U.S. patent number 3,856,008 [Application Number 05/363,400] was granted by the patent office on 1974-12-24 for elastic garment for imposing pressure on underlying body regions.
This patent grant is currently assigned to Jobst Institute, Inc.. Invention is credited to Susan M. Fowler, Carolyn Jobst Gottfried, Dennis G. Mosiniak, Ansis U. Tenteris.
United States Patent |
3,856,008 |
Fowler , et al. |
December 24, 1974 |
ELASTIC GARMENT FOR IMPOSING PRESSURE ON UNDERLYING BODY
REGIONS
Abstract
A garment for applying high pressures to an animal body is
illustrated in a typical embodiment as a leg stocking having
openings between circumferentially closed portions at the knee and
the ends thereof. The openings allow relatively easy removal and
application of the stocking which is stretchable in two directions
giving movement lengthwise for flexing joints, and stretching
circumferentially to apply a high pressure gradient to the leg over
substantially the length of the stocking. The stocking is tailored
to maintain the pressure gradient in the closed portions, and
interdigitized cross links with fasteners operate independently on
selected portions along the length of the openings to continue the
gradient in this area upon closing the openings by overlapping the
fasteners.
Inventors: |
Fowler; Susan M. (Grand Rapids,
OH), Gottfried; Carolyn Jobst (Rossford, OH), Mosiniak;
Dennis G. (Toledo, OH), Tenteris; Ansis U. (Toledo,
OH) |
Assignee: |
Jobst Institute, Inc. (Toledo,
OH)
|
Family
ID: |
26795779 |
Appl.
No.: |
05/363,400 |
Filed: |
May 24, 1973 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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99214 |
Dec 16, 1970 |
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Current U.S.
Class: |
602/62;
128/DIG.15; 602/65; 2/240; 602/64 |
Current CPC
Class: |
A61F
13/085 (20130101); Y10S 128/15 (20130101) |
Current International
Class: |
A61F
13/06 (20060101); A61F 13/08 (20060101); A61f
013/00 () |
Field of
Search: |
;128/165,166,156,157
;2/239,240 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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10,439 |
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Sep 1903 |
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GB |
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11,888 |
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Oct 1907 |
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GB |
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231,579 |
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Apr 1925 |
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GB |
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Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Attorney, Agent or Firm: Wilson; David H.
Parent Case Text
This is a continuation of application Ser. No. 99,214, filed Dec.
16, 1970, now abandoned.
Claims
What is claimed is:
1. A leg stocking comprising a main body portion including thigh,
knee, calf, ankle, instep and foot portions of generally tubular
shape and of flexible material which is longitudinally and
circumferentially elastic having a front seam circumferentially
closed at the top, knee, instep and foot, the remaining portions of
said front seam being openings; a plurality of adjustable fastening
means extending laterally across said openings and spaced along the
length of said main body portion, whereby regions intermediate said
spaced fastening means afford longitudinal elasticity to said
garment along the margins of said openings; said main body portion
at the knee, instep and foot portions being formed to impose a
pressure gradient on the body regions to which it is applied by
gradiations in the ratio of the circumference of the body region to
the circumference of the garment region in registry therewith,
whereby said closed tubular length imposes an inward directed
radial pressure on the body region which is greater at one end
thereof than at the other end, and being tailored to relieve
pressure on the portion of the body encased thereby, whereby the
pressure relief is accomplished by a smooth transition with said
fastening means adjustable to give a gradual change in pressure
gradient from the openings in said main body portion to the knee,
instep and foot portions; said fastening means including lateral
extensions of said material extending from both sides of the
openings with said extensions on one side interdigitating with said
extensions on the other side; a liner between the margins of said
openings and said leg; pressure indicating indices for said
extensions; and a second seam to facilitate tailoring that portion
of said main body portion requiring a substantial change in contour
to conform to the leg.
