Gniadecka M, Karlsmark T, Bertram A
Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
J Am Acad Dermatol. 1998 Dec;39(6):966-70. doi: 10.1016/s0190-9622(98)70271-3.
Lipodermatosclerosis is a sequela of deep venous insufficiency and a risk factor for the occurrence of venous leg ulceration. Medical compression stockings facilitate leg ulcer healing and prevent occurrence of ulcers resulting from removal of edema. Although the exact level of compression necessary for removal of dermal edema in patients with deep venous insufficiency has not been established, garments providing high compressive values of 30 to 40 mm Hg have been recommended. Dermal edema can be visualized by high-frequency ultrasonography.
We used ultrasound imaging to study whether a lower level of compression (class I 18 to 26 mm Hg vs class II 26 to 36 mm Hg) is effective in removal of dermal edema. This question is important because the use of hosiery with a lower compression class would enhance compliance and enable treatment of patients with mixed arteriovenous disease.
In 11 patients skin images were obtained with 20 MHz ultrasound from the malleolar region in lipodermatosclerotic skin and corresponding normal skin of the contralateral leg. The ratio of low echogenic pixel number to total pixel number (LEP/TP), which correlates with dermal water, was measured before and after 5 days of applied compression in two treatment courses where classes of compression were switched randomly. Ankle circumference was also measured.
We found that LEP/TP was 33% higher in lipodermatosclerotic skin than in the matched normal skin indicating presence of skin edema. Application of class I and II compressive hosiery resulted in LEP/TP decrease by 17% (95% confidence interval, 0.07 to 0.26) and 14% (95% confidence interval, 0.04 to 0.21), respectively, suggestive of dermal edema reduction. No statistically significant difference in efficacy of dermal edema removal between class I and II was found. No changes in ankle circumference after application of both classes of compression was observed.
Application of light and moderate compression results in a partial edema removal from the dermis in lipodermatosclerosis in the absence of measurable reduction in leg circumference. Class I compression is as effective as class II for elimination of dermal edema. These data indicate that light compression may be a useful modality for patients with deep venous insufficiency and lipodermatosclerosis who are not eligible for treatment with garments having higher compressive forces.
脂膜炎性硬化症是下肢深静脉功能不全的后遗症，也是下肢静脉溃疡发生的危险因素。医用压力袜有助于腿部溃疡愈合，并防止因消除水肿而导致溃疡的发生。虽然尚未确定消除深静脉功能不全患者皮肤水肿所需的确切压力水平，但推荐使用提供30至40mmHg高压力值的压力袜。高频超声可观察到皮肤水肿。
我们使用超声成像研究较低压力水平（I级18至26mmHg与II级26至36mmHg）是否能有效消除皮肤水肿。这个问题很重要，因为使用较低压力级别的袜子会提高依从性，并能治疗动静脉混合疾病患者。
对11例患者，用20MHz超声从脂膜炎性硬化皮肤的踝部区域及对侧腿部相应正常皮肤获取图像。在两个随机切换压力级别的治疗疗程中，在施加压力5天前后，测量与皮肤水分相关的低回声像素数与总像素数之比（LEP/TP）。同时测量踝围。
我们发现脂膜炎性硬化皮肤的LEP/TP比匹配的正常皮肤高33%，表明存在皮肤水肿。应用I级和II级压力袜后，LEP/TP分别下降了17%（95%置信区间，0.07至0.26）和14%（95%置信区间，0.04至0.21），提示皮肤水肿减轻。I级和II级在消除皮肤水肿的疗效上未发现统计学显著差异。施加两种压力级别后，踝围均未观察到变化。
在腿部周长无明显减小的情况下，应用轻度和中度压力可使脂膜炎性硬化症患者真皮内的水肿部分消除。I级压力在消除皮肤水肿方面与II级一样有效。这些数据表明，对于深静脉功能不全和脂膜炎性硬化症且不适合使用高压力弹力袜治疗的患者，轻度压力可能是一种有用的治疗方式。
