An essential part of the treatment and management of lymphedema are compression bandages. For me, it is an automatic part of my daily ritual that after my shower, applying skin lotion comes compression wrapping of my legs.
This page gives complete information on what compression bandages are, what they do, how to wrap your limb and the care of your bandages.
The goal of compression wrapping is to build a “custom fitted” compression garment for the affected limb(s), applied daily by patient and caregiver, which will help to massage the fluid out of the affected area during normal movement and keep out the additional fluid. The wrapped limb should look uniform and smooth ll the way up with few bulges and hollows as possible.
1.) Assemble all material in area you will be using to wrap
2.) Be comfortable. Sit or lie while wrapping foot.
3.) Stockinette goes on first.
4.) The gauze (Elastomull) toe/foot wrap goes on second
a. The first round is an “anchoring” wrap. Start with the tail under the roll, laying the tail on the top of the foot and bringing the roll completely around the arch back to the top of the foot to catch the end. Then go back around the foot again back to your starting point.
b. Bring the gauze up to the tip of the first toe. The first round on the toe angles up close to but not over the tip. Wrap each toe until covered, 1-4 rounds, spiraling down toward foot. Do not allow to bunch behind the toes. Do not pull tight.
c. Anchor around foot after each toe is covered. Coming off the back of the toe, bring the gauze around sole to the top of the foot and proceed to the top of the next toe.
d. Finish remaining toes in same manner. Wind left over gauze around foot loosely, spiraling toward ankle.
5. If used, apply white fluffy padding (Artiflex) now. Wrap entire leg, putting several layers around knee. Cover heel well also.
6. If used, foam pad goes on top of the foot so the edge rests at the base of the toes. You might have enough gauze left from wrapping toes to secure the foam piece.
7. If used, place foam pads over ankle bones. Padding might also be recommended over the front of the ankle. This fills in the hollows. Wrap over foam.
8. Place the additional pieces of foam, chip bags, or other padding where they have been determined to be the most effective. Vary the formula for filling in spaces.
9. Brown (Comprilan) bandaging goes on last. Do not wrap toes. Start with an 8cm wrap on the foot at the base of the toes. Toes should be pointing up, foot pulled toward body (flexed).
10. You will probably use 2 of the 8cm rolls on the foot and ankle. Roll around the foot once or twice, then roll around the ankle, around the foot angling up and down to form the herringbone pattern. Continue until you have covered foot and ankle. Keep loose, especially across front of ankle.
11. After the ankle roll, start with 1-3 rolls of 10 cm bandage. This should cover upto or just over the knee. Continue up the thigh with 2-6 (or more for very large areas) rolls of 12cm bandage. Remember to pad behind the knee.
12. If slipping down of bandages is a problem, especially in the thigh area, a roll of white bandage (Isoband) can be spiraled around the limb, like a foundation, to which the brown bandages can cling.
13. You may tape ends of bandages to secure. As you become more experienced, you may be able to use less tape. Tape only to the brown bandages.
14. Alternate the direction of each wrap as you add it.
15. Bandage Knee
a. On the lower leg, complete the bandage to just below the knee.
b. The next bandage, roll one time around the lower leg just below the knee
c. Complete the circle around the thigh, above the knee
d. Bring the bandage down at an angle across the patella (Knee cap) to below the knee
e. Circle the lower leg completely, returning to the front of the leg. Angle the bandage up across the patella (knee cap)
f. Each bandage is about 1/2 inch lower than the previous pass on the thigh, and about 1/2 inch higher than the previous pass on the lower leg.
g. Complete the instructions 3 through 7 until you have used up the bandage. One entire bandage is used to “cage” in the knee.
h. Start the next bandage belowe the knee on the lower leg. Spiral up over the baandaged knee, this time widening your spacing to about 1”.
16. Avoid wrinkles, bunching, gapping and loose ends in the wraps.
17. You may give small tugs as you bandage to keep the wraps firm. Do not pull the bandage roll as you may wrap too tight. Check the uniformity of the compression by plucking at the wraps and comparing the tension.
18. Wrap all the way to the groin, capturing the fluid at the top of the thigh as much as possible. Bandages are more likely to stay up if the leg is wrapped up to the junction between the leg and body.