2. A garment for supporting an articulated region of animal bodies
comprising:
a main body portion of flexible, elastic material of generally
tubular shape including a closed tubular length encompassing said
articulated animal body region, said body portion including said
tubular length being formed to impose a pressure gradient on the
animal body region to which the garment is applied by gradiations
in the ratio of the circumference of the animal body region to the
circumference of the garment body region in registry therewith
whereby said closed tubular length imposes an inward directed
radial pressure on the articulated region which is greater at one
end thereof than at the other end, and is gradually reduced along
said length intermediate the ends of said length to level less than
at the low pressure end of said length by the decrease in the ratio
of the circumference of the intermediate portion to the
circumference of the animal body region enclosed thereby below the
ratio of the low pressure end of said length, said body portion
having at least one opening extending along the length thereof
extending from said closed tubular length and having margins for
said opening generally paralleling the longitudinal axis of said
tubular shape; a second closed tubular length adjacent one end of
said main body portion and spaced from said first mentioned closed
tubular length by said opening extending along the length thereof;
said second closed tubular length having a terminal portion
extending to said one end of said main body portion in which the
ratio of the circumference of the terminal portion to the
circumference of the animal body region enclosed thereby is
progressively reduced along the longitudinal dimension of said main
body portion toward said end whereby inward directed radial
pressure on the enclosed body region is progressively reduced
toward said end; and
a plurality of adjustable fastening means extending laterally
across the opening and spaced along the length of said main body
portion, whereby regions intermediate said spaced fastening means
afford longitudinal elasticity to said garment along said opening
margins, said fastening means being capable of adjustably
establishing gradiations of radial pressures on the animal body
along the length thereof.
3. A garment for supporting an articulated region of animal bodies
comprising: a main body portion of flexible, elastic material of
generally tubular shape including a closed tubular length
encompassing said articulated animal body region, said body portion
including said tubular length being formed to impose a pressure
gradient on the animal body region to which the garment is applied
by gradiations in the ratio of the circumference of the animal body
region to the circumference of the garment body region in registry
therewith whereby said closed tubular length imposes an inward
directed radial pressure on the articulated region which is greater
at one end thereof than at the other end, said body portion having
at least one opening extending along the length thereof from said
closer tubular length and having margins for said opening generally
paralleling the longitudinal axis of said tubular shape; and a
plurality of adjustable fastening means extending laterally across
said opening and spaced along the length of said main body portion,
whereby regions intermediate said spaced fastening means afford
longitudinal elasticity to said garment along said opening margins,
said fastening means being adapted for adjustably establishing
gradiations of radial pressures on the animal body along the length
thereof; said fastening means including a first set of extensions
of flexible elastic material having a length extending across said
opening from a first side to a second side of said main body
portion; and said fastening means including a second set of
extensions of flexible, elastic material having a length extending
across said opening from a second side to a first side of said main
body portion; said extensions of said first set being spaced apart
along the margin of said opening a distance at least equal to the
width of said extensions of said second set and said extensions of
said second set each being aligned with the space between
extensions of said first set and being spaced apart along the
margin of said opening a distance at least equal to the width of
said extensions of said first set whereby said extensions
interdigitate and the extensions of each set engage the main body
portion between the extensions of the opposed set to balance the
forces imposed on the animal body region on the opposite sides of
the opening and minimize the tendency of the garment to twist, to
creep on and to chafe the animal body region.
4. A garment for imposing pressure upon regions of animal bodies
comprising: a main body portion of flexible material of generally
tubular shape for encompassing said animal body region, said
material being elastic in the longitudinal and transverse
dimensions of said tubular main body portion, said tubular main
body portion having circumferences along its length which have a
ratio to the circumference of the animal body region with which
they are adapted to register whereby said tubular body imposes an
inward directed radial pressure on the animal body region, said
body portion having at least one opening extending longitudinally
of the tubular shape and having margins for said opening; a
plurality of fastening means extending across said opening
generally perpendicularly to said margins and spaced along the
length of said main body portion, whereby regions of said flexible,
elastic material intermediate said spaced fastening means afford
longitudinal elasticity to said garment along said opening margins;
said fastening means including a first set of extensions of
flexible elastic material having a length extending across said
opening from a first side to a second side of said main body
portion; and said fastening means including a second set of
extensions of flexible, elastic material having a length extending
across said opening from said second side to said first side of
said main body portion; said extensions of said first set being
spaced apart along the margin of said opening a distance at least
equal to the width of said extensions of said second set and said
extensions of said second set each being aligned with the space
between extensions of said first set and being spaced apart along
the margin of said opening a distance at least equal to the width
of said extensions of said first set whereby said extensions
interdigitate and the extensions of each set engage the main body
portion between the extensions of the opposed set to balance the
forces imposed on the animal body region on the opposite sides of
the opening and minimize the tendency of the garment to twist, to
creep on, and to chafe the animal body region.
