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Calciphylaxis is a rare but highly disabling disease, occurring both in chronic kidney disease (CKD) with renal replacement therapy (RRT) and in normal renal function. Given the frequent coexistence of atrial fibrillation (AF) and CKD, anticoagulation is often required. Warfarin, as a promoter of vascular calcification, is frequently reported as a triggering factor of calciphylaxis. Here, we present the case of a 71-year old male patient with a history of AF and a previous ischaemic stroke, on RRT for three years and warfarin therapy. The patient presented with two painful necrotic skin ulcers over the right leg and a skin biopsy confirmed calciphylaxis. After discontinuation of warfarin, the lesions completely healed with sodium thiosulfate intravenous infusion and local wound treatment. A literature search was performed up to 1 September 2022 through PubMed. The following terms were searched in different combinations: 'calciphylaxis'; 'VKA' [vitamin K antagonist]; 'warfarin'; 'haemodialysis'; 'end-stage renal disease'; and 'ulcer'. In our opinion, in patients requiring anticoagulant therapy, the introduction or continuation of vitamin K antagonists (VKAs) should be carefully balanced when calciphylaxis develops, and other options, such as enoxaparin or apixaban, should be considered. Clinical decisions for patients requiring haemodialysis and requiring anticoagulant therapy should take into account the possible risk of warfarin-induced calciphylaxis. Further studies are needed to clarify the safety, tolerability profile and outcomes of each currently available treatment in this patient population. [ABSTRACT FROM AUTHOR]

Treatment of infected wounds remains a major challenge for clinicians. Antimicrobial stewardship is an important pillar in wound treatment and, as the role of bacteria in wound repair is not well understood, new treatment options and products are constantly being developed to tackle local infection and biofilm. This case report describes a case of antibiotic-resistant Burkholderia cepacia skin infection and subsequent leg ulceration in an 86-year-old man during the COVID pandemic in Italy, which was successfully treated in a conservative way using 1% acetic acid and silver oxysalts in conjunction with compression bandage. [ABSTRACT FROM AUTHOR]

Background: Upper Extremity Lymphedema following oncological breast surgery affects not only the patient's physique, but also the patient's psychological sphere. One of the best known PROMs-based questionnaires for investigating the condition is the LYMPH-Q. The study aimed to perform the Italian translation and cultural adaptation of the LYMPH-Q and to assess if, independently from disease evolution, arm sleeve improves QoL in these patients., Materials and Methods: Translation included 4 steps: Forward translation, Back translation, Back translation review and Patient interviews. The questionnaire was administered to 50 female patients older than 18 years of age with UEL who received a prescription for daily use of a compression sheath. A second administration took place 30 days after. Forty-four patients completed the study (Group 1: 26 patients with indication to use compression sleeve who wore it; Group 2:18 patients who despite the prescription did not want to wear it. A descriptive statistical analysis was performed with Prism 9 software., Results: T-tests showed statistical significance for changes in "Symptoms," "Function," "Appearance" and "Psychological" scales. There were no statistically significant changes for "Information scale" in Group 1 and for all scales in Group 2., Conclusion: Data from this observational study show that HR-QOL analyzed from the patients' perspective also tends to improve in terms of symptoms, function, appearance, and psychological sphere in patients with BCRL when using a compression sheath. The Lymph-Q has proven to be a valuable ally of the physician attempting to improve treatment approaches for BCRL based not only on scientific evidence but also on PROMs., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: Compression therapy by inelastic bandages is highly effective in achieving venous leg ulcer healing. Inelastic bandages may be expensive as they need to be changed and discarded at every dressing change. In addition, correct application is difficult in the clinical practice, even by expert healthcare personnel. The aim of our work was to assess whether adjustable compression wraps are more cost effective and more effective than inelastic bandage to achieve venous leg ulcer healing. Methods: Sixty-six venous leg ulcer patients were randomized to be treated by adjustable compression wrap (CircAid® JuxtaCure®) (n = 33) and inelastic bandage (Coban 2 Layer®) (n = 33). Study duration was 12 weeks. During weekly visits, the ulcers were cleansed and dressed with the same products, and the only variable was the compression device. Ulcer size, ulcer pain, patient's perception of compression systems, and compression pressure were assessed during the visits, and the material cost was evaluated at the 12th week. Results: Adjustable compression wraps were significantly cheaper than bandages (p < 0.0001) and were also more effective (not significantly) in achieving ulcer healing. To heal one ulcer patient, €228 had to be spent when applying an adjustable compression wrap and €381 if inelastic bandages were used. About 26/33 (78.8%) patients in the adjustable compression wrap group were healed after 12 weeks versus 23/33 (69.7%) in the inelastic bandage group (n.s.). Ulcer pain was reduced by both compression devices. Patient perception of compression pressure was similar with both compression devices. Compression pressure was similar at application but better maintained by adjustable compression wrap over time. Conclusions: Adjustable compression wraps are significantly cheaper and more effective (not significantly) in achieving venous leg ulcer healing. Self-applicable, adjustable compression wraps are therefore a powerful, cost-effective alternative to inelastic bandages in treating venous leg ulcer. [ABSTRACT FROM AUTHOR]

