Patent Publication Number: US-2021161745-A1

Title: Two-part non-planar graduated compression device for the treatment of circulatory disorders

Description:
RELATED APPLICATION 
     The present invention is a continuation of U.S. application Ser. No. 15/451,176, filed Mar. 6, 2017, now allowed, which is a continuation of U.S. application Ser. No. 13/943,937, filed Jul. 17, 2013, which is a continuation-in-part of U.S. application Ser. No. 12/952,065, entitled “Graduated Compression For The Treatment Of Circulatory Disorders”, filed Nov. 22, 2012, which in turn claims priority to U.S. Provisional Patent Application No. 61/264,213, entitled “Graduated Compression For The Treatment Of Circulatory Disorders”, filed Nov. 24, 2009, the entire disclosures of which are incorporated by reference herein in their entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     A common treatment for circulatory disorders such as lymphedema, edema and venous diseases is to wear a compression garment. Current compression garments are available in various ready-to-wear standard sizes. Unfortunately, a wide array of inventory must be kept on hand when distributing ready-to-wear garments in order to accommodate the population majority. Although compression garments have been designed that can be modified in circumference or length to obtain a better fit, the “nearest” size must still be chosen. 
     Alternatively, custom made-to-measure garments have also been produced as a form of treatment. Unfortunately, measuring, sizing, and ordering these made-to-measure garments is time consuming and may still not result in a properly fitted compression garment. For limbs that are outside of the standard ready-to-wear size range, custom garments need to be built to match the curvature, length and circumference of the limb. As a result, many measurements are needed to make these custom garments and there is a period between measuring, ordering, production and fitting of the garment where the limb profile may change, which can result in an improper fit due to the time it takes for the patient to receive their garment. 
     Various compression garments have tried trimming-to-fit methods where longer bands are cut down from the largest size to fit the patient. Unfortunately, these bands need to be trimmed separately or in pairs and angled in a manner that best conforms to the shape of the limb. This is a slow and time consuming process. Working out the correct lengths and angles of each band can be very difficult, and is often made more difficult due to the fact that the bands need to overlap to obtain complete coverage. 
     Other compression modalities such as bandaging have also been used. An advantage of bandaging is that it can be used on 100% of the population with one inventory set. Unfortunately, bandaging is very time consuming and does not have the benefit of quick and easy application as compared to standard compression garments. In addition, bandaging is not guaranteed to provide reliable/consistent compression levels, and cannot be adjusted as the limb shape and compression needs change. 
     SUMMARY OF THE INVENTION 
     The present invention provides a one-size-fits-all compression garment that can easily and quickly be tailored to match the circumference profile of a particular patient&#39;s limb. 
     In a preferred embodiment, the present invention provides a therapeutic compression garment, comprising: a body portion having a plurality of bands extending from one side; and a spine portion having a plurality of bands extending from one side, wherein the bands extending from the body portion and the bands extending from the spine portion attach the body and spine portions together when the body and spine portions are wrapped around a body limb, and wherein the spine portion is releasably attached onto the body portion such that the spine portion is positionable at different locations on the body portion. The present invention provides therapeutic compression. The spine portion is attached to the body portion at a preferred location, such that the garment best fits the particular patient&#39;s limb. 
     The therapeutic compression garment may be fit onto a patient&#39;s limb by first measuring the circumference of the patient&#39;s limb at a top location, at a bottom location, and then the length of the limb. Next, the garment is assembled around the limb by: (i) aligning the spine portion and the body portion using measurement indicia (on one or the other of the body or spine portions); (ii) attaching the spine portion onto the body portion; (iii) optionally discarding an unused portion of the body portion; and then (iv) wrapping the assembled therapeutic compression garment around the patient&#39;s limb, thereby securing the bands in their proper location. 
     It is to be understood throughout the specification that the present invention may be used on either a patient&#39;s arm or leg, and that examples referring to a leg are merely exemplary, and not limiting. 
     Preferably, hook and loop fasteners are used such that the body and spine portions are first attached together by hook and loop fasteners. After this has been done, the two piece device will then become a continuous one piece garment. Next, the resulting one piece garment will then be positioned behind the limb and the open front side will then be wrapped and fastened together around the front of the patient&#39;s limb. Preferably, the hook and loop fasteners holding the body and spine portions together are stronger than the hook and loop fasteners holding the bands to the body and spine portions when the garment is applied. Thus, pulling on the bands to tighten, adjust, or remove the garment will not cause the body and spine portions to pull apart. Therefore, the user will be less likely to unintentionally disengage to the spine attachments while detaching the other bands. 
