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The treatment of varicose veins is supposed to eliminate congestive symptoms and edema, heal skin complications and prevent complications. Surgical procedures, endovenous thermal procedures, endovenous chemical procedures and conservative measures are used for treatment. Often the invasive and conservative procedures are combined. A precise examination of the varicose veins is required for therapy planning; duplex sonography is the gold standard. Conservative therapy focuses on compression therapy with compression bandages and with compression stockings. Medical adaptive compression systems are also used in the decongestion phase. Extract from red vine leafs, extract from horse chestnut seed and oxerutin are available for oral drug therapy. Conservative therapy is especially indicated when treatment of symptomatic varicose veins is not possible or when symptomatic venous disease persists even after invasive therapy.Die Therapie der Varikose soll Stauungsbeschwerden und Ödeme beseitigen, Hautkomplikationen zur Abheilung bringen und Komplikationen verhindern. Zur Behandlung werden operative Verfahren, endovenöse thermische Verfahren, endovenöse chemische Verfahren und konservative Maßnahmen genutzt. Dabei werden häufig die invasiven und konservativen Verfahren kombiniert. Zur Therapieplanung ist eine genaue Untersuchung der Varikose erforderlich, als Goldstandard gilt die Duplexsonographie. Der Schwerpunkt der konservativen Therapie liegt auf der Kompressionstherapie mit Kompressionsbandagen und mit Kompressionsstrümpfen. In der Entstauungsphase werden auch medizinische adaptive Kompressionssysteme eingesetzt. Für eine orale medikamentöse Therapie stehen roter Weinlaubextrakt, Rosskastaniensamenextrakt und Oxerutin zur Verfügung. Die konservative Therapie ist insbesondere dann indiziert, wenn eine Sanierung einer symptomatischen Varikose nicht möglich ist oder wenn auch nach invasiver Therapie noch ein symptomatisches venöses Krankheitsbild persistiert.

The treatment of chronic wounds is usually a major challenge for the involved medical staff. Various different treatment options have to be tested achieving a satisfactory result. In this retrospective case report, we describe successful treatments with hyaluronan acid ester fleece in six patients with chronic wounds of different origins. Furthermore, all patients received compression bandages or compression stockings, two patients were treated additionally with pressure relief devices and all were debrided if necessary. The chronic wounds of five out of the six patients healed completely over a period of 1.5-11 months or only with a minimal residual defect. However, one patient was still resistant to therapy over five months. In summary, the treatment with hyaluronan esters achieved good results especially in patients with complex medical history that makes a successful therapy particularly difficult.Die Behandlung von chronischen Wunden ist meist eine große Herausforderung für alle Beteiligten. Oft ist der Weg bis zur Heilung langwierig und frustran, sodass verschiedene Therapieversuche durchgeführt werden müssen, bis eine Heilung erzielt wird. In dieser retrospektiven Fallbeschreibung berichten wir über den Behandlungserfolg durch die Therapie mit einem Hyaluronsäureester-Flies, den wir bei 6 Patient*innen mit chronischen Wunden unterschiedlicher Genese erzielen konnten. Alle Patient*innen bekamen zusätzlich Kompressionsbandagen oder Kompressionsstrümpfe, zwei zusätzlich eine Druckentlastung und alle wurden, wenn nötig, debridiert. Die chronischen Wunden von 5 der 6 Patient*innen heilten vollständig oder nur mit einem minimalen Restdefekt ab, 1 Patient war weiterhin therapieresistent. Speziell bei Patient*innen mit Grunderkrankungen, welche eine erfolgreiche Therapie besonders erschweren, konnten wir feststellen, dass durch eine Behandlung mit Hyaluronsäureestern dennoch gute Erfolge erzielt werden können.