Aim: Evaluate technical performances & acceptability of a new multicomponent compression system in one bandage. Method: In this randomised, mono-center controlled trial, compression bandages were randomly applied on both legs of 2 series of 25 healthy volunteers, with either a new generation of compression system in one bandage or an established SSB (Short Stretch Bandage) plus wadding as control (series 1), or the new bandage associated with wadding or the SSB+wadding (series 2). For homogeneity, left & right legs were randomized. All systems were worn day and night during 72h. The primary endpoint was the percentage of subject with a SSI≥10mmHg after 48h. Secondary endpoints included SSI sustainability, slippage (cm), subject comfort and preference. Working and resting interfaces pressures were measured, and SSI were calculated, immediately after application at 4h, 24h, 48h and 72h. Results / Discussion: After 48 hours, the new system (with or without wadding) showed a superior percentage of subjects with an SSI≥10 mmHg compared to the SSB+wadding (p=0.004). (Series 1: 60% vs 20%, p=0.002 and series 2: 80% vs 40% p=0.002). Results are similar after 72 hours (Series 1: 60% vs 16% and series 2: 76% vs 16%). The new system presented good holding properties, was well tolerated, was perceived as significantly more comfortable and was preferred to the control system by most of the volunteers. Conclusion: The new compression system achieved better stiffness performance & acceptability than the SSB, a potential asset for compliance. These promising results need to be confirmed with Venous Leg Ulcer patients. [ABSTRACT FROM AUTHOR]

Aim: Compression bandaging is recommended for venous disease and ulceration. Compliance rates are typically low, and the clinical results inconsistent. An ideal bandage provides the right therapeutic pressure in a consistent manner, stays on, feels comfortable, does not stick to clothing/linen and offers high exudate absorbency. An engineered system that combines both short and long stretch bandages, or the Dual Compression System (DCS) was tested for these factors that predict clinical success, against a traditional 4-layer bandage (4LB). Method: During the study, all patients indicated for compression at a busy wound center were treated with either the DCS system, or a 4 LB randomly. Patients were surveyed on wear comfort and stickiness to clothing/linen. Providers were asked whether the bandages stayed on and if they were easy to apply. All surveys had three choices, better, worse and same/neutral. Results / Discussion: 53 patient participants in the study had a total of 62 leg ulcers. Of these, 31 legs were wrapped with DCS and 31 with a 4LB. 13 of the 4LB (42%) and 27 of DCS (87%) were found to achieve the therapeutic pressure of 40+/-5 mm. Among 43 surveys completed, 30 stated that DCS was more comfortable than the 4LB (5 less comfortable 8 neutral). Stickiness: DCS better (34), Worse (1), Same (8). Nurses in all cases (100%) felt that the 2-layer system stayed on better. Exudate absorption, based on the use of dressings, was rated better for DCS (25), 17 (same), 1 (worse). Conclusion: Based on our findings in this study we predict that DCS will have higher patient compliance rates and thus better clinical success. [ABSTRACT FROM AUTHOR]

Aim: Despite Compression therapy representing the cornerstone of venous leg ulcer (VLU) treatment, a lack of patient's concordance is often observed due to some factors such as thickness of the system, heat sensation, itchiness, etc. induced by compression systems. In vitro tests on two compression systems, i.e. a Multi (2) layered bandage consisting of a short-stretch bandage and a long-stretch bandage, Dual Compression System or DCS versus a 100% short-stretch two-layer bandage system (2LB )were performed to compare them on some criteria which may impact concordance of patients or the acceptability of the caregivers. Method: Thickness of the compression system (mm), breathability (measurement of the air flow passing through the system), stickiness to sheets (evaluation of the friction of both systems on sheets) and absorption level of the first bandage of each system (measured by weighing after immersion in a saline solution (NF-EN13726-1) were assessed through 5-10 repeated measurement undertaken on 3 different batches and healthy volunteers. Results / Discussion: Results show that the DCS system was found to be thinner (3.2mm vs 5.1mm), and more breathable than the short-stretch multi-layer system, 2LB, (709 vs 390 L/m2/s). The DCS did not stick to the sheets compared to the short-stretch multilayer system. The first bandage of the multicomponent system scored higher when absorbing fluids (2536 vs 855 g/m2) Conclusion: The DCS system, containing both short and long stretch bandages, has higher in-vitro scores on important criteria vis-a-vis a pure short-stretch 2-layer bandage (2LB). These may positively impact on quality of life in favor of DCS of patients presenting with a VLU, thus leading to better concordance to this compression system. [ABSTRACT FROM AUTHOR]