     In preferred embodiments, the top and bottom edges of the body portion are marked with measurement indicia and a curved edge of the spine portion is aligned with these measurement indicia, as follows. First, the top of the spine portion is aligned with the measurement indicia on the body portion corresponding to the circumference measurement taken at the top location on the patient&#39;s limb, and the bottom of the spine portion is aligned with the measurement indicia on the body portion corresponding to the circumference measurement taken at the bottom location on the patient&#39;s limb. The spine portion is then attached onto the body portion by one or more hook and loop fastener tabs (positioned along a curved edge of the spine portion). In other embodiments, the measurement indicia are displayed along the mid portions of either the spine or body portions. In the various embodiments of the present invention, these measurement indicia correspond to the circumference of a particular patient&#39;s body limb, or to general body limb sizes such as small, medium, large and extra large. 
     In various embodiments, after the body and spine portions have been fastened together (but prior to wrapping the garment around the patient&#39;s limb), if necessary the user simply discards the unused portion by cutting off the excess. 
     An advantage of the present garment is that it can be provided in one size for all patients (since the actual sizing and adjustment of the garment can be done by the therapist or end user or clinician). Another advantage of the present garment is that it is simple to put on and very easy for a clinician or end user to shape, size correctly, and adjust accordingly. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A  is an illustration of the garment prior to attaching the body and spine portions together. 
         FIG. 1B  is an illustration of the garment after attaching the body and spine portions together. 
         FIG. 2A  is a close up of the top of the garment showing the alignment of the body and spine portions. 
         FIG. 2B  is a close up of the bottom of the garment showing the alignment of the body and spine portions. 
         FIG. 3A  is an illustration of a first alignment of the body and spine portions (as suited for a patient having a small ankle and calf). 
         FIG. 3B  is an illustration of a second alignment of the body and spine portions (as suited for a patient having a small ankle and medium calf). 
         FIG. 3C  is an illustration of a third alignment of the body and spine portions (as suited for a patient having a small ankle and large calf). 
         FIG. 4  is an illustration of discarding an unused portion of the body portion after the body and spine portions have been attached together. 
         FIGS. 5A and 5B  are sequential illustrations of the patient wrapping the garment around their leg. 
         FIGS. 6A and 6B  are a second embodiment of the present invention. 
         FIGS. 7A and 7B  are third embodiments of the present invention. 
         FIG. 8  is a fourth embodiment of the present invention. 
         FIG. 9  is a fifth embodiment of the present invention. 
         FIG. 10  is a sixth embodiment of the present invention. 
         FIG. 11A  is a seventh embodiment of the present invention. 
         FIG. 11B  is a profile view of a band tab hook attachment of the garment of  FIG. 11A . 
         FIG. 11C  is a profile view of a portion of the garment of  FIG. 11A . 
         FIG. 11D  is a profile view of spine tab hook attachment including stay of the garment of  FIG. 11A . 
         FIG. 12A  is a reverse side view of the garment shown in  FIG. 11A . 
         FIG. 12B  is a profile view of a portion of the garment of  FIG. 12A . 
         FIG. 13A  is an eighth embodiment of the present invention in an open position (with the bands removed for clarity of illustration). 
         FIG. 13B  is the garment of  FIG. 13A  in a closed position (with the bands removed for clarity of illustration). 
         FIG. 13C  is an illustration corresponding to  FIG. 13A  (with the bands shown). [ 0038 ]  FIG. 13D  is a top plan view corresponding to  FIG. 13B . 
         FIG. 14A  is a plan view of an alternate embodiment with a guide band on the body portion, wherein the guide band and the body portion wrap together around the body limb. 
         FIG. 14B  is similar to  FIG. 14A , but instead has a pair of parallel guide bands. 
         FIG. 14C  is another alternate embodiment with a guide band spanning between the body and spine portions of the garment. 
         FIG. 15A  is a plan view of an alternate embodiment of the invention in which the garment assumes a non-planar shape when the ends of the body and spine portions are secured together. 
         FIG. 15B  is an illustration of the body and spine portions held together by a notched connector, showing the non-planar shape of the garment. 
