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History

The use of the compression therapy is not new. As early as the Neolithic period (5000-2500 BCE), the images of the soldiers with bandaged lower extremities were found in the drawings of the caves of Tassili in Sahara. The Edwin Smith Papyrus, which dates to roughly 1600 BCE, included additional evidence of mechanical compression therapy for legs. Hippocrates treated his patients’ leg ulcers with tight bandages, which were described in his Corpus Hippocraticum (450-350 BCE). Galen (130-200 CE) used wool and linen compression bandages to prevent blood from pooling in the legs and Oribassius (324 CE) used to treat leg ulcers with tight bandages.

During the Middle Ages the leading use of leg compression bandages was mainly for therapy. This is evidenced by the works of Avicenna (980-1037), Giovanni Michelle Savonarola (1384-1468), Ambrosie Pare (1510-1590), Girolomo Fabrizio di Acquapendente (1537-1619), and other scientists. Guy de Chauliac in his book Chirurgica Magna described the use of compression bandages to treat enlarged veins of the legs. Giovanni Michele Savonarola also treated varicose veins with the help of the leg bandages and described their proper application in his work Practice. In 1628, William Harvey discovered the link between venous stasis and the external pressure. Following that discovery, various compression measures were introduced for therapy: laced stockings, elastic bands, and tight bandages with resin. Later new textile materials were started to use for the production of compression stockings: natural or cellulose fibers (silk, cotton, coconut) and chemical (acrylic, nylon, polyester). Only at the end of the 19th century, after Fisher and Lasker, German phlebologists, discovered that the application of the external pressure helped to treat blood clots in the lower extremities, the compression stockings started to be used for the treatment of deep vein thrombosis.

Knee-high versus thigh-high compression stockings
The graduated (gradient, graded) compression stockings and anti-embolism compression stockings come in knee-high and thigh-high length. A systemic review by Sajid et al was done to compare knee-high and thigh-high graded compression stockings in regards of deep vein thrombosis prevention in medical and surgical patients. This review revealed that there was a 6% risk of developing deep vein thrombosis when wearing knee-high stockings and 4% when wearing thigh-high stockings. It concluded that there was no significant difference in the length of compression stockings when used for deep vein thrombosis prophylaxis. It was suggested that knee-high compression stockings should be the first choice for the deep vein thrombosis prevention in medical and surgical patients. Knee-high stockings are more comfortable, easier to apply, and wearing them increases patients’ compliance with treatment. Knee-high stockings are easier to size for limb measurement than thigh-high compression stockings. Thigh-high compression stockings may create a tourniquet effect and cause localized restriction when rolled down. The study of patients treated for post-thrombotic syndrome, performed in Italy, revealed that redness and itching of the skin was reported in 41% of patients wearing thigh-high and 27% in patients wearing knee-high compression stockings. Consequently 22% of thigh-high wearers and 14% of knee-high wearers stopped the treatment.