5. A garment according to claim 4 including individual first
securing means on the face most proximate said animal body of each
of said extensions of said first and second set; and individual
second securing means individually secured on the face of said main
body portion remote from said animal body, said second securing
means being adapted to securingly engage with respective individual
first securing means on extensions on the opposite side of said
opening, said second securing means each being located on separate
spaced areas of said main body portion on the first and second
sides of said opening which are in an alignment with the space
between adjacent extensions from said opening margins which is
generally perpendicular to said opening margins.
6. A garment according to claim 5 wherein said first and second
securing means are complementary area contact fasteners of the
"Velcro" type.
Description
BACKGROUND OF THE INVENTION
Heretofore pressure stockings capable of maintaining a pressure
gradient which increases toward the distal end of a limb
encompassed by the stocking have been produced. Such a pressure
gradient aids the return of blood to the heart and reduces
accumulation of lymph fluid. The pressure stockings of the prior
art feature a design having its circumference closed by a
permanently sewn seam over the entire length wherein the
cross-sectional circumference of the stocking, relative to the
cross-sectional circumference of the limb decreases toward the
distal end to develop a greater pressure on the surface of the limb
at points more remote from the body. A stocking structure of the
above type is described in U.S. Pat. No. 2,574,873 issued to C.
Jobst -- Nov. 13, 1951.
In certain extreme cases of massive lymphedema the above stocking
was incapable of applying the required pressure which was two to
three times the pressure of the above sewn seam pressure stocking.
When the pressure applying capabilities of the sewn seam stocking
were increased to the proper magnitude, it was found that the
wearer could no longer don the stocking. Alternatively, garments
with openings along the seams to facilitate application and removal
were tried in an effort to achieve the requisite pressure and
facilitate doning. Laced seams tended to slip and thereby equalize
the pressure over the length of the garment. Thus, in practice, the
pressure gradient could not be accurately established and over a
reasonable period of wear, the gradient was dissipated by slippage
of the laces. In addition, the lace inhibited longitudinal
stretching and resulted in creep of the garment against the surface
of the covered limb toward the distal end thereof, thereby chafing
the patient. When other closure or fastening means were employed,
the results were similar due to the continuous nature of the
structure supporting the fasteners inhibiting longitudinal
stretching of the garment.
Burn treatments have been developed wherein during the advanced
healing process the application of pressure of about 5 to 10 m.m.
of Hg inhibits scarring characterized by excessive re-growth of
tissue in the injured area. Where body regions are to be healed as
in the case of the human torso pressures imposed by enveloping
tubular constraining structures can be developed only with rather
substantial forces in view of the broad areas involved. Application
of elastic constraining tubular garments, where sufficient tension
is applied to achieve the desired pressure, has been difficult
since burn scar tissue is particularly sensitive and vulnerable to
shear forces. Further, when a constraining garment is mounted over
burn scar tissue and the patient permitted to move, shear forces
should be minimized, wrinkles in the garment due to gathering of
material should be avoided, shifting of the garment as by twisting
or creeping, should not occur, and chafing of the underlying tissue
by the garment or pads which it constrains should be minimized.
SUMMARY OF THE INVENTION
This invention relates to pressure or compressive type health
garments for animal bodies, and more particularly, to garments
capable of exerting pressures two to four times those available in
known pressure type garments, which can be readily drawn over the
body to be encased. The garment has the ability to maintain a
pressure gradient on a body along the length thereof and is also
capable of providing pressure relief at predetermined regions.
Typical of a garment having the above features is a stocking for
supporting a leg consisting of elastic material stretchable in two
directions to allow flexure of joints by longitudinal stretching,
and radial pressure by circumferential stretching. The stocking
encases the leg by virtue of circumferentially enclosed ends
between which an opening or openings extend, closable by
independently operable fasteners after the leg is inserted through
the enclosed end. The pressure gradient over the length of the
stocking is established by tailoring the stocking to a
circumferential dimension progressively decreasing from the
proximal toward the distal end in greater ratio than that of the
leg to be encased. Open portions of the stockings are closed by the
fasteners which can be positioned to provide the desired
circumferential constrictive force.
