Miller Extremity Garment
MEG-S {small}
MEG-M {medium}
MEG-L {long}
MEG-V {sleeve}
The picture delineates three of the four sizes of the Miller Extremity Garment.
The concepts that led to the development of the digital based devices (MDT/MDF) were also recognized and considered with reference to the larger extremities. At present, no NPWT dressing is truly designated or designed to address injuries to the arms or legs. Current therapies consist of either a mass of open cell foam encasing the extremity and then enveloping it in the sealing film with a drain tube protruding or modifying multiple silicone drains and a gauze complex to “envelope” the extremity. Recognizing the extreme sensitivity of extremity injuries, these methods are potentially exquisitely painful, and cumbersome to apply and remove. Additionally, the sheer bulk of the dressing complex virtually precludes any useful function of the affected extremity. Current treatments include using a “splint” to stabilize the injured extremity itself. The associated dressings are bulky, difficult to apply and remove with the process of both actions usually quite painful. Recognizing that the benefits of NPWT translate well to tissue injuries in all locations, the application of NPWT to tissue injuries of the arms and legs is a natural progression. Typical injuries for use would include tissue avulsions, postoperative treatment, burns, lacerations, etc.
The requirements for an NPWT device that is amenable to these problems would require the following characteristics:
The shortest size would be used for specific hand or foot wounds or other problems amenable to NPWT. The medium size would be used for injuries up to the level of the knee of elbow. The longest size would be useful for injuries involving the upper arm or top of the leg.
One of the more prevalent problems in a wound care practice involves lymphedema and/or Disease of the Vein system. These problems are accompanied by open wounds of the legs, frequently with copious drainage. Recognizing that the treatment of the underlying disease involves compression wraps usually of one or more cloth layers, the problems are immediately recognized. Persistent organic drainage causes the wraps to become saturated drastically reducing their compression. The drainage is held by the wraps against the skin causing maceration and making the skin more susceptible to further injury. Additionally, the organic drainage putrefies causing a significant and socially unacceptable odor. More, the required frequency of the often costly wraps causes a concurrent increase in costs, inconvenience to the patient and caregivers and most significantly, the inability to have a continuous, therapeutic effect of the compression.
With the MEG applied and connected to a suction device, the drainage is efficiently handled by being siphoned away directly to the suction pump and collection container. The compression wraps are then applied over the MEG. This allows for a longer periods of uninterrupted compression without the untoward effects of the drainage. In addition, NPWT is directly applied to any open areas on the leg as well as the mandatory external graded compression, promoting healing of these conditions using two complementary modalities.
It is expected that the MEG would be changed at 3 to 4 day intervals to allow for local cleaning of the legs however, this would be patient and drainage specific. Since the primary goal of this would be drainage removal, it is expected that pressures of 40 to 60mmHg would be appropriate to maintain drainage removal, promote healing of any open wounds and yet, preclude any potential vascular compromise.
Instructions for applying the Miller Extremity Garments (Small, Medium, Large, Sleeve)
Instructions are available as PDF files. You will need Adobe Reader or another PDF viewer to view them.