19. Tape securely at the top and cover all with stretch fishnet (Tubigauze/Elastinet)
20. You should sleep in your wraps. Wear your wraps 22 hours per day, off only to bathe, lotion, dress and allow skin to “breath” for about 2 hours per day. After you have completed the intensive phase of therapy you may sleep in your wraps and wear a compression garment during the day.
**Special thanks to Healthsouth Lakeshore Rehabilitation Hospital - Birmingham, Alabama
Lymphedema banding is one of the most powerful components in the treatment process. When a good bandage is applied, it will function as a custom-made compression garment, each and every time. While the extremity is reducing in size, the bandage is adapting to the new dimensions. A pre-made elastic garment will never have this adaptability.
It is said that the compression bandage contributes to approximately 50% of the reduction achieved with CDT. With this in mind, it is clear to proficiency in the bandaging techniques is crucial to achieve the best possible outcomes.
It increases the effectiveness of the muscle pump mechanism It increases the overall tension in the affected extremity and therefore reducing ultra filtration It supports the skin while it is reducing in size
The lymphedema compression bandage is best described as a multi-layered low-compression bandage. The compression is achieved by the thickness of the bandage, not by the tightness. The bandage will easily consist of 8-10 layers, especially more toward the periphery. The layers may consist of different materials, each with their own distinct function. They can be distinguished in 3 basic layers. These are the absorption, equalization and the compression layers.
The absorption layer is in direct contact with the skin. Its main function is to absorb perspiration and to be a barrier between the skin and the layers of the bandage and thus minimizing irritation and increasing the comfort.
Materials of the absorption layer are preferably cotton-based and washable. Frequently used materials include Stockinette tubular or flat bandages without significant compression or Tubigrip tubular bandages with some compression. The advantage of tubular bandages is the ease of donning/doffing, but the fit may not always be optimal. The advantage of flat, single layer material is the more custom fit, but it requires about two layers for optimal coverage and it is slightly more complex to apply, especially with self-bandaging. Most of this material is washable and reusable.
This layer is placed over the absorption layer and consists of materials that aide in pressure distribution. If used correctly, this layer can be used to equalize, focus or relieve pressure at certain areas within the bandage. This material can be foam, cast padding or a combination of both. Foam is much more durable than cast padding, but it adds significant thickness to the bandage. Cast padding only last 3-4 applications, but it adds significant comfort to the bandage. The ideal solution is a combination of cast padding with foam inserts.
Foam inserts can be used to add compression to an area such as a fibrotic patch or to protect an area from over-pressure such as the shin. Another use can be a foam insert with a cutout to protect any open wounds in the extremity. If no foam is available, pads can be made by using multiple layers of the cast padding material. If cost prohibits the purchase of foam, consider foam rubber packing material.
To get an even layer of cast padding, use at least 2 layers throughout the bandage. With foam one layer throughout is sufficient.
This layer is giving the actual compression on the extremity. It consists of several layers of short-stretch bandage material. Brand names include Comprilan, Conco, Rosidal-K, and many others. Short stretch bandages have only about 20% stretch, compared with up to 100% of elastic bandages such as Ace.
To secure the bandage in place tape is recommended over the elastic clips that are often supplied with the bandages. These clips have sharp points at the edges that may cause small wounds that will worsen the condition. With normal use one strip of paper-tape for each layer and 4-5 strips for the final layer will be sufficient. If the patient has no paper-tape available, masking tape can be used. Avoid using silk-tape, since the heat of the bandage will soften the glue and make for a very sticky bandage after several uses.
The cost of the lymphedema bandage can become quite high. The materials for the absorption layer are quite cheap, the equalization layer materials vary from cheap (cast padding) to more expensive (foam rolls), but most of the cost will be in the compression material. Depending on the size, manufacturer and vendor these will vary from $5 to $10 per roll. Depending on the size of the extremity and the extend of the bandage 4 to 15 compression bandages may be used leading to a cost from $25 to $125 per bandaged extremity! Insurance companies rarely reimburse for these costs.
