Juzo® ExpertPhlebology / Lymphology

Juzo® – more than 95 years of experiencein compression therapy

Juzo® Inc., Ohio, USAJuzo®GmbH, Aichach, Germany

Juzo® logistic center, Aichach, Germany Juzo® factory II, Aichach, Germany

Summary

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Page

Juzo® Expert – Products for special therapy requirements 2 / 3

Phlebology/Lymphology – Summary 4

The vascular and the lymphatic system 5 / 6

Diseases of the vascular and the lymphatic system and their causes 7 / 8

Compression therapy 9

Medical two-way stretch compression stockings, panty hoses and compression arm sleeves 10 / 11

Compression classes and indications 12 / 13

Fastening possibilities for compression stockings 14

Fastening possibilities for compression arm sleeves and possibilities of treatment for hands 15

Juzo® Expert Silver / Juzo® Expert Strong Silver 16Compression therapy with pure silver

Juzo® Expert –Products for special therapy requirements

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The Juzo® Expert products have been designed to cater as effectively as possible to individual,

complex therapy requirements.

Including an exceptionally wide range of products, it covers virtually all areas of phlebology,

lymphology, orthopedics and burn scar treatment.

Products are also available for specific problems. We also offer an unparalleled range of

custom-made products for individual treatments.

Juzo® Expert Meeting the most exacting medicalstandards

Available in four compression classes, in standard sizes or custom-made, Juzo® Expert can be used

to treat virtually all problem areas requiring compression therapy. In the case of specific problems such

as severe lymphatic edema or elephantiasis, Juzo® Expert offers custom-made products, as these

compression products are often the only effective means of treatment.

Specific problems with ankles, knees and hips can be treated effectively with our wide range of braces.

As they are used in such specialised applications, all Juzo® Expert products are made from resilient,

hard-wearing knitted fabrics which meet even the most exacting demands.

That is why Juzo® Expert succeeds where other products often fail.

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Juzo® Expert

Juzo® Expert

Juzo® Expert

Juzo® Expert

For the ultimate in comfort

Fitting guaranteed

Looking good

Easy to clean

The reason why Juzo® Expert products are so amazingly comfortable is that all elastic threads are rewinded with a

double layer of textile threads, forming hard-wearing yet soft fabrics which are pleasant to wear next to the skin.

The fabric knitted from the rewinded threads also allows a greater circulation of air and moisture, which means that

Juzo® Expert products prevent the retention of heat and moisture which is so prevalent with conventional compression therapy

products. As an added bonus, the Juzo® Expert products are available with natural cotton, for patients with hypersensitive skin.

Our products are manufactured from anatomically shaped, highly elastic two-way stretch fabric and can also be made

to measure, ensuring a perfect fit and a controlled application of pressure.

Our production processes have been optimised to guarantee smooth, homogenous surfaces, which means that our

products not only provide effective medical treatment but look great too.

Juzo® Expert products are manufactured to high-quality standards using synthetic elastomers, which means they are

resistent to the effect of the sun and ointments and can be machine-washed.

Easy-care fabrics are especially important for patients who need to wear Juzo® products over prolonged periods.

It makes them more receptive to therapy and thus increases the chances of the treatment being successful.

Summary

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1Are lymphatic edemas and vasculardiseases a frequent problem?

No data

Sprains etc.

Other diseases

General leg complaints

Vascular diseases,weak veins

MenWomen

Experts say that lymphology –the study of diseases whichoccur in the lymphatic vessels –is not paid sufficient attention bythe medical profession, despitethe fact that various forms oflymphatic edema are actuallyquite prevalent.

The opposite is true of phlebo-logy, which is arousing increa-sing interest in a number ofmedical disciplines. And forgood reason. According to datacompiled by the World HealthOrganization (WHO), vasculardiseases are one of the mostcommon complaints. Statisticsshow that approx. one fourth ofthe world’s adults suffer fromvaricose veins and associatedproblems.

Vascular diseases are one of themost common afflictions of thelower limbs.

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Structure of the vascularand the lymphatic system

The function of the vascularand the lymphatic system

The vascular and the lymphatic system2

� Femoral Artery

� Popliteal Vein

� Small SaphenousVein

� TibialisAnterior Artery

� TibialisPosterior Artery

� External IliacVein

� Femoral Vein

� Greater SaphenousVein

Perforators

Veins are important for transpor-ting and storing blood and forregulating body temperature.

