what is compression good for?
- post amputation and venous insufficiency where there is lots of edema
- burn
- to improve circulation within the limb
Effects of External Compression
- improves venous and lymphatic circulation
- limit the shape and size of tissue
- increase tissue temperature
why does external compression need to improve venous and lymphatic circulation?
- increased extravascular pressure can limit fluid outflow from vessels into the interstitial space where fluid can pool
milking
- more compression distally to push it up, then move compression up
- may have multiple chambers to push fluid up
how do external compression devices limit the shape and size of tissue
- compression devices (usually garments or bandages) act as a second skin, shaping and conforming the tissue to the shape of the garment and bandage
- trying to limit and shape the tissue for something specific
how does external compression increase tissue temperature
- compression devices insulate the area leading to an increase in superficial tissue temperate
- increase tissue temp to increase enzymatic activity
why should enzyme activity be increased?
- enzymes are typically breaking down tissue so compression is very good for hypertrophic scarring or when you are trying to control scarring
clinical indications of external compression
- edema
- lymphedema
- prevention of deep venous thrombosis
- prevention of venous stasis ulcers
- residual limb shaping
- control hypertrophic scarring
what is edema
- abnormal amounts of fluid in the extracellular tissue spaces of the body
what does edema occur as a result from
- edema may occurs as the result of imbalance between hydrostatic and osmotic vascular and extravascular pressure
what is the most effective factor for edema?
compression
does fluid rush outside when hydrostatic or osmotic pressure is higher?
hydrostatic
what is hydrostatic pressure?
moving forces against gravity
what is osmotic pressure
concentration of the proteins that are in and outside of the vessels
what is lymphedema
Obstruction, abnormal distribution of nodes and vessels, and decreased
muscular activity can contribute to decreased lymphatic flow
what is primary lymphedema due to
congenital deformation of the system
what is secondary lymphedema caused by?
trauma, infection, surgery, radiation damage and cancer
how does external compression prevent DVT
promotes circulation
how does external compression prevent venous stasis ulcers
promotes cirulation
how does external compression help residual limb shaping
prevents stretching of tissue caused by excessive fluid accumulation
how does external compression help control hypertrophic scarring
- decreased scar height and increased pliability after the use of compression
- Applied after new epithelium has formed, and continued for 8-12 months
contraindications of external compression
- heart failure and PE
- DVT or thrombophlebitis
- lymphatic or venous obstruction
- severe PAD
- local skin infection
- hypoproteinemia (< 2g/dl)
- acute trauma or fracture (until its been fixed and starts to heal)
why is heart failure and PE a contraindication for compression?
shift of fluids from peripheral to central circulation may increase stress on a failing organ system
specific contraindications for lymphedema
- After bilateral mastectomy
- When another area of the body is already involved (i.e. adjacent chest wall
- After pelvic operations when the proximal portions of the LEs have started to swell
- Primary lymphedema
- Genital lymphedema
- Significant fibrosis in the area
