Five Bedside Signs Suggesting Textile Compression Delivers Effective Wound Tissue Micro Deformation, Enhancing Local Protein Synthesis and Increasing Perfusion During Venous Leg Ulcer Therapy

Introduction: We’ve reported dramatic outcomes using an inexpensive warp knitted compression stockinet* to control edema since 2009 (Sibbald) (Ehmann 2020). Anecdotal bedside diagnostic findings that suggest fuzzy wale stockinet compression 1.) increases arterial perfusion of skin and subcutaneous fat, and 2.) delivers physiologically effective micro deformation to wound granulation tissue.Cell membrane mechano transduction signals arise in tissue experiencing micro deformation and upregulate local gene expression, increasing protein synthesis required to heal (Orgill) (Saxena). Healing outcomes with fuzzy wale stockinet appear similar to what is seen with open cell foam Negative Pressure Wound Therapy, NPWT. Ehmann has coined the term Positive Pressure Wound Therapy, PPWT** when fuzzy wale stockinet is intimate with wound surface tissue. (Ehmann 2022)Methods:Photos document anecdotal findings at bedside that suggest enhanced perfusion and dramatic wound bed progress. (Schultz 2003) (Ostler 2019)Results:Wound photos document anecdotal rapid:1) Resolution of epiboly2) Clearing peri-wound stasis dermatitis in refractory VLUs (Ostler 2019)3) Neo epithelialization4) Healing without scar5) Healing full thickness ankle wound with no pedal Doppler signals. (Winkler 2023)Discussion: Fuzzy wale compression stockinet creates furrows in granulation tissue and appears to be considerably more effective than flat compression textiles to speed wound bed preparation. Temple of Asclepius priest healers, c. 350 BCE, swaddled limbs with rough-spun linen which created furrows in subcutaneous fat with effective tissue micro deformation such as we are reporting. Wound granulation compression research holds promise for VLU treatment.*References:Ehmann et al. Experimental Simulation Study to Assess Pressure Distribution of Different Compression Applications Applied Over an Innovative Primary Wound Dressing; Wounds, August 2020. Ehmann S. Augmented Compression Applications Provide Positive Pressure Wound Therapy (PPWT) Science Poster, Spring SAWC April 7, 2022, link accessed 27 Dec 2023 Orgill, D. The Mechanism of Action of the Vacuum-Assisted Closure Device, Plastic and Reconstructive Surgery: September 2008, Volume 122, 786-797. Ostler M. Compression is Key: Silver, Elastic Compression Stockinet, and Hyper-absorbent Felt in Direct Contact with VLU Granulation Tissue Reverses Comorbid Inflammation, Pain and Exudate that Delays Effective Compression Therapy, 2019 SAWC poster. Link accessed 23 Dec 2023. Saxena, V. et al. Vacuum-Assisted Closure: Micro deformations of Wounds and Cell Proliferation, Plastic and Reconstructive Surgery. October 2004, Volume 114, Issue 5, 1086-1096. Schultz G. Wound Bed Preparation: a systematic approach to wound management, Wound Repair and Regeneration. 2003, 11:1-28 Sibbald, R et al. Evaluation of Longitudinal and Tubular Compression Treatment for Lower Limb Edema. Advances in Skin & Wound Care, 33 (12)643-6490. December 2020. Winkler M. Does Three-Dimensional Elastic Compression Therapy Deliver Positive Pressure Wound Therapy: Bedside Observations of Refractory Wound Responses to Compression with a Third Dimension - a Non-Flat Surface. Link accessed 12 27 23 https://compressiondynamics.com/wp-content/uploads/2023/02/PosterThree-Dimensional- Elastic-Compression-Therapy-Positive-Pressure-Wound-Therapy.pdf