“Blood is a very special fluid” –more precisely, it is a perfectmeans of transport whose job itis to move all sorts of substan-ces to even the remotest partsof the body.The blood is pumped continuallythrough the blood vessels by theheart. The blood, enriched withoxygen from the lungs, travelsvia arteries and capillaries (thefinest arterial branches) into allareas of the body where meta-bolic processes take place.Veins collect oxygen-depletedblood, containing the wastemetabolic products from thetissues, and move it back intothe lungs via the heart – thecycle is complete. As well asacting as a transport system,veins also have the importanttask of storing the large amountsof blood circulating around thebody. More than 80 percent ofthe overall volume of blood inthe human body is stored inthe vascular system so that theblood can be made readilyavailable in the circulatorysystem when it is put understrain – e.g. during physicalexertion.Veins are also important for theregulation of body temperature.

Superficial and deep crural vascular system

The lymphatic system isresponsible for drainage

The lymphatic vessels formanother important transportsystem and are responsible fortransporting the tissue fluid, orlymph, from the blood capillaries,after it has been filtered formetabolic purposes. The primaryfunction of the lymphatic systemis therefore to remove the prote-ins and other substances whichcannot be resorbed into theblood capillaries from the inter-cellular spaces. In addition, thelymph capillaries also performimportant drainage functions.In the case of increased capil-lary filtration, they counteractthe accumulation of fluid in thetissues.

Vascular valves control thebackflow of blood

Unlike the arterial section ofthe circulatory system, whichoperates under high pressure(high-pressure system) to ensureoptimal distribution of the blood,the pressure prevailing in theveins is significantly lower.This part of the circulatorysystem is referred to as a low-pressure system. Accordingly,the walls of the veins are thinnerthan those of the correspondingarteries and have less muscula-ture and elastic tissue.

The veins in the legs are dividedinto superficial and deep vascu-lar systems. Superficial veinsrun directly under the skin andabove the musculature.They collect the venous bloodfrom the skin and the subcutane-

ous tissue and take it vianumerous connective veins(venae perforantes) to the deepvascular system which is thedirect vicinity of the arteries.From there, the oxygen-depletedblood from the musculature andbones is taken back via theinferior vena cava into the rightatrium.

In healthy people, around 90percent of venous blood flowsthrough the deep vascularsystem whilst 10 percent travelsvia the superficial system.

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How the vascular and thelymphatic system work

When the muscu-lature is relaxed,blood is suckedout of the super-ficial veins

When the muscu-lature contracts,blood is pumped inthe direction of theheart

Initial lympha-tic vessel

Pre-collector

Lymphcollector

Pores

The vascular valves also form animportant part of the vascularsystem. These pocket-like valvesor “locks” ensure that the bloodflows in the right direction, i.e.towards the heart. As long as theblood flows towards the heart,the valves remain open. Whenthe pressure in the veins increa-ses, for example, when we standup, the valves close and preventthe venous blood from flowingback.

Vascular valves perform importantcontrol functions

Structure of the lymphatic system

Transport sequenze of lymphaticvessels

Muscular pump in calf:Interplay between veins andmuscles

Dense network of lymphaticvesselsAlmost all of the body’s tissuescontain a dense network oflymphatic vessels. The tiniestcomponents of the lymphaticsystem are valveless lymphaticcapillaries which project into thetissue like fingers. Joined ontothese are pre-collectors whichgradually increase in size tobecome lymph collectors.Connected to the ends of thecollectors are lymph nodes,which function as filter stations,trapping any germs and foreignsubstances and making themharmless. From there, new lymphcollectors transport the lymphvia three large channels whichlead into the vascular system inthe upper thoracic cavity.

Various transport mechanismswork together to promote thebackflow of venous bloodIt is not only the action of thevasclar valves, but also acomplex interplay betweenother transport mechanismswhich promotes the transport ofvenous blood back to the heartagainst gravity, or, as it were,uphill.The most important “motors”which cause blood to flow backto the heart from the legs are theso-called muscular pumps, inwhich veins, muscles and jointswork together. The principle isvery simple. Whenever the legsperform bending or stretchingmovements, such as those invol-ved in walking, the muscles con-tract and relax alternately. Whenthe muscles contract, the resul-ting pumping/suction mechanismpushes the blood from the adjoi-ning crural vein in the directionof the heart. This causes thepressure in the emptied deepveins to fall, so that the bloodfrom the superficial vascularsystem is sucked forward, allo-wing it to be transported. Themuscular pumps in the toes,soles, ankles, calves, knees andthighs perform this process insequence.

