1 Prof. Dr. med. Joachim Dissemond Department of Dermatology, Venerology und Allergology University of Essen, Germany Self management in compression therapy Conservative therapy Conservative therapy Leg ulcers Wound management Compression herapy
1
Prof. Dr. med. Joachim Dissemond
Department of Dermatology, Venerology und Allergology
University of Essen, Germany
Self management in
compression therapy
Conservative therapyConservative therapy
Leg ulcers
Wou
ndm
anag
emen
t
Com
pres
sion
hera
py
2
Who will care for us?Who will care for us?
Average life expentancy of the Germans
DO-It-YOURSELF (DIY)DO-It-YOURSELF (DIY)
3
DO-It-YOURSELF (DIY) DevicesDO-It-YOURSELF (DIY) Devices
Qualified staff …
… is missing
… causes high costs
Self management …
… saves ressources/money
… saves time
… is psychologically important
… improves compliance/adherence
Self managementSelf management
4
Problems for self managementProblems for self management
Arthrosis/arthritis
Obesity
Dementia
Lack of strength
Lack of comfort
Lack of education
…
How it should beHow it should be
5
RealityReality
Bild: K. Protz
Bild: K. Protz
Monocentric, prospective clinical study
Inclusion: chronic venous leg ulcers
100 successive patients
Size and numer of bandages were freely selectable
Pressure measurement: KIKUHIME
Study I Essen - ProcedureStudy I Essen - Procedure
Stoffels-Weindorf et al. Hautarzt in press.
6
Sex: 57 women, 43 men
Age: ø 70.3 years
Ulcer size: ø 12.7 cm²
43 were not able to do applicate any bandages
Pressure values: 6 - 93 mmHg
Study I Essen - ResultsStudy I Essen - Results
Stoffels-Weindorf et al. Hautarzt in press.
94% ineffective/incorrect therapy
Stoffels-Weindorf et al. Hautarzt in press.
Study I Essen - ResultsStudy I Essen - Results
7
Multi-layer bandagesMulti-layer bandages
3 different compression systems
Short-stretch bandages (Pütter, Hartmann)
Multi-layer bandages (UrgoK2, Urgo)
Multi-layer bandages (ProGuide, S&N)
3 different groups of probands
Laity
Nurses
Physicians
Study II Essen - ProcedureStudy II Essen - Procedure
Weindorf et al. Phlebologie 2012.
8
Weindorf et al. Phlebologie 2012; 41:18-24.
Study II Essen I - ResultsStudy II Essen I - Results
Adaptive bandagesAdaptive bandages
9
Adaptive bandagesAdaptive bandages
31 patients with venous insufficiency
13 men, 18 women
40-81 years (Ø 65.5)
Short education
Patients should applicate adaptive bandages
Self-management, no adjuvant devices
Adaptive bandages - studyAdaptive bandages - study
Mosti and Partsch. Vasomed 2017
10
Adaptive bandages - resultsAdaptive bandages - results
Mosti and Partsch. Vasomed 2017.
Ulcer stockingsUlcer stockings
11
StockingsStockings
40 patients with venous insufficiency (CEAP: C4-C6)
Aged >65 years
Compression therapy with stockings
40 mmHg (CS40), with open and closed toes
20 + 20 mmHg (CS20+20), with open and closed toes
Test with 8 different donning devices
Sippel et al. Eur J Vasc Endovasc Surg 2015.
Donning devices - studyDonning devices - study
12
Sippel et al. Eur J Endovasc Surg 2015.
Donning devicesDonning devices
Results
without donning device 60% (CS40), 70% (CS20+20)
with donning device 88% (CS40), 90% (CS20+20)
Donning devices significantly improve the ability of elderly patients with CVI to do on compression stockings
Differences in user-friendliness among the devices
Sippel et al. Eur J Vasc Endovasc Surg 2015.
Donning devices - resultsDonning devices - results
13
Sippel et al. Eur J Vasc Endovasc Surg 2015.
Donning devicesDonning devices
Intermittent pneumatic compression
14
(Short-strech)Bandages
Multi-layer bandages
Adaptive compression bandages
Ulcer stockings
(Relapse)Prophylaxis: Stockings/MCS
Intermittent pneumatic compression
Compression therapyCompression therapy
For almostevery patientthere exist a „appropriate“ system
(Short-strech)Bandages
Multi-layer bandages
Adaptive compression bandages
Ulcer stockings
(Relapse)Prophylaxis: Stockings
Intermittent pneumatic compression
Self managementSelf management
plus educationand - ifnecessary -donningdevices
15
Self management will play an increasingly importantrole in the medicine of the future
Education and verification of systems improve the therapeutic outcome
Compression systems must be adapted to the patient's needs and abilities
If possible use self management systems (do-it-yourself devices) for compression therapy
SummarySummary
Thank you for your
kind attention!