Quantifying graduation of layered below-the-knee compression garment combinations using a model-based assessment.

Objective: Often people with lymphedema and vascular conditions will be prescribed layered compression garments to assist them in donning their garments and improve treatment compliance. However, little evidence of the interface pressures produced by these layered garments is available. In the present study, we explored the pressures produced by layering high and low class below-the-knee compression garment combinations and quantified the graduation of these combinations to understand the effect that layer order might have on the interface pressure.
Methods: The present study used a mechanical test design to measure the interface pressure at four sites (B, smallest ankle dimension; B1, circumference at Achilles tendon and gastrocnemius muscle junction; C, widest calf dimension; and D, below the knee) for 30 combinations of low and high class compression garments using a PicoPress (Microlab Elettronica, Ponte San Nicolò, Italy).
Results: The results demonstrated a pattern consistent with graduation for sites B1 to D for 100% of the garment combinations. However, the graduation was reversed for sites B to B1 for 100% of the garment combinations, possibly due to limitations regarding the shape of the model limb. The results indicated no significant differences in the interface pressure when the higher class garment was applied as the bottom layer vs the top layer. A strong correlation (R > 0.95; P < .001) was between the actual pressures produced by the combinations of the garments and the expected pressure determined by summing the pressures of the individual garments.
Conclusions: Graduation was observed from site B1 to site D, indicating that double layering of these garment combinations maintained guideline adherence. Layering the garments produced pressures that were, in general, cumulative of the pressure from each garment alone, with some variance. Because of the uncertainty of the B site results in the present study, the clinical implications in relation to the primary aim are limited. The findings from the secondary aim suggest that clinically, garment wearers can don their layered garments in any order and achieve the same interface pressure results.
(Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)