EP1278497A1 - Tubular compression orthosis for immobilising a lower limb after a venous surgical procedure - Google Patents

Tubular compression orthosis for immobilising a lower limb after a venous surgical procedure

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Publication number
EP1278497A1
EP1278497A1 EP01963059A EP01963059A EP1278497A1 EP 1278497 A1 EP1278497 A1 EP 1278497A1 EP 01963059 A EP01963059 A EP 01963059A EP 01963059 A EP01963059 A EP 01963059A EP 1278497 A1 EP1278497 A1 EP 1278497A1
Authority
EP
European Patent Office
Prior art keywords
orthosis
lower limb
tubular part
mesh
fabric
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP01963059A
Other languages
German (de)
French (fr)
Inventor
Christian Gardon-Mollard
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Innothera Topic International SA
Original Assignee
Innothera Topic International SA
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Innothera Topic International SA filed Critical Innothera Topic International SA
Publication of EP1278497A1 publication Critical patent/EP1278497A1/en
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F13/00—Bandages or dressings; Absorbent pads
    • A61F13/06—Bandages or dressings; Absorbent pads specially adapted for feet or legs; Corn-pads; Corn-rings
    • A61F13/08—Elastic stockings; for contracting aneurisms
    • A61F13/085—Openable readjustable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F13/00—Bandages or dressings; Absorbent pads
    • A61F13/01—Non-adhesive bandages or dressings
    • A61F13/01034—Non-adhesive bandages or dressings characterised by a property
    • A61F13/01038—Flexibility, stretchability or elasticity

Definitions

  • the invention relates to the field of compression orthotics intended for use in venous surgery of the lower limbs, in the immediate postoperative period.
  • Surgical superficial veins include two main procedures, both of which perform surgical removal of the malignant vein (vein removal).
  • Hematomas are less important than in the case of stripping, but the risks of immediate bleeding exist when the patient stands up - risks linked to the ambulatory method. In both cases, to reduce bleeding and reduce its consequences, the surgeon immediately applies very strong compression on the operated limb after the operation, to limit bleeding and post-operative inflammation. In almost all cases, this compression is currently carried out with dry or adhesive tapes.
  • One of the aims of the invention is to propose an orthosis which, put in place immediately after the end of the operation, provides controlled, regular compression over the entire lower limb, not dependent on the operator and sufficiently strong to limit bleeding and post-operative inflammation.
  • Bandages, currently the most used, are the easiest orthosis to use but, as we have seen, the least suitable for the purposes pursued by compression.
  • orthosis Another existing type of orthosis could be used instead, namely medical compression stockings. But these stockings give a degressive, ineffective pressure to the thigh whereas, in post-operative, it is precisely on this area that a strong pressure must apply. In addition, these stockings are very difficult to put on an unconscious patient because of general anesthesia and also because of the bandages placed on the leg, which increase the volume.
  • the orthosis of the invention overcomes all of these drawbacks.
  • the invention provides a tubular compressive orthosis for the compression of a lower limb after a venous surgery intervention, in particular after venous or ambulatory phlebectomy, which includes a compressive tubular part, in mesh or fabric, with variable section conformed to the profile of the lower limb, and the structure of the mesh or fabric of which is chosen, as a function of the perimeter dimensions of the lower limb, so as to apply thereto a substantially constant compression pressure over the height of the limb.
  • - the substantially constant compression pressure is between 30 and 40 mm Hg;
  • the orthosis is in the form of an open stocking, without a knitted foot and heel;
  • the tubular part comprises, in the upper part, a thigh sleeve open along a generator and provided with adjustable closing means;
  • the upper and / or lower ends of the orthosis are made of a breakable and non-scalable material, so as to allow adjustment by cutting the length of the orthosis at the time of its installation.
  • Figure 1 shows the orthosis of the invention, which essentially has the shape of a bottom open to the foot. More specifically, the orthosis 10 is in the form of a knitted tube of variable section adapted to the morphology of the leg, that is to say decreasing from top to bottom, and before- conspicuously devoid of knitted foot and heel.