For several decades, compression therapy, which is associated with few side effects, has been a basis for the conservative treatment of patients with phlebological and lymphological diseases. For the practical implementation of compression therapy, many different materials are available, some with system-specific advantages and disadvantages. Medical adaptive compression systems (MAK) are still a relatively new treatment option in Germany. Apart from the very good practical experience in clinical everyday life, the compilation of the scientific evidence of compression therapy also shows that the scientific data situation is significantly better than for many other medical areas, especially for the treatment of patients with venous diseases. It is important to note that compression therapy must reliably guarantee adequate compression pressure. If these conditions are met, it can be assumed on the basis of the currently available data that the clinical effectiveness of the different compression systems is comparably good. These aspects have now also been well tested for MAK, so that these analogies can be drawn. Therapists today can therefore choose between different, very effective therapy options and take individual factors, patient wishes and economic aspects into account when making their selection.

For the treatment of phlebological and lymphological diseases as well as constitutional edema diseases, a discussion of innovative concepts of medical compression therapy is essential. It is recommended that medical compression stockings should always be prescribed based on symptoms and with the lowest effective interface pressure to optimize the tolerability of compression therapy. Likewise, medical compression stockings with an integrated care formula, but also the application of additional skincare can improve the quality of life and compliance in patients with chronic venous insufficiency. Optimization of ulcer therapy can be achieved by using two-component compression stocking systems. These consist of an understocking and a firm outer compression stocking, which improve the venous and capillary hemodynamics with good wearing comfort and lead to the healing of venous ulcerations. Multicomponent compression bandages and short stretch bandages are proven in the decongestion phase of edema. Multicomponent bandages ensure a sustained interface pressure for at least 5 days and are ideal for outpatient treatment with less frequent dressing changes. For compression therapy in patients with arterial-venous leg ulcers (ABI [ankle brachial index]0.5), specially developed "lite" versions of the multicomponent dressings can be used.

Patients with leg ulcers often have severe edema of the lower extremities, which should be treated as part of a successful wound treatment. Today in Germany the necessary compression therapies are often performed with very error-prone and time-consuming short-stretch bandages only. Multicomponent systems, adaptive compression bandages and leg ulcer stocking systems are newer, much less error-prone treatment options. In addition to the often lacking knowledge, the fears of high costs are also mentioned as reasons for the lack of prescription of these systems. It was therefore our aim to investigate the costs of different treatment options, differentiated in the outpatient and inpatient sector.For the economic calculations, both material and personnel costs were taken into account for different scenarios.Both material and personnel costs were included in the calculation. We were able to demonstrate that the cost for a continuous compression therapy for inpatients accrues between 5.29 Euros to 18.50 Euros per day. For the outpatient setting costs of 2.29 Euros to 34.29 Euros per day were calculated. The different constellations of compression therapy can make sense thus not only for medically but also for economically aspects.As a consequence of this data, both the different systems and the economic factors of compression therapy in patients with leg ulcers should be known to the therapists. These treatment options should then be prescribed and performed according to individual factors, taking into account the needs and abilities of the patients.Patienten mit Ulcus cruris haben häufig ausgeprägte Ödeme der unteren Extremitäten, die im Rahmen einer erfolgreichen Wundversorgung behandelt werden müssen. Die hierfür notwendigen Kompressionstherapien werden heute in Deutschland oft mit sehr fehler- und zeitaufwendigen Verbänden mit Kurzzugbinden durchgeführt. Mehrkomponentensysteme, adaptive Kompressionsbandagen und Ulkus-Strumpfsysteme sind neuere, deutlich weniger fehleranfällige Therapieoptionen. Neben dem oft nicht vorhandenen Wissen werden auch die scheinbar hohen Kosten als Grund für die nicht vorgenommene Verordnung dieser Materialien angeführt. Es war daher das Ziel unserer Untersuchung, die Kosten der verschiedenen Therapieoptionen im ambulanten und stationären Sektor differenziert darzustellen.Für die ökonomischen Berechnungen wurden sowohl die Material- als auch die Personalkosten für verschiedene Szenarien berücksichtigt.Es zeigte sich, dass durch die kontinuierliche Kompressionstherapie im stationären Bereich Kosten von 5,29 Euro bis 18,50 Euro pro Tag anfallen. Für die ambulante Versorgung wurden Kosten von 2,29 Euro bis 34,29 Euro pro Tag ermittelt. Die verschiedenen Konstellationen der Kompressionstherapie SGkönnen somit nicht nur medizinisch, sondern auch wirtschaftlich unterschiedlich sinnvoll sein.Als Konsequenz dieser Daten sollten sowohl die verschiedenen Materialien als auch die ökonomischen Aspekte der Kompressionstherapie bei Patienten mit Ulcus cruris den Therapeuten bekannt sein. Diese Therapieoptionen sollten dann unter Einbeziehung individueller Faktoren und orientiert an den Bedürfnissen und Fähigkeiten der Patienten verordnet und durchgeführt werden.