This type garment is capable of exerting higher pressures than
stockings known in the prior art. Both closed and open seam
portions as well as the garment material are of a nature which
allows longitudinal stretching to give freedom for joint flexure
where required. Material for the garment can be tailored to provide
a pressure gradient over the entire stocking length, and the open
seam is articulated longitudinally by independent fasteners which
can maintain pressure levels in portions of the garment adjacent
the fastener to continue the pressure gradient over the length of
the open portions. Fasteners having graded indices may be employed
to enable a predetermined pressure to be applied in a selected
region by merely placing the fastener adjacent the proper index.
The opening renders the garment easily donnable by the wearer. The
capability of adjusting the pressure of predetermined portions of
the stocking material along the length of the opening allows
gradual pressure gradients to be developed thereby militating
against wrinkling of the garment and accompanying surface chafing
and sores on the encased body.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of a leg stocking in accordance with
the concept disclosed;
FIG. 2 is a diagram illustrating pressure gradients and magnitude
of pressures involved for a normal stocking by curve A, a high
pressure garment by curve B, and modifications of the garment curve
B in curves C and D to obtain a leg stocking;
FIG. 3 is a fragmentary perspective view of the stocking of FIG. 1
with the upper seam opened to expose both a liner and fastener
engaging elements;
FIG. 4 is an enlarged fragmentary cross sectional view taken along
line 4--4 of FIG. 1; and
FIG. 5 is an enlarged fragmentary elevational view of the
fasteners, illustrating the graduated indices thereon.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to the drawings, FIG. 1 illustrates an embodiment of a
pressure type garment for use at pressures higher than those
obtainable with exclusively sewn seam stockings. A garment of the
type illustrated will be referred to, for convenience, as a "high
pressure garment" and the sewn seam stocking as a "normal
stocking." The high pressure garment is illustrated in the form of
a leg stocking for supporting the thigh, calf, ankle and instep
portions of a leg. The stocking material 10 is an elastic fabric
stretchable in the longitudinal and circumferential directions. The
circumference of the stockings is enclosed at the top, knee and
foot by the sewn seam 12. The sewn seam 12 is fabricated by a
multiple thread process which maintains the stretchability of the
stocking material 10 where the seam is formed, particularly in the
longitudinal direction. Typical of the sewn seams 12 and 14
illustrated is a seam by a Wilcox and Gibbs five-needle sewing
machine, which seam is known in the trade as a "flatlock seam."
Where the encased body does not have a smooth contour, an
additional seam in the region where changes in contour occur, may
be introduced as illustrated by the rear sewn seam 14. Location of
seams is not limited to the positions in FIG. 1. Seams are located
as required by the contour of the garment and their utility for the
wearer.
The leg stocking is formed in a manner similar to the stocking
illustrated in U.S. Pat. No. 2,574,873 issued to C. Jobst -- Nov.
13, 1951, which discloses a stocking "having variation in radial
pressure at different points in the length of the stocking so as to
secure just the required amount for assisting circulation without
danger of strangulation." The graduation in the pressure results in
a pressure gradient generally as illustrated by curve A of FIG. 2.
The ideal pressure gradient for a high pressure garment is
illustrated by curve B. While pressure levels vary with the
wearer's needs, a pressure gradient in a normal stocking of 10 to
40 m.m. Hg is practical and usable. In a high pressure garment, the
range would be 40 to 150 m.m. Hg, approaching four times the level
of the normal stocking.
The high pressure garment stocking material 10 has a modulus of
elasticity of two to four times that of the fabric of a normal
stocking. Typically, powernet or bobbinnet materials can be used as
the stocking material 10.
