Compression Bandages

This study was approved by the Institutional Review Board of St. Lawrence University, Canton, NY. The data were recorded from 6 subjects. No personal information was recorded during sessions and all data were analyzed anonymously. Written informed consent was obtained from the subjects prior to the EMG recording sessions.
Each subject was comfortably seated at a desk in front of a computer monitor and wrote on a digitizing table with a pen while looking at the computer monitor that displayed the written traces. EMGs of 8 muscles were simultaneously recorded (Fig. 1a). Since the handwriting involves both the finger and wrist movements, surface EMGs were recorded from intrinsic hand and forearm muscles that produce these movements (Fig. 1b). Bipolar surface EMG electrodes were placed on four forearm muscles: flexor carpi radialis (FCR), extensor digitorum (ED), extensor carpi ulnaris (ECU), extensor carpi radialis (ECR) and four intrinsic hand muscles: opponens pollicis (OP), abductor pollicis brevis (APB), and medial (mFDI) and lateral (lFDI) heads of first dorsal interrosseus). The grounding electrode was placed on the subjects forehead. The skin surface overlying the muscles of interest was first cleaned with alcohol and the electrodes were prepped with electrode paste, firmly pressed to the skin, and fixed in place with hypoallergenic tape. After the electrodes were attached, the whole assembly was wrapped with an elastic bandage (Fig. 1a) to fix the electrode leads to minimize the occurrence of mechanical artifacts in the recordings.
Our system acquired data from three sources: EMG signals were obtained using a amplified recording system (Grass, model 15LT/15A54-2 quad modules) with a digitizer (Polyview/16SYS), pen tracking was accomplished using an Intuos 3/Wacom tablet, and pen contact was detected with pressure sensitive piezo film attached to the tablet. The tablet data were sampled at 100 Hz, which included mouse click events generated when the pen touched the tablet or was lifted from the tablet. EMG signals were differentially amplified (1000X gain), band-pass filtered (-6 dB cutoff points at 5 Hz and 500 Hz) and sampled at 1 kHz per channel. The pressure sensitive piezo film was placed on the writing surface of the tablet and the purpose of the film was simply to indicate the onset of the writing session by generating a triggering pulse (5 V, 0.05 s) sent to one channel of the EMG amplifier. EMG acquisition was handled by Grass software, and a MATLAB script controlled the acquisition of the data from the tablet.
Each subject was instructed to write numeric characters from “0” to “9”. The handwritten traces were displayed on the computer monitor mounted in front of the subject. The subjects were instructed to write the numbers within an 8×8 cm writing area on the digitizing tablet using their individual handwriting patterns. Each subject held the pen in the hand according to his/her individual habits. By a trial we define a recording epoch during which a subject wrote a single character. Each character was successively written 50 times. Therefore, each subject wrote 500 characters (i.e. performed 500 trials) during a daily recording session. Subjects could rest for a few minutes in between the recordings of individual characters, but the electrodes were not removed. Since in this study we sought to recognize individual characters, the subjects were asked to make pauses in between the characters. The trials were paced by the computer software which displayed a fresh writing area in the beginning of each trial. The duration of each trial was 7 s of which 2–3 s corresponded to character writing. Representative examples of the EMG signals and handwriting traces are shown in Fig. 3a.

The therapeutic efficacy of a drug-loaded hydrogel that was selected after the previous studies was evaluated through one in vivo case study; the case study involved a 13-year-old neutered male dog (Serra da Estrela breed), weighing 30 kg, that was admitted to the veterinary hospital (Hospital Veterinário de S. Bento, Lisbon, Portugal) with multiple dog bite wounds. Physical examination of the dog showed a body condition 3/9, hypotension, prostration, and exudative wounds on the left thoracic limb (two lesions: one caudal and another cranial) and the right pelvic limb (one dorsolateral lesion), with signs of severe pain. The animal had claudication of the left thoracic limb due to a previous identical episode. Biochemical and haemogram analyses were performed and revealed hypoalbuminemia (1.4 g/dL), compatible with protein-losing enteropathy. Initially, the animal required stabilisation with fluid therapy Ringer’s lactate (B. Braun^®) through a venous catheter in the jugular (Introcan^®). Analgesic, anti-inflammatory, and antibiotherapy management was performed.
The wounds on the left thoracic limb were cleaned with 1% chlorhexidine (desinclor^®) until the animal was stable, and cryotherapy was performed two times a day for 20 days. After stabilisation, it was possible to perform trichotomy of the injured areas using an Oster^® Golden A5^® shearing machine and Oster CryogenX^® No. 40 shearing blade. Thereafter, cleaning of the wounds was carried out with isotonic saline Ringer’s lactate (B. Braun^®) associated with 1% chlorhexidine. Drug-loaded hydrogels dressings (8 × 8 cm²) were then applied to the two wounds of the left thoracic limb, gloved, and protected by 100% cotton surgical sterile gauze pads (Bastos Viegas^®); they were attached to the limb with adhesive (3M™ Durapore™). The dressing was covered with a second layer of elastic bandage (Bastos Viegas^®) and wrapped in a third layer of self-adhesive bandage (Peha-haht^®). The procedure was performed in a way to avoid clog of the injured area, ischemia, oedema, or cell death. Dressings were changed daily for the first week and then every 48 h until resolution.
Wound management of the right pelvic limb was performed vi disinfection with 1% chlorhexidine associated with isotonic saline Ringer’s lactate, followed by application of 100% cotton surgical sterile gauze pads (Bastos Viegas^®) that were fixed to the skin with a non-woven adhesive band (Omnifix^®E). This management is commonly used in clinical practice in wounds whose closure is expected to occur via second-intention healing, without expected complications.
The study was approved by the Ethical Committee (CEBEA) of Faculdade de Medicina Veterinária da Universidade Lusófona (Ref. n◦27/2019); both the ARRIVE guidelines and EU Directive 2010/63/EU for animal experiments were followed.

After surgery, a compression bandage was applied and the ankle was placed in a neutral position in a short leg brace. Two weeks after surgery, the wound was examined and the sutures were removed; the patients were given advice to partial weight-bear with crutches for a further 2 weeks. Follow-up was performed by outpatient clinical and radiographic evaluation at 1, 3, 6, 12, 18, and 24 months after surgery. The indication on weight-bearing was given based on clinical and radiographic evaluation, but all of the patients achieved total weight-bearing within 6 months after surgery.
During the follow-up, primary outcomes in terms of pain relief (VAS), recovery of function (ROM, AOFAS, FFI, and SF-36), and radiographic assessment (in terms of bone union, changes in angles assessed pre-operatively, and adjacent joints OA) were evaluated independently by two of the authors (T.G. and C.P.—Carlo Perisano). Bone union was assessed radiographically by observing the presence of trabecular lines between the tibia and talus at the point of contact and the disappearance of the radiolucent line [44 (link)]. Adjacent joint arthritis was defined as the appearance of joint space narrowing or osteophyte formation on standing foot and ankle radiographs.
The secondary outcomes were the presence of surgical complications and the need for revision surgery.