This study aimed to investigate the effects of upper body compression garments on performance changes in elite canoeists. A total of 23 elite athletes from the German Canoe Federation (6 women and 17 men) were recruited. On a regatta lake, the athletes completed a 1650-m test track with their competition or training boats and paddles. The athletes were randomised into two groups and performed the test track with and without upper body compression garments. Besides split and end times, capillary blood lactate concentrations were assessed. For statistical analysis, an effect-based approach ("Magnitude-Based Inferences") and an additional case study were conducted. For this purpose, the mean and individual effects were examined in relation to the smallest worthwhile changes. On average, the effect-based approach shows that upper body compression garments do not lead to clear changes in performance. The changes in lactate concentrations were clear, but were considered trivial. In contrast to the average statistical analysis, the results of the case study demonstrate that upper body compression garments lead to an improved performance in 13.0 % and a worsened performance in 4.4 % of athletes. Additionally, a decreased lactate concentration was found in 4.4 % and an increased lactate concentration in 17.4 % of athletes. Our study shows that, on average, upper body compression garments have no effects on the performance and lactate concentration of highly trained elite canoeists. In individual cases, however, there are beneficial as well as harmful effects that may have practical relevant consequences for elite athletes.Ziel der Studie war es zu untersuchen, ob im Elite-Kanusport durch das Tragen von Oberkörperkompressionsbekleidung eine Verbesserung der Leistungsfähigkeit zu erzielen ist. Für die Studie wurden 23 Elite-Athleten des Deutschen Kanuverbands (6 Frauen, 17 Männer) rekrutiert. Diese absolvierten auf einem Regattasee eine 1650 m lange Teststrecke mit gewohnten Wettkampf- bzw. Trainingsbooten und -paddeln. Die Athleten wurden randomisiert in 2 Gruppen eingeteilt und durchliefen die Teststrecke mit und ohne Oberkörperkompressionsbekleidung. Neben Zwischen- und Endzeiten wurden kapilläre Blutlaktatkonzentrationen erhoben. Für die Statistik wurden ein effektbasierter Ansatz („Magnitude-Based Inferences“) und eine zusätzliche Einzelfallanalyse durchgeführt. Hierfür wurde der mittlere bzw. individuelle Effekt in Relation zur kleinsten lohnenswerten Differenz betrachtet. Die effektbasierte Statistik zeigt im Mittel, dass durch das Tragen von Oberkörperkompressionsbekleidung keine eindeutigen Veränderungen hinsichtlich der Leistungsfähigkeit zu erzielen sind. Die Änderungen der Laktatkonzentrationen sind hingegen eindeutig, aber als trivial anzusehen. Im Gegensatz zum mittelwertanalytischen Vorgehen zeigen die Ergebnisse der Einzelfallanalyse, dass es bei 13,0 % der Athleten zu einer Leistungsverbesserung und bei 4,4 % zu einer geringeren Laktatkonzentration durch das Tragen von Oberkörperkompressionsbekleidung kam. Bei 4,4 % der Athleten kam es zu einer Leistungsverschlechterung und bei 17,4 % zu einer höheren Laktatkonzentration. Unsere Studie zeigt, dass das Tragen von Oberkörperkompressionsbekleidung bei hochtrainierten Elite-Kanusportlern im Mittel keinen Einfluss auf die Leistungsfähigkeit und Laktatkonzentration hat. Im Einzelfall zeigen sich jedoch positive und negative Effekte, die für den Elitebereich praktisch bedeutsam sein können.