  • This orthosis is intended to cover the lower limb, as illustrated in Figures 2 and 3, from the foot to the root of the thigh. It must be able to exert a constant compression pressure from the ankle to the thigh on the lower limb (unlike traditional compression stockings, which produce a decreasing pressure from the ankle), of the order of 30 to 40 mm Hg (40.0 to 53.2 hPa), allowing to exert a regular and constant hemostatic effect throughout the lower limb.
  • the tubular orthosis 10 consists of two substantially semi-cylindrical parts 12, 14 extending over the entire length of the orthosis, and connected along two generatrices 16, 18 located on either side of a diameter 20. On the semi-cylindrical part 12 situated on the internal side of the leg, the tubular orthosis consists of a reinforced elastic mesh, for example of the same type as that produced on the rear face of a multi-mesh panty with tights.
  • the orthosis is manufactured in several sizes, typically three or four sizes more or less wide, but in a single length, the orthosis being adjusted to the length of the patient's leg by cutting to the desired length of each of the two ends.
  • the orthosis is then, at least at these two ends, knitted with a structure of the non-ratcheting type to avoid fraying after cutting.
  • the mesh can be of the same type as that of conventional compression stockings, for example Varisma stockings (registered trademark) from Innothéra Topic. It can be of the woven, jersey, pinched or float micromesh type, etc., all meshes known in themselves to those skilled in the art of knitting techniques.
  • the yarn chosen for the weaving of this orthosis may be a cotton and polyamide gimped elastane, a cotton-free polyamide gimped elastane, or a mixture of elastane and elastodiene (rubber latex synthetic).
  • the material advantageously incorporates a high proportion of cotton, to allow easier absorption of serum and bleeding; it is also chosen to be washable and possibly reusable.
  • the fitting of the orthosis of the invention is advantageously done by means of a threading accessory such as that described in WO-A- 99/44558 (Innothéra Topic International), which allows threading and adjustment simple, fast and precise, even in the presence of thick dressings and on a limb still anesthetized.
  • WO-A- 99/44558 Innothéra Topic International
  • FIGS. 5 to 7 An improvement, illustrated in FIGS. 5 to 7, consists in providing in the upper part of the orthosis a non-elastic and adjustable thigh sleeve, for example made of fabric.
  • this sleeve is an open sleeve along a generator, as illustrated in Figure 5.
  • the practitioner places the sleeve 22 on the upper part of the thigh and brings the two ends together free by adjusting the tightening to apply the desired compression on this region of the lower limb.
  • the thigh sleeve 22 is then closed in the desired position, for example by means of hook-and-loop fasteners 24 which allow the tightening to be easily readjusted, if necessary.
  • FIG. 8 illustrates the compression pressure profile - substantially constant - provided by the orthosis of the invention (in A), compared to that - declining - provided by a conventional compression stocking (in B).
  • the dashed profiles correspond to the ideal profiles, while the solid lines illustrate the actual readings. The latter take into account, on the one hand, the morphology of the knee which locally prevents the application of regular pressure and, on the other hand, the fact that it is difficult to maintain the pressure at the top of the thigh due to the large diameter in this region (Laplace law).

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  • Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Prostheses (AREA)
  • Materials For Medical Uses (AREA)
  • Socks And Pantyhose (AREA)

Abstract

The invention concerns an orthosis comprising a compressive tubular part (10), made of mesh or fabric, with variable cross-section shaped to suit the profile of a lower limb, and whereof the structure of the mesh or fabric is selected, on the basis of the perimeter dimensions of the lower limb, so as to apply thereon a substantially constant immobilising pressure over the height of the limb, of the order of 30 to 40 mm Hg. The tubular part extends from the foot to the root of the thigh and comprises a highly elastic extensible internal region (12), linked along two generatrices to an inextensible or hardly extensible external region (14). In the upper part is also provided a thigh sleeve (22) open along a generatrix and provided with adjustable closure means (24).

Description

ORTHESE COMPRESSIVE TUBULAIRE POUR LA CONTENTION D'UN MEMBRE INFERIEUR APRES UNE INTERVENTION DE CHIRURGIE COMPRESSIVE TUBULAR ORTHESIS FOR THE CONTAINMENT OF A LOWER LIMB AFTER SURGERY
VEINEUSEVEIN
L'invention a trait au domaine des orthèses compressives destinées à être utilisées en chirurgie veineuse des membres inférieurs, en période postopératoire immédiate.The invention relates to the field of compression orthotics intended for use in venous surgery of the lower limbs, in the immediate postoperative period.
