(CS-042) Creative Uses of Low Profile Primary Wound Dressings to Enhance Compression Profiles and Wound Healing in Persons with Lymphedema 

Co-Author(s):

Tia Gray, PTA, CLT, CWT; Donald Thomas, PT, DPT, CLT-LANA, CWT

<b>Introduction</b>: <p class="MsoNormal"><span lang="EN" style="font-size: 12.0pt; line-height: 115%;">Persons with lymphedema often struggle with chronic edema/wounds, pain, and heavy exudate.<br /></span></p>
<p class="MsoNormal"><span lang="EN" style="font-size: 12.0pt; line-height: 115%;">Compression is the treatment cornerstone for edema-related chronic wounds and primary wound dressings' (PWD) roles are to optimize the wound healing environment.<span style="mso-spacerun: yes;">  C</span>hoosing PWDs that optimizes wound healing/ compression effectiveness is essential for success.<span style="mso-spacerun: yes;">  </span></span></p>
<p class="MsoNormal"><span lang="EN" style="font-size: 12.0pt; line-height: 115%;">Research demonstrates evenly-distributed alternating compression profiles (EDACP) enhance edema reduction/ facilitate more rapid wound healing. <span style="mso-spacerun: yes;"> </span>EDACPs are hypothesized to apply micro-strain, facilitating lymphangion motricity/ lymphangiogenesis. <span style="mso-spacerun: yes;"> Most </span>PWDs affect sub-bandage pressures/ distribution patterns, but low profile PWDs (LPPWD) do not significantly impact these patterns.<span style="mso-spacerun: yes;">  </span> <br /><br />Hence, using LLPWDs/ EDACPs together should enhance <span lang="EN" style="font-size: 12.0pt; line-height: 115%; font-family: 'Arial',sans-serif; mso-fareast-font-family: Arial; mso-ansi-language: EN; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">edema reduction/ wound healing.<span style="mso-spacerun: yes;">  </span><span style="mso-spacerun: yes;"> </span></span></span></p><br/><br/><b>Methods</b>: <p class="MsoNormal"><span lang="EN" style="font-size: 12.0pt; line-height: 115%;"><span style="color: #000000; font-family: Arial, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">T</span><span style="background: white; mso-highlight: white;">he following is a case series that has utilized these principles in practice by creative uses of LPPWDs under bandaging systems with unique EDACPs to facilitate edema reduction and </span><span style="color: #000000; font-family: Arial, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">wound healing in persons with lymphedema.</span><span style="mso-spacerun: yes;"> </span></span></p>
<p class="MsoNormal"><span lang="EN" style="font-size: 12.0pt; line-height: 115%;">Case series (3-5 cases) with creative uses of LPPWDs:</span></p>
<p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l0 level1 lfo1;">< L<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">low profile zinc-based foam dressing *</span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;">< !L<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">ow profile calamine-based foam dressing** </span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;">< ![<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">active fluid management dressing***</span></p>
<p class="MsoListParagraphCxSpLast"><span lang="EN" style="font-size: 12.0pt; line-height: 115%;"><br /> under unique EDACPs, achieved with the use of fuzzy wale compression stockinette (FWC)**** and multilayered lymphedema bandages </span></p><br/><br/><b>Results</b>: <p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l0 level1 lfo1;">< !<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">Wounds healed 80 - 92% faster with the use of LPPWDs with EDACPs.</span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;">< !<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">Edema reduction ranged from 3-46 % from start of care, with mean of 21%.<span style="mso-spacerun: yes;">  </span></span></p>
<p class="MsoListParagraphCxSpLast" style="text-indent: -.25in; mso-list: l0 level1 lfo1;">< ![<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">Persons with lymphedema showed visible improvements in skin texture/fibrosis, reduction in hyperkeratosis, and reduction or complete resolution of lymphorrhea (before and after photos will be provided).<span style="mso-spacerun: yes;">  </span></span></p>
<p class="MsoNormal" style="text-indent: .5in;"><span lang="EN" style="font-size: 12.0pt; line-height: 115%;"> </span></p><br/><br/><b>Discussion</b>: <p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">LPPWDs and EDACPs have a positive effect on wound healing and edema reduction in persons with lymphedema. </span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;">< !T<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">he use of LPPWDs allow for the EDACPs’ affect in and around the wound bed.</span></p>
<p class="MsoListParagraphCxSpLast" style="text-indent: -.25in; mso-list: l0 level1 lfo1;">< !<span lang="EN" style="font-size: 12.0pt; line-height: 115%;">The primary wound dressing’s effect on wound healing and edema reduction should be considered when applying compression profiles.<span style="mso-spacerun: yes;">  </span></span></p>
<span lang="EN" style="font-size: 12.0pt; line-height: 115%; font-family: 'Arial',sans-serif; mso-fareast-font-family: Arial; mso-ansi-language: EN; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">The impact of the primary wound dressing on compression profiles warrants more research. <br style="mso-special-character: line-break;" /><br /></span><br/><br/><b>Trademarked Items</b>: * Milliken Coflex TLC Zinc
** Milliken Coflex TLC Calamine
*** Milliken Tritec
**** EdemaWear<br/><br/><b>References</b>: 1. Mosti G, Cavezzi A. Compression therapy in lymphedema: Between past and recent scientific data. Phlebology. 2019;34(8):515-522. doi:10.1177/0268355518824524

2. Alavi A, Sibbald RG, Phillips TJ, et al. What's new: Management of venous leg ulcers: Treating venous leg ulcers. J Am Acad Dermatol. 2016/04/01/ 2016;74(4):643-664. doi: https://doi.org/10.1016/j.jaad.2015.03.059

3. Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned from the past 10 years? Int Wound J. 2012;9(Suppl 2):1–19. doi:10.1111/j.1742-481X.2012.01097.

4. Atkin L, Bućko Z, Conde Montero E, et al. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care. 2019;28(Suppl 3): S1–S49. doi:10.12968/jowc.2019.28.Sup3aS1

5. Ehmann S, Walker KJ, Bailey CM, DesJardins JD. Experimental Simulation Study to Assess Pressure Distribution of Different Compression Applications Applied Over an Innovative Primary Wound Dressing. Wounds. Dec 2020;32(12):353-363.

6. Bjork R, Ehmann S. S.T.R.I.D.E. professional guide to compression garment selection for the lower extremity. J Wound Care. 2019;28(Suppl 6a):1–44. doi:10.12968/jowc.2019.28.Sup6a.S1

7. Vaeyens M, Jorge-Peñas A, Barrasa-Fano J, et al. Matrix deformations around angiogenic sprouts correlate to sprout dynamics and suggest pulling activity. Angiogenesis. 2020. doi:10.1007/s10456- 020-09708-y

8. Travasso RD. The mechanics of blood vessel growth. In: Simionescu D, ed. Vasculogenesis and Angiogenesis— from Embryonic Development to Regenerative Medicine. InTech; 2011:187–204.<br/><br/>