Evaluating standardized pressure for garments used in scar management : pressure for burns scar therapy

Abstract

Pressure garments are used to treat scars after major trauma such as burns to suppress the over development of scars. Pressure garments can alleviate the patients discomfort caused by the appearance of the developing scar tissue as well as pain and itching that can be experienced. Some hospitals have in house teams making bespoke pressure garments for patients. The current method used in UK hospitals applies a reduction factor of between 10 and 20% to produce garments. There is little evidence of the pressure delivered by in-house or any pressure garments as pressure sensor equipment is often not available, time consuming and difficult to use and therefore pressure is not measured in clinics at garment fitting. An audit of pressures delivered by 8 previously made pressure garments was conducted. The fabric that had been used to make those garments was tested and a Pressure Garment Design (PGD) Tool was made based on the equations generated from this test data. The historical patient and garment dimensions were entered to the PGD tool. The audit showed that the reduction factor of 20% had exerted between 15mmHg and 54mmHg on these patient’s limbs. A pilot study was then undertaken to compare the standard 20% reduction factor method to the ‘Laplace Law’ method of calculating pressure garment dimensions using a PGD tool. 4 participants were enrolled in the study. Three garments were produced for each participant to trial, one using the reduction method currently used and two that were designed to exert known pressures of 15mmHg and 25mmHg. The garments were worn and washed in rotation for approximately 8 weeks. As is standard practise in clinic, all garments were assessed by the therapist to ensure they were suitable for use by the Participant and the scars assessed for maturation. Prior to issuing the garments and during the study the pressure delivered by the garments was measured using a PICOPRESS pressure monitor. The manual method of calculating garment dimensions using a calculator is time consuming and less accurate than The Pressure Garment Design tool, which proved easy to use, and versatile for the quick adjustment of measurement and pressure values for producing finished garment dimensions. The measuring process and resulting data highlighted problems with measuring pressure on such small limbs. The pressure delivered using all garments varied on the individual due to variations in soft tissue and bony areas and an ability to only measure pressure on flatter body parts of the smallest limbs, which indicates that pressure readings taken on the individual may not be a true indication of the average pressure delivered. The data collected from the Pressure Garment design tool, predicted pressures and the pressure readings on the cylinder, confirmed that the Pressure Garment Design Tool can be used to produce garments capable of delivering a known pressure, and that the reduction factor method delivers a varied pressure in an individual garment on different limb circumferences ranging from 52mmHg on a 17.2cm circumference to 15mmHg on a 37.2cm circumference.