Aim: Compression bandaging is variable on technique, operator experience, overlap, applied tension and bandage properties. We assessed the average nurse's ability to reach 40mmHg target with two bandages. One, a Traditional Two Layer Bandage (TLB), the second, a Dual Compression System/DCS incorporating a pressure guide and long+short stretch components. Method: Skilled nurses bandaged calves of six healthy volunteers five times. Training on bandaging, (COVID 19 time), was remote. Interim analysis showed one nurse, proficient in TLB was not applying DCS correctly. She was then trained in person. Pressure measured at 10 cm above the medial malleolus. Consistency/proximity to target pressure were compared between nurses, subjects, position. ANOVA was used at p< 0.05. Results / Discussion: DCS/TLB values were 40±2 and 36±2 mmHg for resting/standing positions combined. DCS values were close to target pressure (p=0.89). TBL was significantly different from target (p< 0.05). DCS achieved 38% of values in the ranges of 40±5 mm, and TBL achieved 30%, a lower rate of accuracy. Conclusion: Successful 40 mm achievement is operator dependent and training dependent, even if visual aids on the bandage may be present. Training in person is more effective. One of the nurses had extensive experience using TLB* and achieved higher than optimal values with DCS*, but reached compliance within person training. Nurses naïve to either system did better with DCS*. Taken together, the results show that the pressure guide for the DCS* does allow a more accurate application of target pressure than a system without such visual indicators. But for clinicians who are too familiar with one product may still require more intense training. This finding is counterintuitive. [ABSTRACT FROM AUTHOR]

Aim: Despite compression therapy being the gold standard care for venous leg ulcers (VLUs), patient compliance with four-layer compression bandage (4LB) is poor. The Dual Compression System bandage (DCS) is a 2 Layer Bandage (2LB) and improves wound closure rate. The objective this study was to estimate the cost-effectiveness (CEA) the 2LB compared to 4LB to heal one additional VLU. 2LB is more expensive due to its use of advanced materials. Method: We conducted a patient-level microsimulation model to do cost-effectiveness analysis from the US perspective. All clinical data was obtained from a prospective clinical trial. Cost data were obtained from structured literature review and pragmatic metaanalysis adjusted to 2021 USD using the Consumer Price Index. The effect measure was the avoidance of one VLU. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses (PSA) were performed to gauge the robustness/reliability of the results. Results / Discussion: The incremental cost-effectiveness ratio was $1,168 per VLU healed. One would expect to pay $1,168 more with the 2LB system to heal one additional wound versus the 4LB system. For every 100 patients, the additional cost of a 2LB system was expected to be $6,255 but 5 additional wounds would be healed compared to a 4LB. Accounting for the savings from these additional wounds healed, we project savings of $16,580 per 100 patients treated. Conclusion: The 2LB system was a cost-effective strategy for the treatment of VLUs compared to a 4LB system. Further, the 2LB system has been shown to increase patient satisfaction. Adoption of the 2LB should be considered a value-added adjunct to the management of VLUs. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to explore, using visual art methodology, how children and adolescents perceive their lymphedema and conceptualize the barriers and enablers in self-management and to explore the role of an educational camp in promoting self-efficacy. Methods: Participants (speaking English, French, and Italian) were recruited during an educational camp for children with lymphedema. Children and adolescents used different methodologies to depict living and self-managing their condition. Younger children (aged 5-12 years) drew pictures, and all children and adolescents (aged 5-18 years) were given cameras and asked to take photographs that depicted their experience of learning self-management of their condition during the camp. Rose's critical visual methodology framework was used for analysis. Results: Analysis of the data produced five categories: Normal versus altered childhood, living with lymphedema; perceptions of lymphedema and self-care in younger children; adolescents' perception of living and managing lymphedema; learning self-efficacy; and insights into cultural differences in self-care. Conclusions: The study has shown that self-management is complex. Children and adolescents face many daily challenges and frustrations in managing their condition in addition to the normal challenges of development and growth that impact on: home life, time with friends, school activities, and relationships. Children expressed a deep longing for cure and a recognition that their lives were altered by having the condition that led to limitations in sport and wearing fashionable clothes and shoes. The importance of relationships with professionals was critical as was the experience of meeting and learning with other children through the camp experience. Attempts to simplify self-management techniques would appear to be a key priority as would a greater understanding of the self-beliefs young people have of their ability to influence and control their condition and its impact on their life.

