Pressure Garments

A Manual on Their Design and Fabrication

Joanne Pratt, Gill West

• Publisher: Butterworth-Heinemann
• Year: 2014
• Print ISBN: 9780750620642
• eBook ISBN: 9781483183954
• Topic: Technology & Engineering
• Subtopic: Engineering General
• Index: Technology & Engineering

Pressure Garments: A Manual on their Design & Fabrication presents the development and principles of pressure therapy. It discusses the physical description and treatment of burns. It addresses the emotional and physical effect of scars caused by burn injury. Some of the topics covered in the book are the comparison of keloid and hypertrophic scars; management of hypertrophic scarring; methods of pressure application; complications of pressure therapy; pressure therapy treatment regimen; stages in garment design and production; glove measurements; and design considerations. The description of upper limb garments is fully covered. An in-depth account of the measurements, pattern drafting, fabric cutting, and sewing of the garment is provided. The book can provide useful information to therapists, students, and researchers.

1

Pressure therapy: history and rationale

Publisher Summary

This chapter discusses history and rationale of pressure therapy. The application of mechanical pressure is the standard treatment used to minimize the effects of hypertrophic scarring. The use of pressure derives from an early surgical principle, in which the use of bandages and splints was observed to be beneficial. Several methods of pressure application have been documented. They include the use of open-cell adhesive sponge, splints, bandaging, and elasticated garments. Elasticated or pressure garments have become the most commonly used method to manage hypertrophic scars. The amount of pressure has been found to vary in body locations when garments were made by different technicians, and between different types of fabric. Pressure garments can be applied as soon as a wound has healed. They are typically used 24 hours a day with no more than two half-hour breaks daily for hygiene purposes. This treatment regimen may be delayed where open areas on the wound site remain or when the epidermis is particularly thin and/or fragile. This is necessary as the shearing force of donning a garment can contribute to further skin breakdown, delaying the wound healing process.

A burn injury can be both a physically and emotionally traumatic experience. Children under the age of 5 years represent the group most at risk for this type of injury, largely caused by scalds. Fortunately for the majority of burned patients their wounds heal, so that eventually there is little to distinguish the site of injury from the surrounding skin. However, this is not so for all patients. A significant number of them will develop scars at the original site of injury. Wounds caused by injuries other than by burn usually develop scars which resolve in a matter of months. Burn scars can become red and raised with a lumpy appearance and because of their size are referred to as hypertrophic scars. They can remain active, i.e. red, raised and itchy, for a much longer period of time than other scars (see Plate 1). They have been observed to persist for 12 months in Caucasian adults, 24 months in Caucasian children, and occasionally for more than 48 months in Black and Oriental peoples.

The box below highlights the main problems caused by hypertrophic scars. We will consider each of them more closely.

Problems caused by hypertrophic scars

• Itchiness

• Disfigurement

• Contractures

Itchiness

The increased blood supply which causes the red appearance of the hypertrophic scar can also cause the sensation of itchiness (pruritus) which can increase to the point of discomfort for some patients.

Disfigurement

Hypertrophic scars are red and unsightly, drawing attention to an injury. If the scar site is on a very noticeable area like the face, it can be disfiguring, altering the patient’s appearance considerably. This change in appearance is often permanent, and psychological adjustment problems can follow and will need attention.

Contractures

Where a scar is large enough to cover a joint it can decrease the range of movement in that joint because scars tighten as they heal. If the scar tissue is not kept supple through massage and regular movement of the joint, then a contracture can develop.

A patient can experience any one or all of these problems. Their ability to carry out their daily activities, including those of personal care, work and leisure interests, will be compromised.

The aim of this manual is to describe in practical detail one method used to manage hypertrophic scarring, i.e. elasticated garments, hereafter referred to as pressure garments. This treatment developed following early observations that pressure, from bandages or splints for example, appeared to result in flatter scars.

In order to describe how pressure garments are designed and fabricated we have organized this manual as follows:

Manual content

• Rationale of pressure therapy

• Indications for pressure therapy

• Measurement, sewing and design advice

• Individual garment instructions

It is hoped that this information will be especially useful to those practitioners who are hoping to develop a pressure therapy service and to those who wish to develop greater understanding of the mechanics and challenges of applying pressure to human tissue.

It is anticipated that a number of terms used in the text may be new to readers. Highlight boxes will be used to define keywords, with diagrams to support the text.

This chapter continues with a consideration of skin structure, burn wound healing and a review of the methods used to manage hypertrophic scarring.

Normal skin structure

Keywords

Epidermis. The outermost or visible part of skin, which is composed of three strata or layers, the stratum basale, stratum spinosum and stratum granulosum

Dermis. That layer of skin which lies just beneath the epidermis

Collagen. A protein which occurs in 11 different forms in the body as a major constituent of connective tissue, i.e. dermis, bones, muscles, cartilage, blood vessels

Desmosomes. Microscopic connections between those cells in the stratum basale of the dermis and those immediately above them in the stratum spinosum

Squamous. The top layer of dead cells which are shed from skin during normal daily hygiene activities.

Human skin is comprised of two distinct layers, the epidermis and the dermis. It serves as the border between the body’s internal and external environments and, as such, assists in maintenance of the internal state – temperature control, electrolyte balance, etc. It also provides a first line of defence or a barrier against infection. Both the structure and the functions of skin can be seriously disrupted by burn injury.

The epidermis is outermost and has been described as a many-layered pavement of epithelial cells. The epidermis is maintained by a process in which cells bud off in the lowest layer, the stratum basale, which is the only point in the epidermis at which cell division occurs. The cells then travel upwards through the epidermis, during which they undergo a progression of differentiation. Cells first become cuboidal, linked to other cells by desmosomes in the stratum spinosum. On travelling to the upper limits of the stratum granulosum they begin to lose their nuclei and become filled with dark-staining lipid granules. Above the stratum granulosum the cells degenerate into the metabolically inactive squamous cells which humans gradually shed from the skin surface. The epidermis has no blood supply but relies on the diffusion of nutrients from the vessels present in the upper layer of the dermis.

The dermis is divided into a superficial papillary layer and a deeper reticular layer which borders the subcutaneous fat. Collagen, the structural component of the dermis, is a generic term for 11 types of molecule formed by fibrous proteins. It provides the structure in skin, bone and tendon. Collagen’s distinguishing characteristic is its ability to adhere both side to side and end to end. This allows it to form bundles. Type I collagen forms the core of these bundles while types III and V limit the size of bundles from their position on the periphery. While collagen occurs primarily in bun...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• About the authors
• Acknowledgements
• Inside Front Cover
• Chapter 1: Pressure therapy: history and rationale
• Chapter 2: Stages in garment construction
• Chapter 3: Upper limb garments
• Chapter 4: Torso garments
• Chapter 5: Lower limb garments
• Chapter 6: Head garments
• Chapter 7: Modified garments
• References and useful reading
• Appendices
• Index