Depending on the setting different solutions are used to offset these costs. One solution is to absorb the cost of the bandage materials into the cost of the treatments. Another solution used is to give the patient a “shopping list” of the required materials and have them buy the supplies at a recommended vendor. The first option may work better for clinics with a large volume of low-income patients, but the second option tends to facilitate more responsibility from the patient since they will have to purchase more materials if bandages get lost or damaged.
The absorption layer and the compression layer materials are washable. Use a gentle detergent, but no Woolite, since this affects the elasticity in the bandage. Let the bandages air dry, but keep in mind that it will take 2 to 3 days for them to dry completely. This means that the patient may need a second set of bandages to wear while the first set is in the wash.
Since the compression in the lymphedema bandage is achieved by resisting the muscle pump, it is essential to not apply the bandage too tight. Upon completion, the compression bandage will have a consistency somewhere between a cast and a regular bandage. This can be easily checked by tapping on the bandage. It should have a firm consistency with minimal give. When completed, the compression of the bandage should be within the 30-40 mmHg compression range.
As with most things in life, good preparation makes for an easy task and so does practice. Have all supplies ready and within range prior to start bandaging. This means having all the bandages out of the box with all clips removed, tape pre-cut and ready to go and if required any wound dressing materials ready for use with all packages opened. If the compression bandage material has already been used, make sure that it rolled up tightly. If the roll is too loose, the bandage most often will be applied too tight. A tightly wrapped bandage roll will enable easily rolling off, maintaining full control over the bandage application. Practice the application of the bandage frequently, as this will increase the speed of applying it and with that the consistency of compression with each application.
In the clinic the use of a high-low table and bolsters will further increase the ease in applying the compression bandage.
The techniques described on the following pages are based on several years of experience with very large patients with a very limited support system. It is not always consistent with bandaging taught in certification courses. The modifications have been made to increase mobility of the patient by freeing up the main joints and to increase the endurance of the bandages.
The lower leg bandage is indicated on patients who are referred for lymphedema treatment but have mainly a venous insufficiency problem. It is easy to apply with a limited amount of bandages and this can be easily taught to a partner or caregiver. It will maintain excellent mobility for the patient since it is not affecting the knee joint. It is however essential to monitor the patient closely for any swelling starting right above the proximal edge of the bandage. This is why this is mainly used while the patient is still in treatment. It will usually require 4-5 rolls of compression bandage to effectively bandage the lower leg. All bandage techniques demonstrated assume no wounds on the extremities. Make sure to check for proper circulation in the toes throughout the application of the bandage. If the toes turn purple or cold, start over again.
Cover the lower leg with Stockinette, either tubular or flat. When using the flat material, use approximately 2 layers to cover the lower extremity. Have some extra overlap over the toes and over the knee. At a later stage this can be folded back for a more finished look.
Cover the lower leg with at least 2 layers of cast padding, applied in a spiral motion over the foot, a figure-8 over the ankle and a spiral motion over the rest of the lower leg, to just underneath the patella.
Anchor the smallest of the compression bandage (6cm width) over the fore foot. Next bring it behind the heel. Circle the fore foot again and go back behind the heel. Repeat this a total of 3 times. After the third time, come up from behind the heel and finish rolling the bandage over the lower leg with a herringbone technique. At this time make sure not to cover the anterior ankle, since having too much material will limit ankle motion and can be a cause of irritation. On the lower leg use a 2/3rd overlap, meaning that only 1/3rd of the bandage will stick out from underneath.
This step needs to be used for patients with more severe edema with significant foot involvement. For patients with more venous edema it can often be omitted. Adding this step will significantly thicken the bandage over the foot and therefore make it much harder for the patient to fit into a regular shoe. Wearing a regular closed shoe will act by itself as a compression factor.
Start by circling the ankle in three steps, still ensuring not to cover the anterior ankle. After this, continue the bandage on the lower leg with the herringbone technique, maintaining 2/3rd overlap.
For this step use on size up, the 8cm wide bandage. Anchor at the forefoot, just as in step 3 and spiral up over the ankle. Make sure to only use 2 layers over the anterior ankle. Continue on the lower leg with a herringbone technique, maintaining 2/3rd overlap.
Start just above the ankle with the 10cm bandage, using the herringbone and while maintaining 2/3rd overlap.