Lymph is moved by the rhythmicmovements of the lymphaticvesselsRhythmic pump-like movementsin the musculature in the lymphvessels transports the lymph tothe next lymph node, and in thiscase too, as with veins, thedirection of flow is determinedby valves. The contractions ofthe musculature can be increa-sed depending on the volumeof fluid in the lymphatic vessels,thus also increasing transportcapacity.

Restingphaseaftercontraction

Fillingphase

Contractionphase

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3 Diseases of the vascular and thelymphatic system and their causes

Varicosis can be caused by anumber of different factors

There are many different factorswhich can lead to a disruption ofthe normal function of the veins.Vascular complaints are mainlycongenital or arise as a result ofan age-related loss of elasticityin the vein walls. Other factorssuch as pregnancy, lack of exer-cise and activities which predo-minantly involve sitting orstanding can promote the deve-lopment of vascular disease.However, whatever the causebehind the problem, vein-relatedleg complaints are always thevisible and/or tangible symptomof an imbalance between arterialflow and venous backflow. As aresult, the flow of blood from thelegs slows down, which causesthe pressure in the veins to in-crease and the veins to becomedistended. This damages thevein walls and valves and thebackflow of the blood is increas-ingly disrupted – a vicious circlearises.

Varicose veins – a congenitalproblem or a consequence ofillness

Visible, distended, twisted veinsare described as varicose veins(varices). 90 percent of varicoseveins occur in the legs.Depending on the cause, theyare classified as primary varices– e.g. those caused by heredi-tary weakening of the veins, andsecondary varices, which occuras a result of other illnesses.

Failure of the transport functionleads to chronic venousinsufficiency

The failure of the vascularsystem’s transport function isreferred to as chronic venousinsufficiency. It can occur as aresult of the non-treatment ofestablished varices of after avein blockage (thrombosis)caused by a blood clot. The firstsymptoms are pains and a fee-ling of tightness and heaviness.As the veins become blockedand the vessels distended, morefluid passes through the veinwalls, which causes swelling(edema) in the surroundingtissue.

Leg ulcers are the worstconsequence of chronicvascular disease

The accumulation of fluid pre-vents the exchange of oxygenbetween the red blood cells andthe recipient cells, which in turnleads to tissue damage and thedestruction of cells. A visiblesymptom is the formation of anulcer on the lower leg (Ulcuscruris), the most serious conse-quence of chronic venous insuf-ficiency.

Thrombophlebitis or inflamma-tion of the vein walls

An inflammation of the super-ficial veins is referred to asthrombophlebitis. The symptomsare a distinct reddening of theskin and severe pressure pain inthe affected area. Injections orinfusions into the affected veincan often trigger the problem.

An ulcerated leg (Ulcus cruris)Varicose veins (varicosis)

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Massive lymphatic edema atthe elephantiasis stage (Photo: Földiklinik)

Secondary lymphatic edema in the right armafter a mastectomy (Photo: Földiklinik)

When the drainage function ofthe lymphatic vessels is disrup-ted, an increased amount oflymph fluid accumulates in thetissue (lymphatic edema). Thismanifests itself as severe swel-lings in the affected areas.Patients also complain offeelings of tightness, pain andrestricted movement. In the caseof more established lymphaticedemas the connective tissuehardens (induration), resultingin the clinically significantStemmer symptom, i.e. the skincovering fingers and toes canno longer be lifted in a fold asnormal butis taut or cannot be lifted at all.Two forms of lymphatic edemaare distinguished, depending onthe cause. When some lympha-tic vessels are not formed atbirth, the condition is referred toas primary lymphatic edema.However, the secondary forms,in which parts of the lymphaticsystem have been damaged bytumours, operations, inflamma-tion or accidents, are far moreprevalent.One common example of this isthe secondary lymphatic edemaof the arm after a mastectomy.

Drainage problems in the lymphatic vessels can causelymphatic edema

In order to draw a clearerclinical distinction between thevarious degrees of severity,lymphatic edema is divided intothree stages.In the first stage, referred to aspitting edema, the swelling issoft and it is easy to make animpression in it with your finger.The swelling can be reduced bykeeping the limb elevated.The second stage is characteri-sed by a hardening of the con-nective tissue, in which casethe condition is not improved bykeeping the limb elevated.In the third stage the overallvolume of the swelling increasesand is referred to as elephantia-sis owing to fact that it resemb-les an elephant’s leg.

Compression therapy

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4

In compression therapy, the pressure appliedfrom outside reduces the diameter of the veinsand brings the vascular valves closer together.