The pressure exerted by a compression device on a part of the body corresponds to the dosage of the compression therapy. Therefore, the pressure course under compression materials should be investigated in different clinical situations.Pressure measurements were carried out under different compression materials in lying, standing and walking positions within the framework of training, self-experimentation and in patients with venous leg ulcers.The results showed that the pressure varied considerably depending on the material used, the firmness of application, the local configuration (body position) and the time interval between applications. A loss of pressure occurred under each compression therapy, especially under inelastic short-stretch material, mainly due to movement and edema reduction. This pressure loss is decisive for the timing of dressing changes and a reason for the good tolerance of high-pressure levels in mobile patients.Low pressures are particularly suitable for edema reduction. Hemodynamic effects require higher pressures (60-80 mmHg). For this purpose, inelastic materials are preferred which enable lower pressures when lying down (40-60 mmHg). As compression bandages are too loosely applied by many users, pressure indicators on bandages or adaptive bandages with templates are helpful to apply the material with the correct pressure. As a consequence of these findings it is postulated that, at least in studies comparing different compression media, pressure measurements should be carried out in the future, whereby the measuring point and body position should be documented.

In the context of compression therapy, padded bandages are designed to prevent skin damage, increase adherence and support the success of therapy. Routine use is discussed, because comparative studies are lacking.This study examines effectiveness, comfort, and impact of short-stretch bandages without padding compared to underpadded bandages.In all, 61 healthy participants wore padded bandages foam or synthetic cotton wool on one leg and nonpadded bandages on the other. On both sides, a resting pressure of 50 mm Hg was generated. After 60 min resting pressure, skin condition, comfort, pain, and fitting of the bandages were assessed.All bandages showed pressure losses after 1 h; 82.0% of nonpadded bandages had a pressure drop of 9 mm Hg or more. The following were observed in unpadded bandages: constrictions (100.0%), severe redness (77.0%) and bruises (42.6%). Comfort was rated as pleasant by 3.3% without padding, by 83.9% with foam padding, and by 73.3% with synthetic cotton wool padding. Nonpadded compression bandages caused in 62.3% pain from 1-3 (numerical rating scale 0-10).Padded compression bandages maintain the therapy-relevant pressure better, provide more comfort, and cause less pain and skin problems than nonpadded compression bandages. These aspects are crucial for adherence, and therapeutic success. After 1 h of use on the healthy leg, there were obvious differences. Significantly more side effects may appear after several hours of use on previously damaged skin. Therefore, compression bandages should always be padded.

Background: After total knee arthroplasty (TKA) efficient control and reduction of postoperative edema is of great importance. Aim: The aim of this pilot study (EKNZ 2014 - 225 DRKS00006271) was to investigate the effectiveness of multi-layer compression therapy (MLCT) to reduce edema in the early period after surgery compared to the standard treatment with Cool Pack. Methods: In this randomized controlled pilot trial, sixteen patients after TKA were randomized into an intervention group (IG) or a control group (CG). Circumferential measurements were used to assess edema. Secondary outcomes were range of motion (ROM), pain (numeric rating scale, NRS) and function as measured with the fast Self Paced Walking Test (fSPWT). Results: Clinically relevant differences in edema reduction between the two groups were found in the early postoperative period and at the six weeks follow up. Six days postoperatively the group time interaction (IE) in favor of the IG were −3.8 cm (95 % CI: −5.1; −2.4) when measured 10 cm proximal to the joint space and −2.7 cm (CI: −4.1; −1.3) when measured 5 cm proximally. We further observed differences in secondary outcomes in favor of the CG. Six days postoperatively the IE for knee flexion was –8.3 ° (CI: −22.0; 5.4) and for the fSPWT it was 12.8 seconds (CI: −16.4; 41.3). Six weeks postoperatively these differences diminished. Conclusions: The findings suggest that MLCT could be an alternative treatment to reduce postoperative edema in patients after total knee arthroplasty. Eventually possible negative effects on early knee flexion and function must be considered.