La chirurgie des veines superficielles comprend deux interventions principales, qui toutes deux réalisent une ablation chirurgicale de la veine ma- lade (éveinage).Surgical superficial veins include two main procedures, both of which perform surgical removal of the malignant vein (vein removal).
La première intervention est le "stripping", qui est un arrachement sur fil de l'axe variqueux de la saphène interne ou externe. Cette intervention est effectuée sous anesthésie générale, loco-régionale, péridurale ou sous neuroleptanalgésie. Elle est source de délabrements importants des branches collatérales de la saphène qui, par conséquent, vont saigner en provoquant des hématomes, sources de douleurs et d'inconfort pour les patients dans les heures et les jours qui suivent la chirurgie. L'autre technique couramment utilisée est la phlébectomie ambulatoire, qui est un geste chirurgical moins traumatisant que le stripping (mais qui peut aussi être réalisée dans le cadre d'un stripping). Cette technique réalise une exérèse minutieuse des veines superficielles sous anesthésie locale en ambulatoire. Les hématomes sont moins importants que dans le cas du stripping, mais les risques de saignement immédiat existent quand le patient se lève - risques liés à la méthode ambulatoire. Dans l'un et l'autre cas, pour réduire les saignements et atténuer leurs conséquences, le chirurgien applique immédiatement après l'intervention une compression très forte sur le membre opéré, pour limiter les saignements et l'inflammation post-opératoire. Dans la quasi-totalité des cas, cette compression est actuellement réali- sée avec des bandes sèches ou adhésives.The first intervention is the "stripping", which is a tearing of the varicose axis of the internal or external saphenous wire. This intervention is performed under general, loco-regional, epidural or neuroleptanalgesia anesthesia. It is a source of significant dilapidation of the collateral branches of the saphenous vein which, therefore, will bleed causing hematomas, sources of pain and discomfort for patients in the hours and days following surgery. The other commonly used technique is ambulatory phlebectomy, which is a less traumatic surgical procedure than stripping (but which can also be performed as part of a stripping). This technique performs a careful removal of the superficial veins under local anesthesia on an outpatient basis. Hematomas are less important than in the case of stripping, but the risks of immediate bleeding exist when the patient stands up - risks linked to the ambulatory method. In both cases, to reduce bleeding and reduce its consequences, the surgeon immediately applies very strong compression on the operated limb after the operation, to limit bleeding and post-operative inflammation. In almost all cases, this compression is currently carried out with dry or adhesive tapes.
Cette technique présente plusieurs inconvénients :This technique has several drawbacks:
- par nature, elle dépend de l'habileté de l'opérateur,- by nature, it depends on the skill of the operator,
- la valeur et la régularité de la pression appliquée sont impossibles à contrôler : dès lors, les bandes risquent d'être soit trop serrées, donc douloureuses à supporter, soit insuffisamment serrées, donc ineffica- ces. En pratique, dans la période qui suit immédiatement le geste chirurgical, on constate que les patient souffrent généralement bien plus du fait de bandes mal posées que de l'opération elle-même. D'autres méthodes de chirurgie vasculaire provoquent des désagréments de même nature, par exemple les méthodes dites de "chirurgie conservatrice" dérivée de la "cure CHIVA" (cure Conservatrice Hémodynamique de l'Insuffisance Veineuse en Ambulatoire). L'un des buts de l'invention est de proposer une orthèse qui, mise en pla- ce immédiatement après la fin de l'opération, procure une compression contrôlée, régulière sur tout le membre inférieur, non dépendante de l'opérateur et suffisamment forte pour limiter les saignements et l'inflammation post-opératoire. Les bandages, actuellement les plus utilisés, constituent l'orthèse la plus facile d'emploi mais, comme on l'a vu, la moins adaptée aux buts poursuivis par la compression.- the value and the regularity of the applied pressure are impossible to control: consequently, the bands risk being either too tight, therefore painful to support, or insufficiently tight, therefore ineffective these. In practice, in the period immediately following the surgical procedure, it is noted that the patients generally suffer much more from the improperly placed bands than from the operation itself. Other methods of vascular surgery cause similar inconveniences, for example the so-called "conservative surgery" methods derived from the "CHIVA cure" (Hemodynamic Conservative cure for Venous Insufficiency on an outpatient basis). One of the aims of the invention is to propose an orthosis which, put in place immediately after the end of the operation, provides controlled, regular compression over the entire lower limb, not dependent on the operator and sufficiently strong to limit bleeding and post-operative inflammation. Bandages, currently the most used, are the easiest orthosis to use but, as we have seen, the least suitable for the purposes pursued by compression.