         FIG. 15C  is another illustration of the body and spine portions held together by a notched connector, showing the non-planar shape of the garment from a different angle. 
         FIG. 15D  is an illustration similar to  FIG. 15B , but instead showing the inside surface of the garment. 
         FIG. 15E  is an illustration of the side view of the garment of  FIGS. 15A to 15D , showing its non-planar shape. 
     
    
    
     DETAILED DESCRIPTION OF THE DRAWINGS 
     Referring first to  FIGS. 1A to 5B , a therapeutic compression garment  10  is provided. Garment  10  comes in two pieces, being a body portion  20  and a spine portion  30 . Body portion  20  has a plurality of bands  22  extending from one side as shown. Spine portion  30  similarly has a plurality of bands  32  extending from one of its sides as shown. 
     As will be explained, the bands  22  extending from body portion  20  are juxtaposed between the bands  32  extending from spine portion  30  when garment  10  is wrapped around the patient&#39;s limb. Specifically, as seen in  FIGS. 5A and 5B , bands  22  are fastened onto spine portion  30  and bands  32  are fastened onto body portion  20 . Most preferably, bands  22  and  32  have Velcro® (i.e.: hook and loop fastener) ends. Similarly, the surfaces of body portion  20  and spine portion  30  are also covered with corresponding Velcro® (i.e.: hook and loop fastener) surfaces. In some embodiments, bands  22  and  32  may extend past the spine divider (i.e.: the connection point between the body and spine portions) and back onto their own portions respectively. 
     In operation, the therapeutic compression garment  10  is fitted onto a patient&#39;s limb, as follows. First, the patient (or other person assisting the patient) measures the circumference of the limb at a top location and at a bottom location and the length of the limb. For example, the limb would be the leg, the top location would be the calf, the bottom location would be the ankle, and the leg length from ankle to knee crease would determine the preferred garment length. 
     Next, the patient assembles therapeutic compression garment  10  around their limb by: (i) aligning spine portion  30  with the measurement indicia on body portion  20  (as seen in close up  FIGS. 2A and 2B ); (ii) attaching spine portion  30  onto body portion  20 ; (iii) discarding any unused portion of body portion  20 ; and then (iv) wrapping the assembled therapeutic compression garment  10  around their leg (while juxtaposing bands  22  and  32  thereby securing bands  22  onto spine portion  30  and bands  32  onto body portion  20 ). As a result, the two piece garment shown in  FIG. 1A  is first changed into the one-piece garment shown in  FIG. 1B . Next, as shown in  FIG. 4 , an unused portion  20 A of body portion  20  is discarded. Finally, as shown in  FIGS. 5A and 5B , garment  10  is wrapped around the patient&#39;s leg. 
     As can be seen in  FIGS. 3A to 3C , spine portion  30  is releasably attached onto body portion  20 . As a result, spine portion  30  is positionable at different locations on body portion  20 . This permits spine portion  30  to be positioned at different locations depending upon the dimensions of the patient&#39;s limb. Preferably, body and spine portions  20  and  30  are simply attached together by hook and loop fasteners. As illustrated, spine  30  may have three fastener tabs  34  disposed along the curved edge of spine  30  (opposite to the side from which bands  32  extend). The spacing selected between fastener tabs  34  allows the spine curve (i.e.: the connection along which the body and spine portions  20  and  30  are attached together by fastener tabs  34 ) to be positioned such that garment  10  starts to take a three dimensional shape (as opposed to simply lying flat). This shaping helps the garment to best fit the contours of the limb. 
     As can be seen, body portion  20  preferably has parallel top edge  21  and bottom edge  23 . These top and bottom edges  21  and  23  of the body portion are marked with measurement indicia. As seen in the close up view of  FIGS. 2A and 2B , the curved edge of spine portion  30  is aligned with the measurement indicia on the top and bottom edges  21  and  23  of body portion  20 . Aligning spine portion  30  with the measurement indicia on body portion  20  comprises aligning the top  31  of spine portion  30  with the measurement indicia on the top  21  of body portion  20  corresponding to the circumference measurement taken at the top location on the patient&#39;s limb (e.g.: at the calf). Similarly, aligning spine portion  30  also comprises aligning the bottom  33  of spine portion  30  with the measurement indicia on the bottom  23  of body portion  20  corresponding to the circumference measurement taken at the bottom location on the patient&#39;s limb (e.g.: at the ankle). 