If compression bandaging is not performed in a professional manner, the objectives of the therapy may not be achieved and side effects or complications may result.This cross-sectional observational survey examines the handling of the treatment options: short-stretch bandages with padding, multicomponent compression systems, and adaptive compression bandages.During several training sessions on the topic of compression therapy, 137 participants performed compression bandagings on each other. In this regard, they were asked to achieve a predetermined pressure range (short-stretch bandages: 50-60 mm Hg, multicomponent compression systems: 40-50 mm Hg, adaptive compression bandage: 35-45 mm Hg). To evaluate the efficiency, the time used for application, the achieved pressure value, and the comfort were determined.Of the 302 bandagings (n = 137 participants), 28.4% lay within the given target pressure value range. This included 11.2% of performed short-stretch bandages, 35.2% of multicomponent compression systems, and 85.0% of adaptive compression bandages. Significant differences in the mean deviations are found between the treatment options. The bandage was described as being comfortable by 37.7% of users of short-stretch bandages with padding, by 65.0% of those wearing a multicomponent compression system, and by 94.6% of participants with an adaptive compression bandage.In practice, short-stretch bandages are still the most frequently used care option for the creation of a phlebological compression bandage. In this survey, they proved to be unsafe, time-consuming, and uncomfortable in relation to other treatment options. Multicomponent compression systems and adaptive compression bandages are treatment options that may be a contemporary alternative which also bares more comfort for the patient.

For effective compression therapy in patients with venous leg ulcers, sufficient pressure is essential. In everyday life, it is often the patients themselves who apply the compression bandages. Many of these patients have restriction in their movement and had been rarely trained adequately. Hence, there was the question of how efficient are the autonomously applied compression bandages of those patients.In all, 100 consecutive patients with venous leg ulcer were asked to apply compression bandages on their own leg. We documented both the achieved compression and formal criteria of correct performance.A total of 59 women and 41 men with an average age of 70.3 years were included in the study. Overall 43 patients were not able to apply a compression bandage because of physical limitations. The measured pressure values in the remaining 57 patients ranged between 6 and 93 mm Hg (mean 28.3 mm Hg). Eleven patients reached the prescribed effective compression pressure. Of these, formal errors were found in 6 patients, so that only 5 patients had correctly applied the compression bandages.Our data show that most patients with venous leg ulcers are not able to apply effective compression therapy with short-stretch bandages to themselves. Multilayer systems, adaptive compression bandages, and ulcer stocking systems today are possibly easier and more effective therapy options. Alternatively short-stretch bandages could be applied by trained persons but only under the control with pressure measuring probes.

Background: After total knee arthroplasty (TKA) efficient control and reduction of postoperative edema is of great importance. Aim: The aim of this pilot study (EKNZ 2014 – 225 DRKS00006271) was to investigate the effectiveness of multi-layer compression therapy (MLCT) to reduce edema in the early period after surgery compared to the standard treatment with Cool Pack. Methods: In this randomized controlled pilot trial, sixteen patients after TKA were randomized into an intervention group (IG) or a control group (CG). Circumferential measurements were used to assess edema. Secondary outcomes were range of motion (ROM), pain (numeric rating scale, NRS) and function as measured with the fast Self Paced Walking Test (fSPWT). Results: Clinically relevant differences in edema reduction between the two groups were found in the early postoperative period and at the six weeks follow up. Six days postoperatively the group time interaction (IE) in favor of the IG were −3.8 cm (95 % CI: −5.1; −2.4) when measured 10 cm proximal to the joint space and −2.7 cm (CI: −4.1; −1.3) when measured 5 cm proximally. We further observed differences in secondary outcomes in favor of the CG. Six days postoperatively the IE for knee flexion was –8.3 ° (CI: −22.0; 5.4) and for the fSPWT it was 12.8 seconds (CI: −16.4; 41.3). Six weeks postoperatively these differences diminished. Conclusions: The findings suggest that MLCT could be an alternative treatment to reduce postoperative edema in patients after total knee arthroplasty. Eventually possible negative effects on early knee flexion and function must be considered.