On pourrait utiliser à la place un autre type d'orthèse existant, à savoir les bas de contention médicaux. Mais ces bas donnent une pression dégressive, peu efficace à la cuisse alors que, en post-opératoire, c'est précisé- ment sur cette zone que doit s'appliquer une forte pression. De plus, ces bas sont très difficile à enfiler sur un patient inconscient du fait de l'anes- thésie générale et également du fait des pansements mis en place sur la jambe, qui en augmentent le volume. L'orthèse de l'invention permet de pallier l'ensemble de ces inconvé- nients.Another existing type of orthosis could be used instead, namely medical compression stockings. But these stockings give a degressive, ineffective pressure to the thigh whereas, in post-operative, it is precisely on this area that a strong pressure must apply. In addition, these stockings are very difficult to put on an unconscious patient because of general anesthesia and also because of the bandages placed on the leg, which increase the volume. The orthosis of the invention overcomes all of these drawbacks.
À cet effet, l'invention propose une orthèse compressive tubulaire pour la contention d'un membre inférieur après une intervention de chirurgie veineuse, notamment après éveinage ou phlébectomie ambulatoire, qui comprend une partie tubulaire compressive, en maille ou en tissu, à section variable conformée au profil du membre inférieur, et dont la structure de la maille ou du tissu est choisie, en fonction des dimensions périmétriques du membre inférieur, de manière à appliquer à celui-ci une pression de contention sensiblement constante sur la hauteur du membre. Selon diverses caractéristiques subsidiaires avantageuses : - la pression de contention sensiblement constante est comprise entre 30 et 40 mm Hg ;To this end, the invention provides a tubular compressive orthosis for the compression of a lower limb after a venous surgery intervention, in particular after venous or ambulatory phlebectomy, which includes a compressive tubular part, in mesh or fabric, with variable section conformed to the profile of the lower limb, and the structure of the mesh or fabric of which is chosen, as a function of the perimeter dimensions of the lower limb, so as to apply thereto a substantially constant compression pressure over the height of the limb. According to various advantageous subsidiary characteristics: - the substantially constant compression pressure is between 30 and 40 mm Hg;
- l'orthèse est en forme de bas ouvert, dépourvu de pied et de talon tricotés ;- the orthosis is in the form of an open stocking, without a knitted foot and heel;
- la partie tubulaire s'étend du pied jusqu'à la racine de la cuisse ; - la partie tubulaire comprend une région interne extensible à forte élasticité, reliée le long de deux génératrices, par exemple approximativement diamétralement opposées, à une région externe faiblement extensible ou inextensible ;- the tubular part extends from the foot to the root of the thigh; - The tubular part comprises an extensible internal region with high elasticity, connected along two generatrices, for example approximately diametrically opposite, to an external region which is weakly extensible or inextensible;
- la partie tubulaire comprend, en partie supérieure, un manchon cuisse ouvert le long d'une génératrice et pourvu de moyens de fermeture ajustables ;- The tubular part comprises, in the upper part, a thigh sleeve open along a generator and provided with adjustable closing means;
- les extrémités supérieures et/ou inférieures de l'orthèse sont réalisées en une matière sécable et indémaillable, de manière à permettre un ajustement par découpe de la longueur de l'orthèse au moment de sa pose.- The upper and / or lower ends of the orthosis are made of a breakable and non-scalable material, so as to allow adjustment by cutting the length of the orthosis at the time of its installation.