     Fitting is done by measuring the patient&#39;s ankle and calf circumferences. These circumference measurements are represented by a range of indicia markings along the top edge  21  and bottom edge  23  of body portion  20 . The bottom markings reflect the ankle circumference and the top markings reflect the calf circumference. The hook tabs  34  from spine portion  30  are secured to body portion  20  according to where the patient&#39;s ankle and calf circumference measurements fall within the marked ranges. Each tab  34  can be angled independently due to spacing between the tabs and any elasticity in the material used. This allows spine tabs  34  to be further adjusted to create smooth transitions from top to bottom along spine portion  30 . The spine&#39;s already curved edge aids in mimicking the limb&#39;s natural contour. This feature, along with adjustable spine tabs  34 , allows the garment to adjust to almost any limb size and shape. 
     As seen in  FIGS. 3A to 3C , a variety of different alignment positions are possible (since each position will depend upon the exact ankle and calf measurements of the particular patient). Specifically,  FIG. 3A  illustrates a patient having a small ankle and calf  FIG. 3B  illustrates a patient having a small ankle and medium calf.  FIG. 3C  illustrates a patient having a small ankle and large calf, though any variation of leg proportions can be addressed. After spine portion  30  has been properly aligned, it is then simply pressed against body portion  20  such that it is held in position by hook and loop fasteners  34 . (Note: the side of body portion  20  and spine portion  30  is preferably covered with a hook and loop fastener surface.) 
     Next, as shown in  FIG. 4 , spine portion  30  is simply pulled back aside, and the patient/clinician then cuts off the unused portion (designated  20 A) of body portion  20 . Thus, the unused portion  20 A is removed from a side opposite to the side from which bands  22  extend. 
     Next, as seen in  FIGS. 5A and 5B , the assembled garment  10  is then wrapped around the front of the leg, thereby securing bands  22  onto spine portion  30 , and securing bands  32  onto body portion  20 . Thus, bands  22  are simply fastened onto spine portion  30  by hook and loop fasteners. Similarly, bands  32  are attached to body portion  20  by hook and loop fasteners. Preferably, the hook and loop fasteners holding the body and spine portions  20  and  30  together are stronger than the hook and loop fasteners holding the bands  22  and  32  to either of the body and spine portions  20  or  30 . As a result, tightening, adjusting, or disengaging bands  22  and  32  at the front of the garment does not pull apart the body and spine portions  20  and  30  at the back of the garment. The preferred difference in hook and loop strength provides the user with additional guidance as to which hook tabs should be disengaged while doffing or adjusting the therapeutic garment. Optionally, one or more reinforcement tabs  40  (see  FIG. 11A ) can also be used to further secure the body and spine portions  20  and  30  together. Reinforcement tabs  40  can similarly be made of hook and loop fastener surfaces such that they can attach directly on top of body and spine portions  20  and  30  (to reduce the risk of the spine-to-body connection being disengaged along the back of the garment). 
     The hook and loop fasteners may be secured directly on to the surface of (i.e.: sewn onto) the ends of bands  22  and  32 . In contrast, the hook and loop fasteners may optionally extend from the edges of the body and spine portions  20  and  30 . As a result, the addition of the hook and loop fasteners onto the body and spine portions  20  and  30  would not add any significant thickness to the final garment, reducing the risk of accidental spine tab  34  removal. 
     As illustrated, there are three tabs  34 . It is to be understood that the invention encompasses any number of tabs  34 . For example, using additional smaller tabs (e.g.: four or more) can better match the limb profile, however more adjustments would be necessary. The adhesion strength of the spine to body portion connection may also be reduced due to the increased number of spine tabs  34 . Conversely, using fewer tabs  34  (one or two) decreases the ability for the spine to contour to the limb because current hook material available is inelastic in nature and doesn&#39;t bend easily. If an elastic pliable hook were to be used, the entire curved portion of spine portion  30  could be made from one tab. 
