Hrev_master Veins and Lymphatics 2017; volume 6:6627 [page 10] [Veins and Lymphatics 2017; 6:6627] An innovative compression system providing low, sustained resting pressure and high, efficient working pressure Josefin Damm,1 Torbjörn Lundh,2 Hugo Partsch,3 Giovanni Mosti4 1PressCise AB, Herrljunga, Sweden; 2Chalmers University of Technology, Gothenburg, Sweden; 3Medical University of Vienna, Austria; 4Angiology Department, Clinica MD Barbantini, Lucca, Italy Introduction Chronic venous insufficiency (CVI) can cause considerable morbidity and reduced quality of life.1 Compression therapy, such as bandages and stockings, is the corner- stone and golden standard in the prevention and treatment of CVI today.2 It is also shown that compression used after the heal- ing of ulcers, reduces the rate of recurrence.3 It has been found that compres- sion products with a stiff, non-elastic mate- rial, are essential for an improved haemody- namic effect, indicating that low resting pressure and high working pressure is vital, in order to achieve the most effective and well tolerated compression treatment.4 However, one great challenge is that by applying a stiff bandage, either as a single component or as a part in a multi-compo- nent product, one always adds, a not so eas- ily quantified, resting pressure. In order to achieve the most effective treatment it is easy to apply the bandage in a too tight and uneven manner, often resulting in painful resting pressures.4 In earlier studies, it has been shown that common for todays prac- tice is that the compression treatment is dependent on the applier and that only about 10% of the healthcare personnel man- agers to apply a pre-defined target bandage pressure.5 It has also been shown that the applied pressures decrease in effectiveness, only after a couple of hours, due to e.g. oedema reduction, resulting in poor com- pression treatment over time.6 Aim The goal is to find a method to provide a well-defined resting pressure and a method that increases the working pressure without changing the pre-defined resting pressure, as well as maintaining the pres- sure over time. Materials and Methods First, an elastic compression bandage (Lundatex® medical by PressCise) provid- ing and maintaining a certain pressure level was applied on the leg. The bandage is based on Laplace’s law, where the pressure is a product of the force, times the overlap, times the curvature. The bandage is provid- ed with visual guidelines for correct stretch per each turn and correct overlap. Due to the specific elastic properties in the material the force is adjusted to the changes in cur- vature when the guidelines are followed. This results in a well-defined pressure, with minimal variability. Several patches (PressPatch™ by PressCise AB) made in a hook and loop material and with an optimal shape, were attached over the elastic band- age, creating a multicomponent compres- sion system (Lundatex® system by PressCise AB). The patches adhere directly to the bandage material without any force being added; hence there is no increase of resting pressure. In the front of the leg a special patch was added (FixPatch™ by PressCise AB). This patch can be opened easily e.g. every morning, in order to main- tain the pressure level over time. In one pilot-study interface pressures were meas- ured on point B1 and C on patients with severe venous reflux in the great saphenous vein (CEAP C2-C5), during lying and standing (n=18). Three consecutive meas- urements where done: 1) the elastic band- age applied to the leg with a pressure of 20 mmHg, 2) the elastic bandage applied to the leg with a pressure of 30 mmHg and 3) after attaching the stiff patches to the elastic bandage. In a second pilot-study the pres- sure was measured on one healthy volunteer at B1, over seven days. Measurements were taken in supine, at dorsal flex and standing position, twice a day. The pressure-measur- ing device used was PicoPress® (by Microlab Italia). Results The elasitc bandage provides a well- defined pressure, independent of placement or position. The patches add the stiffness to the underlying material and increase only the working pressure. With the patches, resting pressure is close to the same pressue as before, however working pressure increases signifi- cantly. As expected, there were a significant drop of working pressure in the evening day one in the 2nd pilot-study, due to some odema reduction. The correction of the FixPatch™ Correspondence: Josefin Damm, PressCise AB, Herrljunga, Sweden. E-mail: josefin@presscise.com Conflict of interest: two of the authors have commercial interest to declare. Josefin Damm and Torbjörn Lundh are co-inventors of the patches. The authors are also co-founders of the start-up company PressCise AB. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright J. Damm et al., 2017 Licensee PAGEPress, Italy Veins and Lymphatics 2017; 6:6627 doi:10.4081/vl.2017.6627 Figure 1. Pressure measurements on B1, in supine (resting) and standing position with the bandage providing 20 mmHg and 30 mmHg (baseline) and pressure measurements in supine and standing position with the patches added over the bandage (patches). (n=18). No n c om me rci al us e o nly Conference presentation [Veins and Lymphatics 2017; 6:6627] [page 11] each morning, however, maintained the work- ing pressure level over seven days. Conclusions The presented device is of considerable practical interest in order to achieve a quan- tified compression treatment. It may also be especially essential for those patients who should have a low controlled resting pres- sure, as e.g. patients with mixed arterial venous disease and for whom hemodynam- ically active pressures are desirable as soon the patient is active. The easy way to main- tain the pessure level over time may also be of great benefit for self-management. References 1. Moffatt CJ, Franks PJ, Doherty DC, et al. Psychological factors in leg ulcera- tion: a case-control study. Br J Dermatol 2009;161:750-6. 2. Partsch H. Understanding the patho- physiology of compression. Understanding compression therapy: EWMA position document; 2003. 3. O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev 2012;11:CD000265. 4. Partsch H, Clark M, Bassez S, et al. Measurement of lower leg compression in vivo: recommendations for the per- formance of measurements of interface pressure and stiffness. Dermatol Surg 2006;32:224-33. 5. Protz K, Heyer K, Dörler M, et al. Compression therapy: scientific back- ground and practical applications. J Dtsch Dermatol Ges 2014;12:794-801. 6. Protz K, Heyer K, Verheyen-Cronau I, Augustin M. Loss of interface pressure in various compression bandage sys- tems over seven days. Dermatology 2014. Figure 2. Pressure measurement over seven days, on one subject. Correction of the front patch (FixPatch™) was done daily, before bed rise No n c om me rci al us e o nly