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On va maintenant décrire plus en détail l'invention, en référence aux dessins annexés. La figure 1 est une vue de l'orthèse de l'invention, avant mise en place. Les figures 2 et 3 montrent, respectivement de côté et de dos, l'orthèse de la figure 1 mise en place sur un membre inférieur. La figure 4 illustre une variante de l'orthèse de la figure 1. La figure 5 illustre un perfectionnement apporté à l'orthèse de la figure 1. Les figures 6 et 7 montrent, respectivement de côté et de dos, l'orthèse perfectionnée de la figure 5 mise en place sur un membre inférieur. La figure 8 illustre les profils de pression de contention respectifs procurés par l'orthèse de l'invention et par un bas de contention classique.The invention will now be described in more detail, with reference to the accompanying drawings. Figure 1 is a view of the orthosis of the invention, before implementation. Figures 2 and 3 show, respectively from the side and from the back, the orthosis of Figure 1 placed on a lower limb. FIG. 4 illustrates a variant of the orthosis of FIG. 1. FIG. 5 illustrates an improvement made to the orthosis of FIG. 1. FIGS. 6 and 7 show, respectively from the side and from the back, the improved orthosis of Figure 5 placed on a lower limb. FIG. 8 illustrates the respective compression pressure profiles provided by the orthosis of the invention and by a conventional compression stocking.
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La figure 1 représente l'orthèse de l'invention, qui a essentiellement la forme d'un bas ouvert au pied. Plus précisément, l'orthèse 10 se présente sous forme d'un tube tricoté à section variable adapté à la morphologie de la jambe, c'est-à-dire allant en diminuant du haut vers le bas, et avanta- geusement dépourvu de pied et de talon tricotés.Figure 1 shows the orthosis of the invention, which essentially has the shape of a bottom open to the foot. More specifically, the orthosis 10 is in the form of a knitted tube of variable section adapted to the morphology of the leg, that is to say decreasing from top to bottom, and before- conspicuously devoid of knitted foot and heel.
Cette orthèse est destinée à recouvrir le membre inférieur, comme illustré figures 2 et 3, depuis le pied jusqu'à la racine de la cuisse. Elle doit pouvoir exercer sur le membre inférieur une pression de conten- tion constante de la cheville à la cuisse (à la différence des bas de contention traditionnels, qui produisent une pression dégressive à partir de la cheville), de l'ordre de 30 à 40 mm Hg (40,0 à 53,2 hPa), permettant d'exercer un effet hémostatique régulier et constant tout au long du membre inférieur. L'orthèse tubulaire 10 est constituée de deux parties sensiblement hémicylindriques 12, 14 s'étendant sur toute la longueur de l'orthèse, et raccordées le long de deux génératrices 16, 18 situées de part et d'autre d'un diamètre 20. Sur la partie hémicylindrique 12 située côté interne de la jambe, l'orthèse tubulaire est constituée d'une maille renforcée élastique, par exemple du même type que celle réalisée sur la face postérieure d'une culotte multi- maille d'un collant.This orthosis is intended to cover the lower limb, as illustrated in Figures 2 and 3, from the foot to the root of the thigh. It must be able to exert a constant compression pressure from the ankle to the thigh on the lower limb (unlike traditional compression stockings, which produce a decreasing pressure from the ankle), of the order of 30 to 40 mm Hg (40.0 to 53.2 hPa), allowing to exert a regular and constant hemostatic effect throughout the lower limb. The tubular orthosis 10 consists of two substantially semi-cylindrical parts 12, 14 extending over the entire length of the orthosis, and connected along two generatrices 16, 18 located on either side of a diameter 20. On the semi-cylindrical part 12 situated on the internal side of the leg, the tubular orthosis consists of a reinforced elastic mesh, for example of the same type as that produced on the rear face of a multi-mesh panty with tights.
La partie hémicylindrique 14 située côté externe de la jambe, quant à elle, est tricotée avec une maille peu extensible, c'est-à-dire à allongement court, de manière à appliquer une contention plus importante sur cette face externe.The semi-cylindrical part 14 located on the external side of the leg, for its part, is knitted with a slightly stretchy mesh, that is to say with short elongation, so as to apply a greater compression on this external face.