     Alternatively, garment  10  may be provided to the user with portions  20  and  30  already fastened together (via bands  22  and  32  fastened to opposing body portion  20  and spine portion  30 ). In this situation, fitting would be done by holding the free end of the body portion  20  against the limb and wrapping the garment around the limb so that spine portion  30  encircles the limb and overlaps back onto the outside of the free end of body portion  20 . Spine portion  30  is then attached to body portion  20  so that the garment is as snug as possible. Further fitting is achieved by pulling on each individual hook tabs  34  in order to mimic the limb contour and further shape the fit of the garment to match the shape of the limb. 
     Once the garment has been fitted and the body and spine portions are fully secured together, the garment is removed by disengaging the juxtaposed bands  22  and  32 . Once removed, the body-to-spine attachment can further be secured by smoothing out the material or making minor adjustments for clean transitions between the spine hook tabs  34 . The excess material can be trimmed following the inside edge of the spine hook tabs  34 . 
       FIGS. 6A and 6B  illustrate a second embodiment of the invention in which spine portion  30  has a straight edge opposite to the side from which bands  32  extend. Specifically,  FIG. 6A  shows an interior (i.e.: surface to be put against the skin) of the garment.  FIG. 6B  shows a corresponding exterior view after bands  22  and  32  have been attached onto the outside surface of the garment. In previous Figures, a curved edge on spine  30  increases the ability of the spine portion  30  to contour to the limb. This is because the circumference at the ankle is generally smaller than the circumference at the calf, which creates a curved contour. Thus, the curved edge spines (seen in  FIGS. 1A to 5B ) best match the curves of the limb profile. In contrast, the use of a straight spine ( FIGS. 6A and 6B ) would force the material to stretch and adjust more than with a curved spine. Thus, in the embodiment of  FIGS. 6A and 6B , garment  10  is preferably made out of elastic or limited stretch material. As also seen in  FIGS. 6A and 6B , body portion  20  may have cut away tabs  23  permitting a user to cut away a top (or bottom) portion of the device, thereby shortening the length of the device on the body limb. Specifically, the user could cut off a portion of the height of the device by cutting horizontally across body portion  20  along dotted line one of dotted lines  27 . Similarly, cut away tabs may be found on spine portion  30  to trim the height of spine portion  30 . Alternatively, as illustrated, the Velcro® fasteners on the ends of band  32  may have gaps  37  there between. Should the user wish to trip the height of the garment (i.e.: it&#39;s length along the body limb), the user could cut off a portion of the height of the device by cutting horizontally across spine portion  30  along one of the illustrated dotted lines. 
     Also in this embodiment, body portion  20  has measurement indicia that designate more general sizes such as small, medium, large and extra-large (S, M, L, XL). Lines can be drawn from top to bottom on body  20  such that a user with a “small” leg cuts along a line  24 A whereas a user with a “medium” leg cuts along a line  24 B to discard portion  20 A. Such lines  24 A,  24 B, etc. provide a “rough guide” as to the size of portion  20 A to discard. Note: similar lines (which may either be markings or perforations) could be used with the garment of  FIG. 1A  as a method of removing a significant portion of the unused body portion  20 A prior to performing a final adjustment to the spine location thus allowing the patient to easily test the spine placement before removing the remaining portion of the body portion  20 . 
     One advantage of the present system is that the need for time-consuming length adjustments is eliminated. Instead, only two predetermined length models (i.e.: body portion  20  and spine portion  30 ) need to be stocked. This advantageously decreases needed inventory space. 
     Currently all adjustable designs in the market rely on trimming band length and/or adjusting its angle to fit the garment to the limb. The current invention adjusts the body of the garment to match the contour of the limb independently of any band adjustment. Current compression garments with spines or a second set of bands that are used for adjustment have overlapping adjustment points which make them difficult to use. In contrast, the present invention requires the securing of only three tabs  34  and the trimming of one piece  20 , as compared to the trimming and angling of several bands. 
     In existing compression devices, length adjustment is typically done by cutting off a complete set of bands. In contrast, the present invention trims the width of a band so as to keep gradient compression and not to cut through any assembled materials that could fail due to the cut. In addition, the present invention is a one-layer system, as compared to the three or four layers typically used in bandaging approaches. 
     Regardless of compression band engagement design (overlap, juxtaposition, interlock, d-ring, etc.), the present design can be converted to a one-size-fits-all garment. It will also match the leg contour regardless of where the fit is made circumferentially on the limb. If the user applies the fitting spine to the shin area while fitting, but then positions it to the back of the calf so the compression bands are easily accessible in the shin area for application, the garment will still match the contour of the limb. 