One treatment –two goals

Muscle

Bone

Bone

Muscle

Promotion of venous backflowin the treatment of vasculardiseases...

The use of compression therapyin the treatment of vasculardiseases essentially pursues onegoal – to promote the flow ofblood back to the heart and thusto considerably reduce pain andswelling.

The use of compression stock-ings is intended to build on thesuccess achieved after theblockage has been removed andto prevent the patient’s conditionfrom deteriorating. A compres-sion stocking exerts a preciseamount of external pressure onspecific parts of the limb.This means that the fluid whichhas accumulated in the tissuesis more readily absorbed by theblood vessels, thus preventingswelling. Secondly, the externalpressure causes the diameter ofthe veins to decrease and bringsthe valves closer together, en-abling them to close more easily.Thirdly, when the leg is moved,the pressure which arises as aresult of the musculaturepushing against the resistenceof the compression stockingcauses more blood to be pumpedfrom the vascular system in thedirection of the heart.The power of the muscularpumps in the foot and calf isappreciably increased, whichmeans that more blood can betransported back to the heart.

...and increasing the pressurein the tissues in the treatment oflymphatic edema

Compression therapy also playsan important role in the treat-ment of lymphatic edema, butfor completely different reasonsthan in the treatment of vasculardisorders. The aim here is not tocorrect the disruption which hasoccurred in the vascular haemo-dynamics but to increase thepressure in the tissue in order toachieve an improvement in theabsorption of fluid into the lym-phatic vessels. Doctors recom-mend that manual lymphdrainage, physiotherapy andcompression bandages initiallybe used to reduce and stabilisethe lymphatic edema. In casesof prolonged treatment, thebandages are replaced with acompression stocking.Individual factors such as thepatient’s susceptibility to areoccurrence of swelling andthe weakness of the connectivetissues determine which com-pression class is needed.Specialist stores will adaptcompression stockings to theindividual requirements of thepatient, such as their worksituation, degree of mobility andage.

We would like to thank Dr. Földi,Földiklinik, Hinterzarten (Germany),for the photos.

Medical two-way stretch compression stockings,panty hoses and compression arm sleeves

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40%

70%

100%

Compression

Juzo® compression stockingsguarantee correctly dosedpressures up to compressionclass 4, decreasing from distalto proximal, in accordance withthe haemodynamic conditionsprevailing in each case.

The pressure decreases step-lessly from the ankle up towardsthe heart and down to the tip ofthe toes.

Fabric

All elastic threads are rewindedwith a double layer of textilefibers for optimal elasticity,exact compression and comfort.Natural raw material such ascotton is used to make productsfor patients with irritated skin.

Stockings with seam

Juzo® stockings with seam givepatients the outstanding benefitswhen high compression isneeded without the drawbacksof thick, unsightly fabric.Juzo® stockings with seam meetthe most exacting demands.

Seam

The seam is also compressiveand elastic, which means it hasthe same beneficial effect as thetwo-way stretch fabric.The fine, flat seams are verypleasant to wear next to the skinand do not leave any impres-sions.

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Elasticity

The elasticity which Juzo’stwo-way stretch fabrics providearound the knee and thigh isabsolutely unbeatable.Our products are particularlycomfortable for patients withlarger thighs.

Fit without wrinkles

Offering outstanding elasticity,the soft two-way stretch fabricfits perfectly and follows everymovement.

Foot

The foot of the stocking isprovided with a soft, suppleedge which does not pinch orrestrict movement.To ensure that the patient is ascomfortable as possible, thepressure decreases towards thetip of the toes.

Solutions in problematic cases

Individual custom-made pro-ducts make it possible to treatmore unusual cases.The outstanding anatomic fitand excellent elasticity makethe product more acceptableto the patient.

Heel

The compressive-elastic heel,knitted in the shape of the foot’snatural contours, ensures asecure and non-restrictive fit,particularly around the ankleand instep heel area.

Body part

The body part of Juzo® medicaltwo-way stretch compressionpanty hoses is made from aspecial knitted fabric for anexcellent fit.

Special features

Specific problems call forspecific solutions.For example, Dr. Rotter pressurepads can be used to increasepressure in particularly trouble-some areas in the perimalleolarregion.