L'"élasticité" est ici entendue dans son acception classique, à savoir la capacité d'un matériau textile tendu à reprendre ses dimensions et sa forme lorsque les forces de déformation on disparu ; cette élasticité s'expri- me en pourcentage d'allongement par rapport à un mètre au repos."Elasticity" is understood here in its classic sense, namely the capacity of a textile material stretched to regain its dimensions and shape when the deformation forces have disappeared; this elasticity is expressed as a percentage of elongation compared to a meter at rest.
On considère qu'il y a "allongement court" (maille peu extensible, telle que celle de la partie 14) lorsque l'allongement maximal est inférieur à 70 % (voir notamment C. Gardon-Mollard et A. -A. Ramelet, La Contention Médicale, Masson, Paris, 1999, p. 51-54) et "allongement moyen" (maille élastique, telle que celle de la partie 12) lorsque l'allongement maximal est compris entre 70 et 140 %.We consider that there is a "short elongation" (slightly stretchy mesh, such as that of part 14) when the maximum elongation is less than 70% (see in particular C. Gardon-Mollard and A. -A. Ramelet, La Contention Médicale, Masson, Paris, 1999, p. 51-54) and "average elongation" (elastic mesh, such as that of part 12) when the maximum elongation is between 70 and 140%.
Avantageusement, l'orthèse est fabriquée en plusieurs tailles, typiquement trois ou quatre tailles plus ou moins larges, mais en une longueur unique, l'orthèse étant ajustée à la longueur de jambe du patient par dé- coupe à la longueur voulue de chacune des deux extrémités. L'orthèse est alors, au moins à ces deux extrémités, tricotée avec une structure de type indémaillable pour éviter un effilochage après découpe. La maille peut être du même type que celle des bas de contention classiques, par exemple les bas Varisma (marque déposée) d'Innothéra Topic. Elle peut être de type tramée, jersey, micromesh pincée ou flottée, etc., toutes mailles connues en elles-mêmes du spécialiste des techniques de tricotage.Advantageously, the orthosis is manufactured in several sizes, typically three or four sizes more or less wide, but in a single length, the orthosis being adjusted to the length of the patient's leg by cutting to the desired length of each of the two ends. The orthosis is then, at least at these two ends, knitted with a structure of the non-ratcheting type to avoid fraying after cutting. The mesh can be of the same type as that of conventional compression stockings, for example Varisma stockings (registered trademark) from Innothéra Topic. It can be of the woven, jersey, pinched or float micromesh type, etc., all meshes known in themselves to those skilled in the art of knitting techniques.
En ce qui concerne le fil choisi pour le tissage de cette orthèse, celui-ci peut être un élasthanne guipé coton et polyamide, un élasthanne guipé polyamide sans coton, ou encore un mélange d'elasthanne et d'élasto- diène (latex de caoutchouc synthétique). Néanmoins, le matériau incorpore avantageusement une forte proportion de coton, pour permettre une absorption plus facile des sérosités et des saignements ; il est également choisi pour être lavable et éventuellement réutilisable. La mise en place de l'orthèse de l'invention se fait avantageusement au moyen d'un accessoire d'enfilage tel que celui décrit dans le WO-A- 99/44558 (Innothéra Topic International), qui autorise un enfilage et un ajustement simples, rapides et précis, même en présence de pansements épais et sur un membre encore anesthésie. Diverses variantes sont bien entendu envisageables.As regards the yarn chosen for the weaving of this orthosis, it may be a cotton and polyamide gimped elastane, a cotton-free polyamide gimped elastane, or a mixture of elastane and elastodiene (rubber latex synthetic). However, the material advantageously incorporates a high proportion of cotton, to allow easier absorption of serum and bleeding; it is also chosen to be washable and possibly reusable. The fitting of the orthosis of the invention is advantageously done by means of a threading accessory such as that described in WO-A- 99/44558 (Innothéra Topic International), which allows threading and adjustment simple, fast and precise, even in the presence of thick dressings and on a limb still anesthetized. Various variants are of course conceivable.