Openings 16 on the front of the leg stocking between the sewn seams
12 are illustrated in FIG. 1 as closed by tabs 18. When the tabs 18
are unfastened, the openings 16 give the leg stocking clearance to
pass over the leg to be encased. FIG. 3 illustrates the tabs 18 in
more detail and reveals an inner liner 20 which may be used between
the skin surface and the openings 16 to afford the wearer comfort
from the edges of the openings 16. The liner is depicted by hidden
lines in FIG. 1, and can be inserted as an independent element or
attached to the knee portion of the leg stocking. The tabs 18 above
the sewn seam 12 at the knee are illustrated in a non-engaged
position in FIG. 3. Tabs 18 are extensions of the stocking material
10 and, therefore, are stretchable both in the longitudinal and
circumferential directions. They are distributed over the length of
the openings 16 with adjacent tabs 18 extending from opposite sides
of the openings 16. Extension of tabs 18 as integral portions of
the stocking body from opposite sides of the openings 16 in an
alternating pattern enables the tabs 18 to be interdigitated when
lapped over the openings 16 which have been pulled closed. The
alternating extension of tabs 18 from opposite sides of openings 16
decrease the tendency of a garment to twist and reduces oblique
friction forces on the skin of the enclosed body which causes
abrasion and chafing.
Advantageously, the tabs 18 can be secured by fasteners made up of
pads 22 and 24 having facings of fibrous entanglements 28, as
illustrated in FIG. 4. Pads 22 each can be an array of loops on a
fabric backing secured to the outer face of the body of the
stocking in spaced positions with which the tabs 18 will register
when drawn across the openings 16. In this manner the stocking
material in the zones between pads 22 and forming the base regions
of tabs 18 extending to the opposite side of opening 16 are of the
same elastic character as the major body portions of the stocking.
Pads 24 each can be an array of hooks on a fabric backing secured
to the inner face of the tabs 18 near their ends. The mating
portions 22 and 24 hold securely upon pressure engagement of the
faces and can be manually peeled apart to render the openings 16
accessible. An example of the fasteners illustrated are those
commercially available under the trademark "VELCRO." The fasteners
have the advantage of infinite adjustment in the direction
transverse of the stocking. Other types of fasteners could be used,
for example, snaps, buttons or hooks. Since the tabs 18 are
extensions of the stocking material 10, pulling each tab across an
opening 16 to a predetermined point establishes the circumference
for that portion of the leg stocking, thereby producing the desired
constructive force and radial pressure. Due to the flexible nature
of the stocking material 10, the tabs, being extensions of the
stocking material 10, are independent of each other enabling that
portion of the leg stocking attached to one cross link 18 to be
stretched to a different circumferential dimension than the portion
attached to an adjacent tab 18. The pressure gradient available in
a tailored sewn seam is, therefore, also achieved in the portion of
the leg stocking having tabs 18.
The flexibility of the tabs 18 allows the pressure gradient applied
by a leg stocking to be varied without abrupt pressure changes to
give pressure relief to an area like the knee. FIG. 1 illustrates a
sewn seam at the knee which is tailored to establish a pressure
level of a normal stocking in the region of the knee to prevent
strangulation at the knee. A transitional gradient from the higher
pressures along the openings 16 through the lower pressures of the
closed knee region of the garment can be tailored entirely in the
open regions, entirely in the closed region, or partially in each
of the contiguous regions. Strangulation would occur at the knee if
the pressure level indicated by the ideal high pressure gradient,
curve B of FIG. 2, was applied to the blood vessels at or near the
surface of the area behind the knee. The dotted line curve C is
indicative of the pressure relief afforded the knee and illustrates
the smooth transition of the slope of the pressure gradient curves
as the pressure falls to that of the normal stocking and then
returns to the ideal gradient, curve B, for the high pressure
garment. Similar relief is given to the foot and instep where
pressures would otherwise exceed the tolerable comfort zone of the
wearer. The highest pressures, therefore, exist at the ankle of the
leg stocking and, in practical applications, are as high as 150
m.m. Hg. The dotted line curve D of FIG. 2, illustrates the drop in
pressure from the ankle to the instep and foot.
The degree of stretchability in the longitudinal direction and
flexibility in achieving smooth pressure gradients in a high
pressure garment increase with an increase in the number of tabs
per unit length of garment opening 16 and is adjustable to the
requirements of each case. Since the tab circumferentially
stretches a select portion of the garment, the smooth transitions
of pressure gradient can be achieved. Such transitions are
especially useful where pressure relief is required for a region of
the body. The tabs can be adjusted to optimize the transitions and
minimize the tendency of the garment to wrinkle.
