculation were performed 5-14 days from initial evaluation.

In each case there was a significant and rapid decrease in limb volume reduction noted in the first 5-14 days from initial evaluation and/or start of care. This marked limb

Discussion• Utilization of the 2 layer bandage application significantly aided in the rapid and successful treatment of full leg edema of

various etiologies and lymphedema.Li b l d ti i t i d til th ti t fit i t th i i t f l t noted in the first 5 14 days from initial evaluation and/or start of care. This marked limb

volume reduction was enough to allow for measurement and ordering of compression garments as appropriate for long term management of the patient.

I believe that the early results of this case series may be indicative of cost savings in relation to more effective limb volume reduction that decreases the amount of treatment visits required to achieve goals before discharge from service.

• Limb volume reduction was maintained until the patients were fit into their compression garment for long term management.

• Patients could be measured and have garments ordered sooner into their course of treatment due to rapid volumetric reduction.

• Patients reported minimal disruption/annoyance in their daily lives during wear while maintaining mobility due to the less bulky bandage.

• None to minimal skin irritation issues were experienced

* 3M ™ Coban™ 2 Layer Compression System Poster funded by 3M Health Care, St. Paul, Minnesota

treatment visits required to achieve goals before discharge from service. None to minimal skin irritation issues were experienced.

ConclusionsThis wrapping technique, adapted to fit the entire limb, effectively controlled edema above and below the knee providing a rapid, effective, and highly functional treatment option for these challenging situations.

• Note the rapid and significant limb volume reduction that occurs consistently between the first and second visits • Continual decline in edema is seen by limb volume reduction in the majority of the cases w/ little rebounding• Rapid reduction allows long term compression measurement/fitting within 3-5 visits in most clients

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