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PRODUCTS FOR PRACTICE 3M™ COBAN™ demonstrated that 3M™ Coban™ 2


Compression System: n


n n


provides effective, therapeutic compression for the treatment of venous leg ulcers4, 24-25 has reduced slippage5


improves health-related quality of life5


n


is safe, well-tolerated and comfortable2,5


. , and preferred by


patients in comparison with a four- layer system5


How does the system provide effective compression? Enhanced calf muscle pump The two interlocking layers of 3M™ Coban™ 2 together produce a relatively stiff inelastic sleeve that resists being stretched when the calf muscle expands as it contracts during movement.


The effect of this resistance by the sleeve to muscle expansion during muscle contraction is to produce peaks in pressure under the sleeve and within the calf muscle during movement (working pressure) (Figure 1).


2 Compression


made easy


Since the compression sleeve does not give way when the muscle contracts, intermittent pressure peaks can be registered under the bandage, reflecting a massaging effect on the leg during walking. As the muscle relaxes between contractions, the pressure drops producing the variation in pressure amplitude during movement. The pressure peaks cause intermittent ‘squeezing’ of the veins and muscles that enhances venous return and calf muscle pump function.


3M™ Coban™ 2 Lite also produces spikes in pressure during movement, but because it has fewer elastic fibres than 3M™ Coban™ 2, when it is applied with comparable stretch, it produces a resting pressure that is 25% lower. This reduces the risk of pressure damage and so makes it more suitable for patients who have arterial occlusive disease (ABPI 0.5–0.8) or reduced tolerance for compression.


Effective compression at rest After application of the cohesive layer of 3M™ Coban™ 2 at full stretch, a resting pressure of more than 40mmHg can be


Figure 1 Pressure changes under the 3MTM Lay


mmHg 100 80 60 40 20 0


Stand CobanTM 2 Compression System Exercise Recovery Amplitude


Definitions Lay = resting pressure Stand = standing pressure Exercise = working pressure SSI = static stiffness index: the difference between resting and standing pressures, a measure of bandage system stiffness. Higher SSIs indicated ‘stiffer’ bandages Amplitude = variations in pressure during exercise


SSI


Resting pressure (here 40 mmHg)


Time


Box 2 How does compression therapy reduce oedema and heal leg ulcers?


The effect of compression therapy is to squeeze the limb, and so to reduce oedema


by: n


n n n


reducing the diameter of major veins and consequently local blood volume18


aiding venous return of blood to the heart by improving calf muscle pump action19


reducing the formation of excess interstitial fluid20


improving the microcirculation and tissue oxygenation18


n enhancing lymphatic function20 n


removing and decreasing production of proteases and inflammatory cytokines in the wound microenvironment21


.


In venous leg ulceration, the underlying pathophysiology is assumed to be a result of venous hypertension resulting in chronic venous insufficiency22


. Venous hypertension increases


capillary permeability resulting in tissue oedema and a number of biochemical and physiological effects that may contribute to cell damage, tissue breakdown and the formation of venous leg ulcers16,18,23


. It is thought that the same


mechanisms may also hinder tissue repair. Compression improves venous return and reduces oedema, which will aid healing.


delivered. On standing, both 3M™ Coban™ 2 and 3M™ Coban™ 2 Lite will produce a pressure of more than 60mmHg (see Figure 1), which is the level accepted as the pressure required to counteract venous hydrostatic pressure in the lower leg20,26


.


What makes the bandage system easy to apply? 3M™ Coban™ 2 and 3M™ Coban™ 2 Lite each have only two layers and the outer layer is designed to be applied at full stretch. This simplifies application: there are fewer layers to apply and there is less uncertainty in obtaining the correct tension to achieve the desired pressure.


In an international multicentre study 32 expert bandagers applied the bandage they used the most to an artificial limb over pressure sensors three times and repeated the process with 3M™ Coban™ 2. The bandagers were found to apply 3M™ Coban™ 2 at more consistent


S.2


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