     All previous compression garment models rely on a spine or curve point that is centrally/symmetrically located on the garment. For trim to fit versions, material is cut equally on each side of the garment or from band ends. In contrast, the present invention is unique in that it can quickly and easily be adjusted to match the contour of the limb with or without falling on a central point in the garment. 
     Fitting and applying the garment to appropriate compression can typically be done in less than five minutes. This is far superior to the time involved with bandaging a limb, sizing and fitting a standard size garment, or measuring and producing a custom-made garment. 
     Optionally, the present invention also includes a “Built-In Pressure System™” and guide card. The patient&#39;s ankle circumference measurement determines the appropriate range on the Built-In Pressure System card for the patient. This eliminates the need to translate the patient&#39;s ankle circumference into a nominal size, furthermore simplifying the fitting process. The Built-in Pressure System card allows the patient to adjust the garment to the prescribed amount of compression. 
       FIG. 7A  is a third embodiment of the present invention in which garment  10  has D-rings  35  attached to the ends of bands  32 . In this embodiment, the ends of bands  22  are placed through D-rings  35  and then attached back onto themselves. As can be seen in this embodiment, the bands  32  can be quite short, and may simply be short projections on spine portion  30  onto which the D-rings  35  are attached. As can also be seen, bands  22  can be quite long in this embodiment as they are long loops of materials that weave through D-rings  35  and then attached back upon themselves. The advantage of such a D-ring system is that it allows the patient to tighten the garment using only one hand. Note as well that the measurement indicia are found on spine portion  30  in this embodiment of the invention. Only two spine tabs  34  are used. 
       FIG. 7B  is quite similar to  FIG. 7A , however, instead of D-rings on the ends of bands, the spine portion  30  instead has holes  38  passing therethrough. Bands  22  are passed through holes  38 , and are then looped back upon themselves.  FIG. 7B  illustrates the fact that the present invention is not limited to devices that have bands extending from both of the body and spine portions. Instead, either of the body and spine portions need not have bands extending therefrom, all keeping within the scope of the present invention. 
       FIG. 8  is a fourth embodiment of the present invention in which garment  10  has bands  22  and  32  which are not juxtaposed between one another. Instead, each band  22  is simply fastened onto a respective band  32  (preferably by Velcro® hook and loop fasteners). Body portion  20  has a plurality of numbered perforations (lines 1, 2, 3, 4, 5, 6) allowing unused portion  20 A to be removed more easily. This embodiment further includes an elastic wrap  50  for applying compression to an area of the limb that would be difficult to cover (such as the foot or hand), or where flexibility is needed (such as the elbow or knee). Elastic wrap  50  could also be used to cover the junction between garments when using two garments  10  to cover different segments of the limb. It could also be made of a nonslip material to anchor the garment in place and extend from the top of the garment instead. 
       FIG. 9  is a fifth embodiment of the present invention in which garment  10  has an intermediary portion  60  is positioned between body portion  20  and spine portion  30 . Preferably, intermediary portion  60  is attached to body portion  20  by hook and loop fasteners, and spine portion  30  is attached to intermediary portion  60  by hook and loop fasteners. Thus, body and spine portions  20  and  30  are connected together by way of intermediary portion  60 . A number of intermediary portions  60  can be kept on hand to prevent the waste of cut away portions  20 A as the patient&#39;s limb changes in circumference over time. As can also be seen, bands  22  and  32  may be made of different widths along the length of the garment (for example with narrower bands at the ankle/wrist and wider bands at the calf/elbow), as shown. Also in this embodiment, bands  32  may have pockets  37  that can be used to hold one side of the garment in place while the other side is wrapped over and attached. 
       FIG. 10  is a sixth embodiment of the present invention in which garment  10  has bands  22  having ends that are received through holes  37  in bands  32 . Such interlocking bands provide conformity to the shape of the body limb. Also included is an ankle/foot wrap portion  70  for applying compression to the ankle-foot region. As can also be seen, there are indicia (S, M, L, XL) printed on body region  20  (for positioning spine portion  30 ). Tabs  34  can be attached to connect spine portion  30  onto body portion  20  at the preferred (i.e.: S, M, L, XL) location corresponding to the size of the patient&#39;s limb. A tension measuring card  80  may also be included in the device as sold. The tension measuring card  80  has scales relating to the size of the patient&#39;s limb. Tension measuring card  80  relates the distance that the garment is stretched to the tension in the garment bands by measuring the spacing between lines printed on the garment as the garment is stretched. 