Medical compression therapy is widely used to treat phlebologic diseases. Compression bandages as well as compression stockings are used. Compression has been identified to be an effective conservative therapy for the healing of venous ulcers and other indications. Thus, the evidence for the use of medical compression therapy and for which indications is presented.Review and systematic presentation of the evidence-based use of compression. The current literature, guidelines, and consensus statements were searched and the indications for compression therapy are presented.There is a high level of evidence that compression therapy is effective to heal venous ulcers and to prevent recurrent ulcers. The use of compression bandages and hosiery after interventional and surgical procedures for varicose veins is based on experience but not on randomized controlled trials. According to clinical experience, the healing of inflammatory skin diseases (e.g., erythema nodosum, pyoderma gangrenosum, necrobiosis lipoidica, cutaneous leukocytoclastic vasculitis, and psoriasis of the extremities) is supported by compression therapy. Compression therapy in patients suffering from venous ulcers is highly recommended.

Patients with peripheral arterial occlusive disease who show an ankle arterial pressure of minimum 60 mmHg can be decongested by use of special padded bandages. Afterwards, medical compression stockings (class 1) with high strength and less elasticity are recommended. Mobile patients seem to benefit from progressive compression therapy with highest pressure above the calf. Compression after uncomplicated interventions of varicose veins or spider veins tends to be modified to a short and excentric compression in patients without risk factors. Valid datas are not available yet. Adaptive compression bandages show pros concerning efficiency, economy and more comfort for patients with edemas or ulcers.

Compression therapy is a physical therapy with few side effects, which is used especially in patients with edema of the lower extremities. The indication for compression therapy is given here for edema of very different origins such as, for example, venous or lymphatic disease symptoms as well as renal insufficiency, obesity or inflammation. However, different contraindications must be considered in these patients. Of particular importance are the advanced peripheral arterial occlusive disease and the polyneuropathy, which need special attention.Due to the large number of different compression materials and systems available today, in spite of these contraindications, compression therapy can be carried out with a large proportion of patients with edema of the lower extremities. The therapy should be adapted to the comorbidities and individual needs as well as personal abilities in the context of a patient-oriented care.

Compression therapy, together with modern moist wound treatment, is the basis for a successful conservative treatment of patients with chronic leg ulcers. In clinical practice, it is often the patients themselves who apply compression therapies. Many of the mostly elderly patients, however, are not able to reach their legs and feet due to movement restrictions, such as arthritis, arthrosis and even obesity. An adequate compression therapy also requires extensive experience and regular training. In practice only the minority of patients can perform bandaging well and therefore this should not be recommended. Self-management with do-it-yourself medical devices will become more and more important in the future. In addition to the psychological factors, cost aspects and demographic change, an expected lack of qualified nursing staff due to the number of elderly patients who are potentially in need of care means that self-management is becoming increasingly more important. For the essentially important compression therapy of patients with chronic leg ulcers, there already exist various therapy options. The needs, preferences and abilities of the patients concerned can be considered when selecting the appropriate system. Particularly for the self-management of compression therapy, adaptive compression bandages are suitable for patients with leg ulcers during the initial decompression phase and ulcer stocking systems in the subsequent maintenance phase.

Compression therapy is the basis for successful treatment in most patients with venous leg ulcers. Concerning compression therapy, the initial phase of decongestion and the following phase of maintenance should be differentiated. While in the maintenance phase (ulcer) stocking systems are now frequently recommended, in the decongestion phase compression bandages are mostly still used, which however are often inappropriately applied. In German-speaking countries, compression therapy with short-stretch bandages has a long tradition. However, their correct application requires good training and monitoring, which is often lacking in daily practice. Less error-prone treatment alternatives are multicomponent systems, some of which have an optical marker for the control of the correct subbandage pressure. In another new type of compression system, which is called adaptive or wrap bandages, the compression pressure can be adjusted using a Velcro fastener. Accompanying intermittent pneumatic compression therapy can also be used in the decongestion phase. Thus, there are now several different treatment options that can be used for the decongestion phase in patients with venous leg ulcers. Often bandages with short-stretch materials are very prone to errors and should in most cases be replaced by other compression systems today. The patient's preference, need, and capability should be considered when selecting the appropriate system for the individual patient.