Dans une première variante illustrée figure 4, la partie hémicylindrique externe 14 présente une étendue périphérique plus importante que la partie interne élastique 12, c'est-à-dire que les deux génératrices de raccordement 16, 18 se trouvent d'un même côté du diamètre 20. Une autre variante consiste à confectionner l'orthèse au lieu de la tricoter, en employant à cet effet deux sortes de tissu présentant les mêmes caractéristiques de déformation que celles exposées plus haut, à savoir un tissu à faible allongement sur la face externe 14 et un tissu élastique sur la face interne 12. Pour éviter les inconvénients liés aux coutures, on peut employer pour raccorder les deux parties hémicylindriques des procédés de soudure textile à chaud ou par haute fréquence, en eux-mêmes connus.In a first variant illustrated in FIG. 4, the external semi-cylindrical part 14 has a greater peripheral extent than the elastic internal part 12, that is to say that the two connecting generators 16, 18 are on the same side of the diameter 20. Another variant consists in making the orthosis instead of knitting it, by using for this purpose two kinds of fabric having the same deformation characteristics as those exposed above, namely a fabric with low elongation on the external face. 14 and an elastic fabric on the internal face 12. To avoid the drawbacks associated with the seams, it is possible to use the two semi-cylindrical parts to join processes of hot or high frequency textile welding, in themselves known.
Un perfectionnement, illustré figures 5 à 7, consiste à prévoir en partie supérieure de l'orthèse un manchon cuisse non élastique et ajustable, par exemple en tissu. Pour permettre un enfilage aisé, ce manchon est un manchon ouvert le long d'une génératrice, comme illustré figure 5. Après enfilage de l'orthèse, le praticien plaque le manchon 22 sur la partie supérieure de la cuisse et en rapproche les deux extrémités libres en ajustant le serrage pour ap- pliquer la contention voulue sur cette région du membre inférieur. Le manchon cuisse 22 est alors refermé dans la position voulue, par exemple au moyen de fermetures à bandes agrippantes 24 qui permettent d'en réajuster aisément le serrage, si nécessaire. La figure 8 illustre le profil de pression de contention - sensiblement cons- tant - procuré par l'orthèse de l'invention (en A), par rapport à celui - dégressif - procuré par un bas de contention classique (en B). Les profils en tiretés correspondent aux profils idéaux, tandis que les profils en trait plein illustrent les relevés réels. Ces derniers tiennent comptent, d'une part, de la morphologie du genou qui empêche localement l'application d'une pression régulière et, d'autre part, du fait qu'il est difficile de maintenir la pression en haut de cuisse en raison du diamètre important en cet région (loi de Laplace). An improvement, illustrated in FIGS. 5 to 7, consists in providing in the upper part of the orthosis a non-elastic and adjustable thigh sleeve, for example made of fabric. To allow easy donning, this sleeve is an open sleeve along a generator, as illustrated in Figure 5. After donning the orthosis, the practitioner places the sleeve 22 on the upper part of the thigh and brings the two ends together free by adjusting the tightening to apply the desired compression on this region of the lower limb. The thigh sleeve 22 is then closed in the desired position, for example by means of hook-and-loop fasteners 24 which allow the tightening to be easily readjusted, if necessary. FIG. 8 illustrates the compression pressure profile - substantially constant - provided by the orthosis of the invention (in A), compared to that - declining - provided by a conventional compression stocking (in B). The dashed profiles correspond to the ideal profiles, while the solid lines illustrate the actual readings. The latter take into account, on the one hand, the morphology of the knee which locally prevents the application of regular pressure and, on the other hand, the fact that it is difficult to maintain the pressure at the top of the thigh due to the large diameter in this region (Laplace law).

Claims

REVENDICATIONS
1. Une orthèse compressive tubulaire pour la contention d'un membre inférieur après une intervention de chirurgie veineuse, notamment après éveinage ou phlébectomie ambulatoire, caractérisée en ce qu'elle comprend une partie tubulaire (10) compressive, en maille ou en tissu, à section variable conformée au profil du membre inférieur, et dont la structure de la maille ou du tissu est choisie, en fonction des dimensions périmétriques du membre inférieur, de manière à appliquer à celui-ci une pression de contention sensiblement constante sur la hauteur du membre.1. A tubular compressive orthosis for the compression of a lower limb after a venous surgery intervention, in particular after venous or ambulatory phlebectomy, characterized in that it comprises a compressive tubular part (10), in mesh or fabric, with variable section conforming to the profile of the lower limb, and the structure of the mesh or fabric of which is chosen, as a function of the perimeter dimensions of the lower limb, so as to apply thereto a substantially constant compression pressure over the height of the limb .