Background: The aim of this study was to explore the professional experience of caring for children and adolescents with lymphedema and to explore the way in which they understand and implement self-management strategies and the influence of their own self-efficacy beliefs on this process. Methods and Results: Participants were recruited during an educational camp for children with lymphedema. Three individual semistructured focus groups were undertaken in English, French, and Italian with simultaneous translation. Data were analyzed using interpretative phenomenological analysis (IPA). Analysis of the data produced three superordinate themes: professional concepts of self-management, professional practice, and redefining the cornerstone of lymphedema care. An additional seven subthemes were as follows: readiness to self-management, professional perspectives on self-management, defining success and treatment failure, emotional burden, traditional views on complex decongestive therapy, new ways to practice, and sole practitioner versus multidisciplinary teams. Conclusions: The purpose of the study was to explore the challenges professionals face when introducing self-management to children and adolescents with lymphedema and their parents and to explore their own sense of self-efficacy in approaching this. The research allowed in-depth discussion about the ways they conceptualize self-management and faced professional challenges. The research highlighted the need to define what is considered an acceptable outcome within a complex and uncertain condition and the self-management strategies that are needed to support this.

Background: Limited research has shown the impact lymphedema has on children and families. The aim of this study was to explore the parental experience of caring for a child or adolescent with lymphedema and the daily challenges of self-management and self-efficacy. Methods and Results: Participants were recruited during an educational camp for children with lymphedema ( N  = 26). Three individual semistructured focus groups were undertaken in English, French, and Italian with simultaneous translation. Data were analyzed using interpretative phenomenological analysis. Analysis identified four superordinate themes; the journey, treatment management, independence, and psychosocial impact. Ten subthemes were identified: bandaging/compression, professional support, holistic care, fear, self-efficacy, acceptance, friendship, guilt, distress, and hope. Conclusions: Parental self-management of children with lymphedema is complex and invades many aspects of life. Lack of professional agreement over what constitutes self-management leads to parental confusion and anxiety. Self-management is demanding, and parents are ambivalent to its effectiveness, but choose to persevere through fear of their child's condition deteriorating. Self-efficacy is evident in complex problem solving, despite parents believing that they are not adequately prepared for this.

Objective/background: The objective of this study was to compare the efficacy and comfort of inelastic bandages (IBs) and adjustable Velcro compression devices (AVCDs) in reducing venous leg edema in the initial treatment phase., Methods: Forty legs from 36 patients with untreated venous edema (C3EpsAsdPr) were randomized to two groups. Patients in the first group received IBs (n = 20) and those in the second AVCDs (n = 20). Both compression devices were left on the leg day and night, and were renewed after 1 day. Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose. Leg volume was calculated using the truncated cone formula at baseline (T0), after 1 day (T1) and after 7 days (T7). The interface pressure of the two compression devices was measured by an air filled probe, and the static stiffness index calculated after applying compression at T0 and T1, and just before removal of compression on T1 and T7. Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale., Results: At T1, the median percent volume reduction was 13% for the IB group versus 19% for the AVCD group; at T7 it was 19% versus 26%, respectively (p < .001). The pressure of the IBs was significantly higher compared with the AVCDs at T0 (63 vs. 43 mmHg) but dropped by > 50% over time, while it remained unchanged with AVCDs owing to the periodic readjustment by the patient. Comfort was reported to be similar with the two compression devices., Conclusion: Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema., (Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Graduated compression is routinely employed as standard therapy for chronic venous insufficiency., Aim: The study aims to compare the haemodynamic efficiency of a multi-component graduated compression bandage (GCB) versus a negative graduated compression bandage (NGCB) applied with higher pressure over the calf., Methods: In 20 patients, all affected by greater saphenous vein (GSV) incompetence and candidates for surgery (Clinical, etiologic, anatomic and pathophysiologic data, CEAP C2-C5), the ejection fraction of the venous calf pump was measured using a plethysmographic method during a standardised walking test without compression, with GCB and NGCB, all composed of the same short-stretch material. Sub-bandage pressures were measured simultaneously over the distal leg and over the calf., Results: NGCBs with median pressures higher at the calf (62 mmHg) than at the distal leg (50 mmHg) achieved a significantly higher increase of ejection fraction (median +157%) compared with GCB, (+115%) with a distal pressure of 54 mmHg and a calf pressure of 28 mmHg (P < 0.001)., Conclusions: Patients with severe venous incompetence have a greater haemodynamic benefit from NGCB, especially during standing and walking, than from GCB., (Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)