Feel the bandage for firmness. Where the bandage feels softer to touch is where the next roll will start. Again, use a 10cm bandage, using the herringbone and maintain the 2/3rd overlap. This bandage should end right underneath the patella. If not, add another bandage roll to complete the compression bandage. Secure the bandage with 4-5 strips of tape.
To finish the bandage off, the absorption material can be folded back and either taped to the bandage or folded underneath the last layer of compression material.
If the extremity is wide or tall, use larger size bandages to accommodate the patient. For very large extremities use double-length rolls of compression bandages. These are available from different manufacturers in the wider sizes (10 and 12 cm).
For patients with severe toe or finger involvement it may be necessary to also wrap these individually. Most authors use one or more rolls of gauze bandage for this purpose. Experience has shown that products such as Coban can be an excellent substitute for this. Cut the Coban in ¼ inch strips and gentle wrap these around the toes or fingers. The main advantage of using this material is that it significantly reduces bulk, which can be especially irritating between the toes.
The full leg bandage described here various from the usually described bandages in that it is a two separate component bandage. The lower part is the lower leg bandage as described above. The justification of this approach is the following. The thigh is significantly softer that the lower leg. Reduction in edema will result in girth reduction at a much higher pace in the thigh than in the lower leg. The bandage will fall apart first at the thigh. Most often the lower leg part will remain intact long after the thigh part has fallen apart. Having a one-piece bandage would mean correcting the entire bandage when the thigh part loosens up. The other justification is that a one-piece bandage significantly reduces the mobility of the knee. The two-piece approach will facilitate activity from the patient, which will help promote circulation.
Apply the absorption layer material on the thigh, partially overlapping the lower leg bandage.
Apply the equalization material, partially overlapping the lower leg bandage. If desired, additional padding may be added behind the knee joint.
Apply the compression bandage to the thigh, starting just above the patella, using the herringbone technique. Depending on the size of the leg, use a 10 or 12 cm wide bandage. If the leg is very large, use a double-length roll. To help shape the lower part of the thigh, a slight tuck can be used at the end of each turn. Make sure not to over tighten the bandage.
This part will connect the lower leg portion with the thigh. First anchor a 10 cm bandage distal from the patella. Next spiral it relatively loosely over the knee joint with 3/4th overlap. Once above the knee joint, continue with the herringbone technique at normal tension. The loose spiral will allow for knee mobility.
Apply this layer identical to the layer in step 9. Start right above the patella again and use the herringbone technique.
Continue with bandaging the thigh with herringbone technique and 2/3rd overlap until the top of the thigh has been reached. Start new layer where the bandage starts feeling softer. Finish the bandage off by folding back the top and taping it off.
The above steps are suggestions for a leg with normal proportions. When needed, modify the bandage to accommodate for irregular shapes by using more padding and foam inserts, but keep the same principles in mind.
The upper extremity compression bandage is similar to the lower extremity bandage, except for the hand technique. An important focus of this bandage is often to give sufficient compression on the dorsum of the hand while maintaining hand dexterity in order not to render the hand useless.
Apply thin (1/4”) strips of Coban® as an anchor around the mid-hand. Next apply strips around each finger in a spiral way with some overlap, starting at the nail bed working toward the mid hand and anchoring the end onto the anchors. When all fingers are covered, close up any open areas with additional strips. Make sure not to pull the Coban® too tight when applying it.
Apply a layer of stockinette over the arm starting at the mid-hand up to the axilla. When using tubular material make a small cutout for the thumb.
Apply the padding material in a spiral fashion with 50% overlap. Additional material may be added to protect the inside of the elbow.
Start with a 6cm compression bandage around the hand an wrist, leaving the thumb and finger open. Apply 3 layers of material. Continue up to the forearm with a herringbone technique.
Apply an 8 cm bandage starting at the wrist with a herringbone technique up to the fore-arm.
Apply additional bandages if needed until just below the elbow.
Anchor a 10 cm bandage just below the elbow. Then loosely spiral it over the elbow joint with a ¾ overlap. Once past the elbow joint continue up the upper arm with a herringbone.
Add additional bandage to the upper arm until the bandage is firm up to the axilla.
