OBJECTIVE: To compare the proportion and rate of healing, pain, and quality of life of low-strength medical compression stockings (MCS) with traditional bandages applied for the treatment of recalcitrant venous leg ulcers. METHODS: A single-center, randomized, open-label study was performed with consecutive patients. Sigvaris prototype MCS providing 15 mm Hg-25 mm Hg at the ankle were compared with multi-layer short-stretch bandages. In both groups, pads were placed above incompetent perforating veins in the ulcer area. The initial static pressure between the dressing-covered ulcer and the pad was 29 mm Hg and 49 mm Hg with MCS and bandages, respectively. Dynamic pressure measurements showed no difference. Compression was maintained day and night and changed every week. The primary endpoint was healing within 90 days. Secondary endpoints were healing within 180 days, time to healing, pain (weekly Likert scales), and monthly quality of life (Chronic Venous Insufficiency Quality of Life [CIVIQ] questionnaire). RESULTS: Of 74 patients screened, 60 fulfilled the selection criteria and 55 completed the study; 28 in the MCS and 27 in the bandage group. Ulcers were recurrent (48%), long lasting (mean, 27 months), and large (mean, 13 cm(2)). All but one patient had deep venous reflux and/or incompetent perforating veins in addition to trunk varices. Characteristics of patients and ulcers were evenly distributed (exception: more edema in the MCS group; P =.019). Healing within 90 days was observed in 36% with MCS and in 48% with bandages (P =.350). Healing within 180 days was documented in 50% with MCS and in 67% with bandages (P =.210). Time to healing was identical. Pain scored 44 and 46 initially (on a scale in which 100 referred to maximum and 0 to no pain) and decreased within the first week to 20 and 28 in the MCS and bandage groups, respectively (P <.001 vs .010). Quality of life showed no difference between the treatment groups. In both groups, pain at 90 days had decreased by half, independent of completion of healing. Physical, social, and psychic impairment improved significantly in patients with healed ulcers only. CONCLUSION: Our study illustrates the difficulty of bringing large and long-standing venous ulcers to heal. The effect of compression with MCS was not different from that of compression with bandages. Both treatments alleviated pain promptly. Quality of life was improved only in patients whose ulcers had healed.

OBJECTIVES: Occasional leg symptoms, like feelings of heaviness and tension, and occupational or evening oedema are considered typical features of a venous disorder but show low specificity in epidemiological and observational studies. We evaluated the prevalence and nature of such symptoms in subjects with no history or signs of venous disease and investigated the optimal strength that medical compression stockings (MCS) should exert in order to alleviate the symptoms and to prevent leg swelling. METHODS: Specifically designed questionnaires were used to assess the symptoms of 40 healthy employees of a factory producing MCS. Lower leg volumes were quantified in the morning and evening. Calf size hosiery providing documented ankle pressures of 4-9 (mean 7.3), 12-18 (mean 14.9) and 18-22 (mean 19.5) mmHg, respectively, were tested in a prospective, open-label, randomized trial lasting three weeks. Endpoints were the relief of symptoms, prevention of vesperal oedema and comfort in wearing the stockings. RESULTS: Sixty-five percent of the participants reported at least occasional leg symptoms and oedema. Somatic-type symptoms (i.e. pain, heaviness, swelling, unattractive legs) were present in two, psychic-type symptoms (i.e. leg- and personality-related unrest and stress) in 17 and both components in seven of the 40 subjects. MCS exerting 15 and 20 mmHg prevented the symptoms and oedema. Stockings providing <10 mmHg were ineffective and those providing >19 mmHg were not well-tolerated. The effect on the somatic-type symptoms was strongly correlated with the amount of lower leg volume which could be reduced by wearing stockings (P = 0.005). No correlation was found between the efficacy of compression and the emotional component of the symptoms. CONCLUSION: The cause of occasional pain in the legs of apparently healthy people is unknown. Some features of the syndrome reflect an emotional disorder while others mirror venous insufficiency. MCS of 15 mmHg effectively relieve the symptoms resembling venous insufficiency, prevent oedema and are well-tolerated.

This paper discussed the random growth model of the capillaries in its growing process, analyzed the relations between the growth of the capillaries, the metabolism of the organism tissue, and micro environmental condition and secretion of the growth factors. Furthermore, the paper discussed the growth law of the capillaries in the porous silk fibroin films (PSFF) in order to provide a theoretical basis for the designing and making of the new biomaterial of the PSFF more suitable for the growth of the cells and capillaries.

Stocking supports have represented, for more than two millennia, the most efficient way to treat the veinous diseases and lymphatic disorders. Although this treatment consists solely in the application of a mechanical pressure to help the blood in reaching back the heart, very little is known on this mechanical effort exerted on a human limb by knitted fabrics. However, nowadays the precise assessment of this pressure distribution is crucial in fitting the treatment to the patient pathology and morphology. In order to describe rationally, for the first time, the pressure distribution induced on a leg, a combined experiment-simulation 2D methodology has been set to validate this mechanical approach. The present article is the first part of a two-papers communication. Experimental aspects are presented here, first to measure these stocking pressures on a rigid leg using the SIGaT((R)) device based on a pneumatic sensor. Then, the knitted fabric mechanical response is characterized under uniaxial tension for large strains, to evaluate the simplified Laplace-based pressure that can be compared with the pressure measurements, knowing the local curvature radii of a leg section. This experimental approach is to be completed with numerical simulations of the stocking mechanism on the same model leg.

Background. Evening edema of the legs is a physiologic phenomenon occurring after sitting and standing. Objective. The objective of this study was to investigate which compression pressure is necessary to prevent leg swelling. Methods. In 12 volunteers, the volume of both lower legs was measured in the morning and 7 h later, the difference being defined as evening edema (mL). The procedure was carried out for 4 days, in which the subjects wore below-knee stockings of different compression levels alternatively on one leg only in a random order. Compression pressure was assessed using the HATRA device. Results. The average evening edema of the noncompressed legs was 62.4 mL on the left side and 94.4 mL on the right side (n.s.). Evening edema was significantly reduced to 40.3 mL by light support stockings, to -34.1 mL by compression class A, to -39.6 by compression class I, and to -59.1 mL by compression class II. Mainly stockings exerting a pressure above 10 mmHg improved subjective symptoms. Conclusion. Calf-length compression stockings with a pressure range between 11 and 21 mmHg are able to reduce or totally prevent evening edema and may therefore be recommended for people with a profession connected with long periods of sitting or standing. HUGO PARTSCH, MD, JOHANN WINIGER, AND BERTRAND LUN HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.

The aim of these studies was to evaluate the biomechanical characteristics of two devices and provide information for clinical choice. In vitro cadaveric spine testing which consisted of the stability test and the yield strength test was performed. In hemicorpectomy model, the AF was stiffer than the Kaneda in flexion, extension and left lateral bending (P < 0.01). In total corpectomy model, the AF was stiffer than the Kaneda in flexion, left lateral bending and axial rotation (P < 0.01). The average values of yield strength(M) for the Kaneda, the AF and the intact were 477.3 kg, 544.4 kg and 493.6 kg resectively. The stability of the AF is superior to that of the Kaneda. In total corpectomy, the Kaneda is significantly unstable in axial rotation. Both devices restore effectively load carrying capacity of the spine.