       FIG. 11A  is a seventh embodiment of the present invention in which garment  10  (i.e.: both body portion  20  and spine portion  30 ) are made of a thick material such as foam laminate with directional seams  29  and  39  are sewn in to create alternating channels of high and low pressure running along the interior of the garment along the body limb. Such alternating channels of high and low pressure may facilitate drainage of lymphatic fluids. Velcro® stays  40  may be used to further secure tabs  34  to body portion  20 .  FIG. 11D  shows a close-up profile view of this attachment.  FIG. 11B  is a profile view of the attachment of band  22  back onto body portion  20  (after the end of band  22  has been juxtaposed between two bands  32 ).  FIG. 11C  is a profile view of a portion of the garment of  FIG. 11A  showing directional seams  29  running along body portion  20 . As can be seen, the vertical profile (i.e.: thickness) of the connection in  FIG. 11B  is higher than the vertical profile (i.e.: thickness) of the connection in  FIG. 11D . This can be advantageous in that it makes it easier to detach the bands  22  and  32  than to detach the body and spine portions  20  and  30 . In this embodiment, the bands  22  and  32  extending across the front of the body limb adhere with a lesser strength than the attachment of the spine and body portions  20  and  30  across the back of the body limb. 
       FIG. 12A  is a reverse side view of the garment shown in  FIG. 11A . The dotted area  90  is an area where an optional bladder or foam may be added to distribute pressure. Similarly, area  92  represents a region where an ulcer is often present (just above the ankle) and spot pressure is required. Foam or bladder piece  94  is positioned in dotted area  90   FIG. 1213  is a corresponding profile view. 
       FIG. 13A  is simplified view of an eighth embodiment of the present invention in an open position.  FIG. 13B  is the garment of  FIG. 13A  in a closed position. In this embodiment, garment  100  is a one-piece cylindrical structure. (In  FIGS. 13A and 13B , the exterior straps of the garment have been removed for clarity of illustration. The exterior straps are shown in  FIG. 13C ). The device is first supplied as shown in its “open” position of  FIGS. 13A and 13C . An adhesive tab  110  is provided on the outside of the cylindrical device. Garment  100  is either placed on the body limb, and then “closed” to the position shown in  FIG. 13B ; or alternatively, garment  100  may be closed and then fitted over the body limb. In operation, adhesive tab  110  (which may comprise Velcro®) is simply pulled forward and attached onto the body of the cylinder, as shown. This causes garment  100  to be folded over onto itself (to the position of  FIG. 13B ), thereby narrowing the circumference of the garment (such that it applies therapeutic pressure to the limb). Similar to the embodiments described above, the positioning of adhesive tab  110  may be set such that it best conforms to the shape of the particular patient&#39;s limb. Therefore, measurement indicia may be printed on the outside of garment  100  (either along the top and bottom edges and/or along the mid section of garment  100 ). The user therefore simply moves adhesive tabs  110  to a preferred position corresponding to the measurement indicia. For some patients, the top tab  110  may be moved farther forward before being attached to garment  100  (e.g.: if the patient has a thinner calf). For some patients, the bottom tab  110  may be moved farther forward before being attached to garment  100  (e.g.: if the patient has a thinner ankle region).  FIG. 13C  shows exterior bands or straps  22  and  32  (which are attached to the exterior of the garment on the opposite side as shown in  FIG. 13C ). Bands  22  and  32  are used to tighten the garment around the patient&#39;s limb, using the same system as was described above.  FIG. 13D  corresponds to  FIG. 13B  and shows the folded over section  120  when garment  100  is moved to its “closed” position about the body limb. It is to be understood that in various embodiments of the device, folded over section  120  may be trimmed off and removed for patient comfort. This would result in a garment operating essentially the same as a two-piece (spine and body) device as described above. 
       FIGS. 14A and 14B  show an alternate embodiment of the present invention which uses one or more guide bands  200 . In  FIG. 14A , a single guide band  200  is used. In  FIG. 14B , a pair of parallel guide bands  220 A and  200 B are used. 
     Guide bands  200  operate to wrap together with body portion  20  around a limb prior to bands  22  and  32  wrapping body portion  20  and spine portion  30  together around the limb. 