When indicated and the patient is deemed capable of doing so, they should be trained in self-bandaging. Of course family members can also be trained in applying the bandages. It is most important to educate the patient about the importance of bandaging, proper technique and care of the bandage materials. Even though it seems complicated and frustrating in the beginning, give the patient or family member positive reinforcement and convince them that any bandage they will apply will be better than wearing no bandage at all.
Take sufficient time during the treatment sessions to practice the bandaging techniques, as proper bandaging at home will help with hygiene and treatment outcomes. It may be good to have several sets of practice bandages in the clinic to avoid wasting time re-rolling them. This may also be a good time to have the patient considering the purchase of a bandage roller, a simple and affordable (approx. $15) tool that will significantly reduce bandage-rolling time.
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by Paige-Leigh Zazzali
For those who have trouble wearing sleeves or stockings to treat their lymphedema, they may opt for compression bandages. These bandages will provide the patient with more comfort because they are not as tight on the limb. Many use compression bandages at night and the sleeves or stockings during the day.
In lymphedema patients, lymph nodes only work when they are compressed. The lymph nodes must be compressed by massage, or a physical form of pressure, such as the Compression Bandages. You want your bandages to be firm, but not too tight. Your doctor will determine the right pressure for your bandages. He should walk you through the proper bandaging procedure a few times until you are comfortable bandaging your limb yourself.
Compression bandages must be washed frequently, if not, daily. This helps keep them clean and retain their elasticity. You should replace your bandages every few months. You will probably want to invest in a few bandages; that way, you will always have a clean bandage when you wash the other ones.
Physicians recommend wearing compression bandages over your stockings or sleeves if you are flying. Cabin pressure can increase swelling and the bandages will provide extra support and comfort. Remember your medicine or prescription when traveling!
Judith R. Casley-Smith
Compression garments and compression garments, are probably the most difficult problem we have had in the maintenance and control of lymphoedema before, during and after treatment. These are not yet completely solved. However the situation is a great deal better than it was when we started Complex Physical Therapy (C.P.T., Complex Lymphatic or Lymphedema Therapy - C.L.T.) in Australia, in 1987. They are an absolutely essential adjunct to this treatment.
Bandages are essential during C.P.T., since the limb's size changes rapidly and so the size of the compression 'garment' and the amount of compression must also change rapidly. They are necessary partly because of the destruction of the elastic fibres of the skin in lymphoedema, to maintain the reductions gained by massage in the newly lax tissues, and to reshape the limb - using specially shaped padding. They will also cope (via the addition of special padding) with the variation in limb size from one area to another, e.g. a large bulge to a much more constricted area, which a compression garment cannot control.
In palliative care, bandages (and, particularly, garments) are often contra-indicated, unless they provide relief for the patient.
If the patient is able to bandage themselves after treatment, then they may find that bandaging at night, rather than wearing a compression garment is much more comfortable. It is certainly preferable to wearing a compression garment which becomes too tight to permit sleep. The bandaging may need to be redone during the night. (This increase in size and the aching of a limb at night is due to the lack of movement which causes a lessening of the pumping by the tiny initial lymphatics.)
A bandage at night is also more comfortable than an 'elastic' compression garment because of its low resting pressure (see below); garments have to be made more elastic than bandages simply so that it is possible to get them on. However bandaging in place of wearing a compression garment at night is only preferable if the patient has been properly taught the principles of bandaging and is able to bandage the limb without causing damage.
If a garment is worn at night, it may need to be of a lower compression. At night, if necessary, one can use a garment that is starting to wear out. It is important to keep as much compression as can be tolerated (i.e. as close as possible to that used by day).
Bandaging over the compression garment is also recommended during long aircraft flights. The low cabin pressure (as well as the long time sitting motionless), can cause swelling even in spite of a pressure garment which is normally quite adequate. This is especially important immediately after a course of C.P.T., when the limb is very vulnerable!
Bandaging at night and in aircraft is particularly recommended for patients whose lymphoedema has a hyperplastic component, i.e. with mega-lymphatics in the subcutaneous tissue and other areas. (This hyperplasia is often associated with too few deep collecting lymphatics.) Elevation at night is also recommended for these, and for those with lymphoedema whose limbs are still soft and pitting.
