Compression therapy with Compreflex Wraps of Sigvaris

Susan Butcher is a lymphoedema therapist, she’s been working in the healthcare industry for over 18 years. She’s in the treatment and management of patients with edema associated with lymphedema, lipedema, and vascular disorders. 

Susan has started an institute called the edema institute; this will be for the treatment, management, and education of patients and health professionals. It has a role of supporting the role of surgeons and the GP will play and the outcomes should be all about the patient’s best. 

Susan started talking about persistent edema that's just not settling; if it does not settle down in the evening when the patient goes to bed or when they get up in the morning. If that edema is still present, then there is probably a signal or a sign saying that something more is going on, which could be a vascular issue. Hence, the venous system is just not working correctly. 

She shared the story and medical history of a patient in her mid-70s who came to her; in 2007. The patient had three leaky heart valves; the surgeons are not concerned at this stage; they are just monitoring the valves in the heart. She was on heart medication for that. 

In 2017, she had her gallbladder removed, and in 2018, her right knee was replaced.  

So, when Susan spoke with her before the demonstration, she felt most of the problems she had started mainly in 2016. 

• She had a burning sensation in the lower part of her leg.  
• She was starting to lose a little bit of her mobility. 
• On visiting her GP, he suspected she had a cellulitis infection and was treated with antibiotics that did not improve the cellulitis settled down. However, she still had the pain and the heaviness in the legs.  
• She was referred off then to a specialist who then did scans and found that she had two small veins in the lower leg, one in each leg.  
• Laser treatment was still done very shortly. Afterward, she was then, after her laser surgery, fitted with medical compression below knee stockings of 30 to 40 millimeters of mercury.  
• With that point, she then was not fitted again to with stockings until later in 2008. 

Recommendations usually suggest that stockings medical compression stockings are fitted every six months. In the past, patients that have fitted into the Compreflex wrap have seen relatively rapid results quite quickly.  

With some patients who have gone into a below knee before the knee and the thigh, they got a reduction while putting the garments. And within half an hour, they can see that they need to tighten up a below knee wrap. So, that’s how quickly they can get results with these garments, but most patients would see an outcome within 24 to 48 hours as long as they’re compliant and they are wearing the garments. 

Traditionally, they found the lymphedema therapist used short stretch bandaging, it is costly as they have to replace the bandage and obviously, they are looking at a reduction. So, when they put the bandaging on the limb is reducing and they got slippage with bandage so, it wasn’t a cost-effective was of producing this.  

So, when Compreflex reduce wrap came out, it just ticked all the boxes in the sense that it’s doing everything the same as what bandaging would do but just more ease for people to be able to use and cost affordable as well. It also gives the patient flexibility, a sense of control over their own condition, they become more active and the appearance wise without wearing the bulky bandaging that comes with the heat that comes with it. 

She shared a video started by measuring the patient (her name is Margaret) up for Compreflex reduce, they put her into a boot, a calf, a knee, and a thigh piece. 

1. Placing the tape measure underneath the feet coming across the head of the metatarsus. 
2. Then taking the tape measure at skin tension. 
3. Measure the eye measurement you make sure the patient's foot stays firmly planted on the ground sliding tape slightly underneath and coming up and straight through. 
4. For the length of the foot: 
   • A handy tip is to have a pen at the base of the heel placing your tape measure zero at the base of the heel and take the measurement to the head of the metatarsus. 
5. Start measuring for the calf piece:  
   • First of all, we need to find the malleolus and you're working on the lateral side here and you put a mark.  
   • You then need to come up the leg and find where the head fibula is. 
   • Those are both your zero points from there.  
   • You then measure up five centimeters and then your next measuring point is at 25 centimeters. 
   • We're then going to take the circumference of both of those points and again you're doing this just at skin tension. 
   • We have our two zero points we put the zero of the tape measure at the malleolus and the top of the tape measure at the head of the fibula and that gives you your g point which is your length.  
6. For the knee piece:  
   • You are taking the fibular head point you made when you did the calf piece and coming down five centimeters; this is always on the lateral outside that we measure.  
   • For the knee, we found the patella point; we put a mark a zero, and we have come up five centimeters and put a mark. 
   • Then, we need to do the circumferences at those points again skin tension 
7. We are going to find the measuring points for the Compreflex thigh: 
   • Finding the top of the patella we place a mark. Our next point is at the gluteal fold, and sometimes on larger patients. This can be a little tricky by putting a tape through the groin and coming around that will allow you to mark in the correct position. 

One of the significant advantages, especially with the reduced wrap, is accommodating all the different sizes where a medical compression stocking would not be as successful. 

Presenting their reduced components to the pack in the video, they have a calf piece, two sets of liners, the spine for the calving piece, extra Velcro tabs, pegs, a marking pen, and tension tabs. 

1. They will use the components to undo the reduced calf wrap and pop this onto Margaret's leg to start the production of cutting it down to size. 
2. Placing the wrap around the patient's leg getting pegs, pegging the garment into place. 
3. Then with the marking pen, start to mark the shape that is wanted the garment cut into it's easier to come back a second time and cut more than it is the first time. 
4. Then they get the garment back up on the table and join the dots and place one piece of fabric onto the other and make it into the shape of the calf then get our scissors and cut the fabric. 
5. Then take the spine and unzip it and place the spine onto the outer edge of the garment. 
6. Always starting with the bottom of the zip at the base then flip the garment over and place the other spine, by turning it over and do the zipper up and for the top piece either use one of your small Velcro tabs or use your larger piece and just put it on to where it needs to be at the top then cutting it accordingly. With this one, they use a smaller one to start with. 
7. They have the garment cut to size putting the liner onto the patient's leg place the wrap over the liner. 
8. Starting at the bottom and wind the tabs around to the relaxed position, they are not putting any tension on the tabs at all. 
9. Then they will place the tension tabs as they have the straps in the relaxed position; at the end of every strap, they will place a tension tab; these are color-coded.  
10. This strap is suitable for patients because the therapist can tell the patient where to pull the tabs. 
11. They start pulling the tension pulling the straps to our tension points. 
12. And then repeat the same process for the foot, thigh, and knee.