Severe brain, thoracic and intrapelvic injuries, as well as heavy bleeding, are the main causes of death in patients with major trauma. Unstable pelvic ring fractures can cause this bleeding and the so-called "C problem". This is usually due to haemorrhagic shock caused by the loss of large volumes of blood from the presacral venous plexus, iliac vessels and the fracture surfaces. Many clinical studies have shown that, in the preclinical setting, unstable pelvic ring injuries are often underestimated. The application of a non-invasive external pelvic ring stabilisation (pelvic binder) is therefore recommended if a pelvic fracture is possible. Several circumferential pelvic binders have been developed and their prehospital use is increasing. Clinical and biomechanical studies have demonstrated that there is a favourable haemodynamic effect in unstable fractures, due to rapid closure of the pelvic ring. It is unclear whether the pelvic binder can be safely removed in a presumably haemodynamically stable patient. A correctly placed pelvic binder leads to anatomical closure of the pelvic ring. Therefore unstable pelvic ring fractures may be clinically and radiologically overlooked. This is a particular problem in unconscious patients. Furthermore, the real severity of the injury may then be underestimated in the diagnostic evaluation. Unconsidered opening of the pelvic binder can thus provoke renewed deterioration of the circulatory situation, especially if the injury was adequately treated by the binder and the C problem was controlled. The aim of this article is to describe procedures for handling pelvic binders, particularly as to how to deal with an already applied pelvic binder and how to "clear the pelvic region" while reducing the risk of haemodynamic instability. A detailed analysis of the literature and a Delphi-like discussion among several experts were performed. The following points were raised: 1) Assessment of the clinical situation, including trauma kinematics. 2) Assessment of the haemodynamic status. 3) Check of the need to open the pelvic binder for diagnostic/therapeutic measures before completing all diagnostic tests. 4) Assessment of the radiology diagnostic testing and release of the pelvic region. The result is a so-called "clear the pelvis algorithm" which describes a structured approach according to specific criteria and which specifies the circumstances under which the pelvic binder can be opened. Additional studies are necessary to analyse the applicability and safety of this algorithm in a clinical context. Our advice is not to "clear" the pelvis if no X-rays or CT scans of the pelvis have been carried out without (or with an opened) pelvic binder.

The amount of physical pressure plays an important role in complex decongestive therapy (CDT). As a function of pressure, microcirculation takes place between blood vessels and tissue. As part of the total lymphatic system, lymphatic vessels transport the lymphatic load from the interstitial space to the blood stream. The lymphatic vessel system, characterized by specific anatomical conditions like initial lymphatic vessels, precollectors, collectors, and lymphatic strains, is the therapeutic target of complex decongestive therapy. Components of CDT include manual lymphatic drainage, compression therapy, decongestive kinesitherapy, and good skin care, which increase the transport capacity of the lymphatic vessel system. Currently, CDT is acknowledged as the main conservative treatment of lymphedema of primary and secondary genesis, lipolymphedema, and phlebolymphedema. In clinical practice, we are increasingly confronted with edema of multifactorial genesis requiring a critical discussion and stocktaking of comprehensive clinical findings in terms of the indication for CDT. Therapeutic success depends on a joint application of all CDT components and patient compliance. To an increasing extent, medical research tries to combine successfully CDT with adjunct treatment options.

The diabetic foot syndrome (DFS) is a complication of diabetes mellitus, implying a serious impairment in quality of life for patients in advanced stages of the disease. Early detection of risks and stage-appropriate intervention are essential to increase the chances of foot salvage. The pathophysiological conditions for the formation of a DFS and treatment guidelines are currently underestimated. Up to 80 % of amputations are preventable if appropriate therapeutic steps were initiated on time in patients with DFS as part of a multidisciplinary approach. By proper prevention, the number of patients with DFS as well as the risk of recurrent ulcers can be reduced. This CME article gives an overview of the pathogenesis, diagnosis, therapy and prevention of DFS.