FIG. 5 illustrates a predetermined indexing system having
longitudinal and transverse indices 30 and 32, respectively. The
transverse index 32 is a guide for the amount of pressure to be
applied by indicating how far the ends of the tabs 18 should be
pulled past the opening 16, and the longitudinal index 30 locates
the various portions of the stocking to which a select pressure is
to be applied. The transverse indices 32 are placed in between the
fastener pads 22, placing each adjacent its mating tab 18 when
pulled to the closed position.
The preferred embodiment illustrates a leg stocking but could just
as well have been any of numerous garments for any limb of an
animal body and, further, for bodies other than limbs, such as
corsets and the like, wherever a graduated degree of support is
required. An infinite number of combinations of sewn seams 12 and
openings 16 may be utilized as required by particular applications.
A high pressure garment could be achieved without the use of any
sewn seams employing the tabs 18 and fasteners 22 and 24.
Other embodiments of the garment include pressure bandages,
particularly those requiring the development of high tension in the
elastic material of the garment body such as is required for burn
garments. Typically a burn vest can be employed for the treatment
of burn scars in the torso. Such vests embrace the torso. They can
be applied to the patient most conveniently if provided with an
opening extending longitudinally of the tubular body which
registers with the injured body region, as opening 16. The closure
comprised of interdigitated cross links 18 of elastic material with
adjacent cross links 18 extending from opposite sides of the
openings enables such an opening to be closed in a manner to
develop the necessary tension in the material of the garment body
portion without imposing shear on the patient. In particular, the
garment can be pre-tensioned before it is closed around the patient
and then closed on the patient by imposing essentially only radial
inwardly directed forces as it is brought into contact with the
wound dressings. The balanced tension maintained across the closed
opening by the interdigitated cross links extending from opposite
sides of the openings avoids the usual localized pulling transverse
of the opening as imposed by most prior art closure structures
where tension is developed from but one side. Further, while the
individual tabs and the garment body were stressed before being
closed they do afford a means of localized adjustment. By employing
discrete tabs or extensions 18 of elastic material on each side of
the garment opening 16 spaced apart at least the width of
interdigitated extensions and providing individual securing means
individually secured on the face of the main body of the garment as
the Velcro pads 22, the usual constraints against longitudinal
elasticity of the garment are avoided in that a region of the body
material, unconstrained by securing means, is available between
each extension securing pad 22. A zipper closure or a Velcro strip
parallel to the opening and secured to the body portion does not
provide this longitudinal elasticity. As a result, movement of the
patient is accommodated in small increments over the enclosed body
portion without imposing sheer longitudinal of the garment opening
and without developing the gathered and thus wrinkled area typical
of those prior art closures.
It is significant that the opening of the garment is closed without
the closure means imposing any components of force longitudinal of
the opening. The elastic cross links or extensions 18 extend across
the opening 16 generally perpendicularly to the margins of the
opening through all of the range of forces imposed. Prior art
lacings impose longitudinal forces on the opening margins and
garment portions in their vicinity by virtue of the runs of the
laces parallel to the opening or inclined from a perpendicular to
the opening. As the prior art garments with lace closures are
subject to body movement the lacings tend to shorten the garment
along the length of the opening, gather the material of the garment
body along the opening, wrinkle the garment and impose shearing
stress on the tissue enclosed.
From the above it will be appreciated that certain features of the
garment construction offers advantages in applications other than
those involving pressure gradients as where uniform pressure with
minimized shearing stress is desired for burn garments. Such burn
garments frequently are required to develop substantial force in
order to produce the requisite pressure over the large areas to
which they are applied.
In the case of the pressure gradient stocking, the garment is one
capable of exerting pressures two to three times that of a normal
stocking and capable of establishing a pressure gradient upon a
body. The garment, sewn seams and tab closed openings are
stretchable longitudinally to eliminate garment creep relative to
the surface of the body encased. Pressure relief can be given to
regions of the enclosed body requiring it, and smooth transitions
of pressure gradient militate against chafing. The pressure relief
prevents strangulation and affords the wearer comfort as well as
joint flexibility. The garment openings render the garment easily
donnable and the opening fasteners are securable manually.
Fasteners of the type illustrated are infinitely adjustable and
especially adaptable to indexing systems. The tabs allow subsequent
adjustment of pressure levels upon the wearer's improved or
worsened condition.
* * * * *