     Preferably, bands  200  have a fixed end  202  and a free end  204 . Fixed end  202  is attached (e.g.: sewn or glued) to body portion  20 . Free end  204  is preferable connected to body portion  20  by hook and loop fasteners and is thus positionable on body portion  20 . As a result, guide band  200  can be adjusted such that its circumference and positioning around the body limb is optimal. In operation, the guide bands  200  can be used as a guide sleeve once the garment has been sized to the user. This allows the user to slide the garment on and place it in a desired position on the limb before donning the compression bands (i.e.: tightening the garment around the limb). As such, the user need not hold the device in place by first securing the top two bands in position (and then start applying the bottom bands with compression, working their way back up to the top.  FIG. 14C  shows an alternate embodiment with guide band  200  being attached at one end  204  to spine  30  and the other end  202  attached to body portion  20 . In this embodiment, the band  200  in  FIG. 14C  may be made of two pieces that can be fastened together, as shown. 
       FIGS. 15A to 15D  show an alternate embodiment of the invention in which the garment forms a non-planar shape when the body and spine portions are secured together (prior to the garment being wrapped around the body limb). The advantage of this particular non-planar shape is that once the two portions are fastened together, the garment forms a contoured shape that matches the shape of the user&#39;s limb. In the case of a knee (or elbow), the contouring is especially helpful in that it reduces bunching that often occurs during flexion. 
       FIG. 15A  shows the shapes of the body and spine portions prior to being secured together. Body portion  20  has a first side  25  (from which bands  22  extend) and an opposite second side  27 . Similarly, spine portion  30  has a first side  35  (from which bands  32  extend) and an opposite second side  37 . The operation of the body and spine portions and their associated bands is similar to that described above. However, what is different in the embodiment of  FIGS. 15A to 15D  is the novel geometry of sides  27  and  37  which when attached together give the garment a non-planar shape prior to the garment being wrapped around the limb of a patient. By joining the second side  27  of the body portion  20  and the second side  37  of the spine portion  30 , the garment is given its novel non-planar shape. 
     In preferred aspects, at least one (or both) of the body and spine portions are dimensioned to be narrower across their mid-sections than across either or both of their top and bottom edges. Specifically, body portion  20  is narrower across its mid-section  29  than across either of its top edge  21  or bottom edge  23 . Similarly, spine portion  30  is narrower across its mid-section  39  than across either its top edge  31  or its bottom edge  33 . Stated another way, the second sides  27  and  37  are curved inwardly at their mid¬sections and outwardly at one or both of their top and bottom edges. It is also to be understood that one or both of the body and spine portions may be curved inwardly at its mid-section. For example, edge  27  may be curved while edge  37  is straight, or vice versa; or both of edges  27  and  37  may be curved. This illustrated embodiment is particularly useful if the center of the garment is applied around a knee or elbow. Conversely, however, if the center of the garment is instead applied around a calf, then the mid¬sections  29  and  39  may instead be wider than the top and bottom edges  21 ,  31  and  23 ,  33 , respectively. It is to be therefore understood that the present invention encompasses embodiments with the mid-section of the garment being wider or narrower than the top and bottom edges. 
     In preferred embodiments, indicia will run along not only the top and bottom edges ( 21 , 31  and  23 , 33  respectively) of the garment. In addition, indicia will also preferably run along the mid-sections  29 , 39  of the garment as well. As such, optimal sizing and placement of the body and spine portions can be achieved, and the garment will achieve its desired contoured shape. 
       FIGS. 15B to 15D  illustrate the novel non-planar shape the garment assumes when edges  27  and  37  are connected or held together. Edges  27  and  37  may be sewn together at their edges, and/or they may be held together by connector  300 . Connector  300  preferably spans across edges  27  and  37  as shown. Connector  300  may be sewn or glued directly onto body portion  20  and spine portion  30 . Alternatively, connector  300  may be attached to body portion  20  and spine portion  30  by hook and loop fasteners. 
     As can be seen, connector  300  may be formed from a continuous body of material with a series of notches  302  extending along one or both sides of the body, as shown. Notches  302  permit connector  300  to flex in a lateral direction (perpendicular to the central axis of connector  300 ). In preferred aspects, notches  302  extend across more than half the width of the connector.