Chronic venous insufficiency is very common and has an important socioeconomic impact. It is associated with a high morbidity for the patients and causes high costs for the healthcare systems. In recent years novel treatment modalities have evolved and their efficacy has been evaluated in many studies. Knowledge of pathophysiology, the diagnostic procedures and therapeutic options for chronic venous insufficiency is important for effective treatment of affected patients.

Prevention and therapy of deep vein thrombosis and pulmonary embolisms in patients with acute stroke (ischemia and hemorrhage) represent a special challenge in the clinical routine. This article gives an overview on the epidemiology, risk factors and causes of deep vein thrombosis and pulmonary embolism in patients with acute stroke. The focus lies on the efficacy and safety of prophylactic treatment with compression stockings, compression devices and anticoagulants. Special therapeutic options in the event of symptomatic deep vein thrombosis and pulmonary embolisms in patients with intracerebral hemorrhage and increased risk of recurrent bleeding are presented.

The beneficial effect of compression treatment for soft tissue swelling is undisputed. Yet it is only a subordinated option in trauma therapy and is used if at all preferably for the lower extremities. In a preliminary study we were able to show that fitted compression gloves had a positive effect.In a prospective randomised study the effect of compression treatment on the rehabilitation period was examined.In this study including 57 patients it was shown that due to a quicker reduction of swelling, measured via the circumference and volume of the forearm the range of motion increased faster than in the control group without compression treatment. Volume differed by 16 % between the injured and healthy arm in the compression group, yet by 25 % in the control group, representing a significant difference. An improvement in range of motion was seen, but did not reach statistical significance.Fitted compression gloves as a rehabilitation means after surgical treatment of distal radius fractures can lead to a quicker restoration of function and thereby decrease the treatment duration.

The most important column in the conservative lymphedema therapy still represents the complex decongestive physical therapy/KPE.This is a multimodal therapy, which consists of four components. (1) skin restoration and/or skin care, (2) manual lymphatic drainage, (3) compression therapy and (4) decongestive exercises. The KPE is also divided into two phases. Phase 1-the decongestion-serves primarily the mobilization and transporting away the banked protein-rich oedema fluid and seamless transition into the Phase 2-the maintenance phase, which serves to preserve the achieved treatment success. The implementation of the KPE should be stage-adjusted, but depends also on the location (genital, head, face), and on co-existing comorbidities (congestive heart failure, diabetes mellitus, obesity, muscular-skeletal disorders, mental illness, etc.). It should be modified for children, elderly persons and for patients with malignant lymphedema.

Despite recent medical progress primary and secondary lymphedemas still represent a therapeutic challenge and they often lead to a significant reduction in quality of life. Lymphedemas usually develop in the extremities, the male external genitals as well as the female breast as a consequence to the axial alignment of the lymphatic collectors. Early stages are characterized by an excess of lymph fluid increasing the volume of the affected part of the body whereas later stages represent an increasing amount of solid tissue. Thus therapeutic efforts can focus on the reduction of the surplus of liquid and/or solid components. Generally there are conservative and operative strategies. Conservative measures mainly focus on the improvement of fluid mobilization and drainage and comprise compression garments, manual lymphatic drainage, and apparative intermittent compression. Operative approaches comprise procedures for surgical tissue reduction (symptomatic/ablative approaches) and/or procedures with the intention of enhancing lymphatic transport (causal approaches). Surgical tissue reduction can be performed by open resection and/or liposuction. Traditional surgical causal techniques such as transposition of local flaps aim at leading lymph away from the congested region of the body. Modern microsurgical causal approaches contain methods of reconstruction of interrupted lymphatic pathways as well as techniques for the conduction of lymph into local veins. In this review we depict and discuss the features of the multiform spectrum of the surgical therapy of lymphedemas on the basis of literature as well as our own clinical and experimental experience.

Lymphedema is a chronic and progressive disease when untreated. It can be assumed that more than 5% of the population suffer from a form of lymphedema. The therapy options depend on the individual symptoms and the wishes of the patient and include conservative measures as well as surgery or a combination of both.