Compression classes and indications

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• Restless and fatigued legs

• Minor varicosity without significant tendencytowards edema

• Incipient varicosity in pregnancy

• Severe varicosity with tendency towards edema

• Post-traumatic tumidity

• Recovery from moderate ulcerations

• After superficial thrombophlebitis

• After sclerosation and/or stripping of the varices inorder to stabilise the therapeutic effect

• Severe varicosity during pregnancy

• Atrophie blanche

• Dermatosclerosis

• Conditions resulting from constitutional orpost-thrombotic venous insufficiency

• Severe tendency to edema

• Secondary varicosity

• After healing of severe, already recurrent ulcers

• Lymphatic edema and elephantiasis

4

123

light

18 – 21 mm Hg

medium

23 – 32 mm Hg

strong

34 – 46 mm Hg

extra strong

> 49 mm Hg

Compression class Indication

1

432

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• Arterial circulatory disturbance

• Ulcus cruris

• Eczema cruris (and weeping dermatoses)

• Stasis dermatitis

• Thrombophlebitis acuta

• Non-reduced edemas

• Immobility

• Non-compensated cardiac insufficiency

Contraindication

A wide range of modelsfor individual treatments

ADBelow-knee stocking

AFHalf-thigh stocking

AGThigh stocking

AGThigh stocking withhip attachment

AGThigh stocking withbody part

ATPanty hose

Fastening possibilities for compression stockings

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Compression panty hose

The body part of Juzo’s medicaltwo-way stretch compressionpanty hoses is made from aspecial knitted fabric for anexcellent fit.Various models are available:• Different body parts– with compressive body part– with high-elastic body part

• Different styles– with open crotch– with fly

Thigh stockingwith hip attachment

The alternative – easy to put on.

Thigh stockingwith body part

The perfect way to hold up oneor two stockings.

Adhesive lotion(Model 9800)

Special roll-on lotionfor a comfortable hold –very skin-friendly.Washes off easily with water,simple and convenient use.

Thigh stockingswith silicone border

With normal silicone border orwith lace border.

Fastening possibilities for compression armsleeves and possibilities of treatment for hands

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Silicone border

Circular silicone border(approx. 2 cm wide),silicone coated.

Compression sleevewith extended shoulder part

Elastic shoulder part withVelcro fastening for beingattached to the strap of thebra for an excellent fit.Adjustable to width of bra strap.

Silicone supportfor an even better fit

Custom-madecompression gauntletwith thumb stub

Custom-madecompression glovewith open or closed fingers

Adhesive lotion(Model 9800)

Special roll-on lotionfor a comfortable hold –very skin-friendly.Washes off easily with water,simple and convenient use.

Compression sleevewith shoulder and strap

Passes under the armpit of theopposite arm.

Juzo® Expert Silver / Juzo® Expert Strong SilverCompression therapy with pure silver

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Abscesses, erysipelae, furuncles, wound infections – these areall diseases of the skin, frequently caused by an infection with

pyogenic organisms, such as Staphylococcus aureus.Patients with lymphologic and phlebologic diseases are

particularly often concerned by bacterial infections, but alsopersons suffering from burns or scalds and scars. Included

here are therefore conditions of disorder or clinicalsyndromes, which are usually treated by application of

compression therapy measures.

That is why Juzo® has now extended its Expertprogram to include the provision of compression

with an antibacterial effect:In addition to providing a compression effect,

the new qualities Juzo® Expert Silver /Juzo® Expert Strong Silver offer an

antibacterial effect through the silver thread,which is incorporated in the knitted material.The amount of silver, corresponding with theskin flora, restores the equilibrium of inflamedand irritated skin and provides protection from

further infections.

And this is how Juzo® Expert Silver /Juzo® Expert Strong Silver works:

The Juzo® Expert Silver / Juzo® Expert Strong Silvercompression garments are provided with a continuous

X-Static silver thread knitted into the material,which covers the complete skin area of the specific

part of the body to be treated.The antibacterial effect is caused by amanated silver ions,

which have a broadbanded spectrum of effect againstbacteria such as Staphylococcus aureus, which appear

prevalently on damaged skin.Wearing the silver-bearing textiles will reduce itching,

irritation, as well as the number of bacteria(e.g. Staphylococcus aureus and Staphylococcus

epidermidis). Medical studies illustrate, that no unwantedside effects will be caused by external application.1

Naturalness • Antibacterial effect • Thermodynamic effects • Odor inhibition • Durability

1 Jünger M et al. Efficacy and safety of silver textile in thetreatment of atopic dermatitis (AD). CMRO 2006; 22:748

Julius Zorn GmbH Juliusplatz 1 86551 Aichach /Germany www.juzo.com