Indeed if a patient's limb reduces overnight without a garment or bandages, then it is not necessary for them to wear one at night. If it increases without these aids, then they must wear one at night. They must also of course wear one during the day.
There is a problem about how elastic bandages should be. Some elasticity is essential if they are to permit movement (of both joints and muscles) and if they are to fit closely around the curves.
On the other hand, if the bandages are too elastic they are useless. As a limb is moved, it presses or relaxes against the bandages and the total tissue pressure will vary; this variation is inversely proportional to the elasticity of the bandages. During walking, the greater the variations in total tissue pressure, the greater is the lymph flow (and, incidentally, the less frequently venous ulcers develop and the more rapidly they disappear). Hence the less elastic bandages are, the greater will be the variations in total tissue pressure, with all their benefits for increased movement of fluid in the interstitial tissue, uptake by the initial lymphatics and transport by the collecting lymphatics.
A compromise must be achieved. Limbs which will be subjected to extensive movements should have much more elastic bandages than those that probably will only be moved to a small extent. The more elastic bandaging will facilitate movements. If the movements are extensive, the tissues will be subjected to a range of total tissue pressures similar to those experienced by more rigidly encased ones subjected to lesser motions. The supporting bandages of a sportsman with a mildly torn ligament should be more elastic than those around the lymphoedematous leg. When the sportsman is relaxing, his bandages should also be much less elastic.
Which bandages to use in the clinic situation or after treatment depend on a number of things. They must be able to maintain the required compression. This means that they must be strong and able to be tightly pulled, and durable.
A sleeve or stocking of gauze which can be changed and washed daily should first be put on. Do not cut this to the length of the limb; it needs to be almost double this length so that it will be the right length when stretched sideways, and to allow for shrinkage.
Fingers or toes may need to be bandaged separately at this stage.
Suitable padding should be applied, starting at the distal end of the limb (the foot or hand) and working up the limb towards the trunk. This is to prevent indentations forming from the outer bandaging and to equalise the pressure over the entire limb. It will also prevent chafing and protect any tender areas.
As well, foam padding (of various densities, shapes and formations) is applied to shape the limb, fill hollows, even-out pressure of the outer bandage, and break down fibrotic areas.
Finally, the low-elastic (low-stretch) bandage is applied.
Again one starts at the distal end of the limb and works up. The width of the bandage increases, with the smallest width being used adjacent to the fingers or toes, and gradually widening as bandaging progresses.
A very wide one may be used around the abdomen, to the waist if necessary. This can be achieved by joining bandages together, end-to-end (for ease of application) and also side-to-side to make a wide enough bandage. (Use a zig-zag stitch.) An even gradation of pressure is essential. This must be greater at the fingers or toes and gradually decrease towards the trunk.
There are a number of methods of bandaging, all of which work. The use of an extra outer layer of bandaging to provide extra compression allows a patient to remove just the outer layer at night if it is unendurable. The knee joint should be bandaged in an extended position.
If you have trouble keeping the bandage up, 'Handygauze Cohesive' or 'Surgifix' (tubular elastic net) - Beiersdorf - can be used for a few winds under the last part of the bandage. You should also firmly tape the end of each roll to the previous one.
Bicycle pants (Lycra) also help hold the top bandages in place without putting too much pressure on the thighs. A panty-girdle can provide extra abdominal pressure, but must NOT cut in at the waistline.
Orthopaedic, or adjustable, open-toe shoes are good during treatment. These accommodate the extra bulk during treatment and are available from a number of surgical suppliers.
Bandages must be washed frequently. This not only keeps them clean, but helps them to regain their shape and elasticity. They should always be rolled, under tension. Do not attempt to apply unrolled bandages. Always apply bandages so that the roll is uppermost, facing you, and rolling away from your fingers - thereby applying the bandage from underneath the roll. Thus correct tensioning is easier.
Note that the available finger and toe bandages are more elastic than those for the limb. For this reason, do not apply them as tightly, or with as many layers. The tips of the fingers or toes should not turn white! These bandages are applied by wrapping one digit first and then passing the bandage completely around the hand or foot, just proximal to the digits, before commencing to bandage the next one. This prevents 'webbing'. If there is a bulge, e.g. at the upper part of the foot which creates an indentation between this and the toes, a small role of foam may be used to fill the gap. The above bandaging will also give some extra pressure at this point if it is required.