2. L'orthèse de la revendication 1 , dans laquelle la partie tubulaire (10) comprend une région interne (12) extensible à forte élasticité, reliée le long de deux génératrices (16, 18) à une région externe (14) faiblement extensible ou inextensible.2. The orthosis of claim 1, in which the tubular part (10) comprises an internal region (12) extensible with high elasticity, connected along two generatrices (16, 18) to an external region (14) weakly extensible or inextensible.
3. L'orthèse de la revendication 2, dans laquelle les deux génératrices (16, 18) reliant les régions internes et externes sont approximativement diamétralement opposées.3. The orthosis of claim 2, wherein the two generators (16, 18) connecting the internal and external regions are approximately diametrically opposite.
4. L'orthèse de la revendication 1 , dans laquelle la pression de contention sensiblement constante est comprise entre 30 et 40 mm Hg.4. The orthosis of claim 1, wherein the substantially constant compression pressure is between 30 and 40 mm Hg.
5. L'orthèse de la revendication 1 , caractérisée en ce qu'elle est en forme de bas ouvert, dépourvu de pied et de talon tricotés.5. The orthosis of claim 1, characterized in that it is in the form of open stockings, devoid of knitted foot and heel.
6. L'orthèse de la revendication 1 , dans laquelle la partie tubulaire s'étend du pied jusqu'à la racine de la cuisse.6. The orthosis of claim 1, wherein the tubular part extends from the foot to the root of the thigh.
7. L'orthèse de la revendication 1 , dans laquelle la partie tubulaire comprend, en partie supérieure, un manchon cuisse (22) ouvert le long d'une génératrice et pourvu de moyens de fermeture (24) ajustables.7. The orthosis of claim 1, wherein the tubular part comprises, at the top, a thigh sleeve (22) open along a generatrix and provided with adjustable closure means (24).
8. L'orthèse de la revendication 1 , dans laquelle les extrémités supérieu- res et/ou inférieures de l'orthèse sont réalisées en une matière sécable et indémaillable, de manière à permettre un ajustement par découpe de la longueur de l'orthèse au moment de sa pose. 8. The orthosis of claim 1, wherein the upper ends res and / or lower of the orthosis are made of a breakable and non-ratchet material, so as to allow adjustment by cutting the length of the orthosis at the time of its installation.
EP01963059A 2000-09-04 2001-08-03 Tubular compression orthosis for immobilising a lower limb after a venous surgical procedure Withdrawn EP1278497A1 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
FR0011240A FR2813523B1 (en) 2000-09-04 2000-09-04 COMPRESSIVE TUBULAR ORTHESIS FOR THE SUPPORT OF A LOWER LIMB AFTER VENOUS SURGERY, PARTICULARLY AFTER VEIN OR AMBULATORY PHLEBECTOMY
FR0011240 2000-09-04
PCT/FR2001/002541 WO2002019955A1 (en) 2000-09-04 2001-08-03 Tubular compression orthosis for immobilising a lower limb after a venous surgical procedure

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KR100790578B1 (en) 2008-01-02
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CN1388752A (en) 2003-01-01
FR2813523B1 (en) 2003-03-07
PL354988A1 (en) 2004-03-22
BR0107033A (en) 2002-07-23
KR20020069184A (en) 2002-08-29
RU2002114574A (en) 2004-02-10
AU8410701A (en) 2002-03-22
US20030060845A1 (en) 2003-03-27
FR2813523A1 (en) 2002-03-08
RU2266728C2 (en) 2005-12-27
CN1183887C (en) 2005-01-12
JP2004508101A (en) 2004-03-18
US20050267393A1 (en) 2005-12-01
OA12205A (en) 2006-05-09

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