N.B. bandaging should never be applied so tightly that is causes severe aching or pain. Analgesics should never be used just to compensate for this. The patient should get up and walk around or do some arm exercises. If this does not relieve the pain, the bandage MUST be removed and re-applied. Patients may have to put up with a certain amount of discomfort, bulkiness and tightness during treatment, but they must be vocal and complain if pain becomes a problem.
The lymphatics only pump when they are compressed (by muscular contraction, massage, or other form of pressure) against something solid and unyielding; too elastic bandages just give way and do not compress the lymphatics, which hence do not pump.
A bandage with low elasticity (low-stretch) causes a high pressure within the limb when a muscle contracts (the working pressure), thus compressing lymphatics. The resting pressure, however, is low - i.e. there is less pressure when the muscles are relaxed than would be the case with a highly elastic bandage (high-stretch); hence the lymphatics can fill more readily. This is why bandages are more comfortable at night than compression garments (which usually have a higher resting pressure because they are more elastic).
Crêpe or elastic bandages (including Ace) are not suitable. They have a high resting pressure and a low working pressure, which is just opposite to what is needed. They will not only be uncomfortable and keep one awake at night, but will not control the lymphoedema.
Arm: 6 cms → 8 cms → 10 cms
hand ————> upper arm
Leg: 8 cms → 10 cms → 12 cms
foot —————> thigh or 10 cm - 12 cm foot to thigh
Padding - see suppliers. Padding under short stretch bandages comes in a variety of widths. Use as appropriate - usually 6 cm, 10 cm and 12-15 cms.
Tubular bandage used under the padding. It comes in a large number of sizes. This can and should be changed and washed daily. Measure the circumference of the largest part of your limb and divide this by 2. Give this to the supplier. They should be able to work out the correct size to send. Some are softer than others; some shrink with washing daily.
These are elastic bandages so apply with care (not too tight!). With many of these, use a 5 cm one and fold it in half, lengthways. Reroll the folded bandage before applying. Wash folded and reroll.
Crepe bandages may be used. They come in a 15 cm width. Even better are two of the 10 cm Comprilan bandages joined edge to edge length-ways (i.e. not end to end!) with a zigzag stitch to maintain elasticity and to avoid overlapping the bandage and making a ridge. This combined bandage may be joined with another similar one (end to end) to achieve the length needed. A suitable panty-girdle which does not exert extra pressure over the thigh bandages may take the place of this.
Adhesive bandages are suitable for venous disorders with only a mild lymphoedematous adjunct. They are usually taken only to the knee, may be left on for three weeks, but not with significant lymphoedema.
1. Fingers or toes - bandage.
2 .Tubular stocking - over whole of limb.
3. Padding over whole of limb (plus foam padding where necessary).
4. Short stretch- outer bandage - over whole of limb.
Use tape (never clips) for joining the end of one bandage to the next.
5. A heavy crepe bandage or joined short stretch bandages, around abdomen - if necessary.
6. Handygauze Cohesive or Surgifix or bicycle pants if you have trouble keeping the bandage up or together at the top.
The pressure of fluid (hydrostatic pressure) in venous and lymphatic vessels of limbs is greatest distally, and gradually reduces toward the proximal end of the limb. For a compression to be effective it must also apply graduated compression. Only through graduated compression is the potential for a tourniquet effect reduced. This concept applies regardless of the condition being treated.
Compression bandaging compensates for the diminished skin and tissue pressure associated with lymphedema and helps to prevent the limb from refilling with lymph. Bandaging follows every M.L.D.
to reduce the ultrafiltration rate to prevent the reaccumulation of evacuated lymph fluid to help break up deposits of accumulated scar and connective tissue Low Stretch Bandages (extensible but not elastic)
to raise skin and interstitial pressure of the lymphedematous limb to create a high “working pressure” resistance to keep “resting pressure” low to improve the efficiency of the muscle and joint pumps When the treatment is complete, the compression bandaging is replaced with a custom-fitted compression garment to maintain the lymphedema reduction. Self-bandaging is recommended at night.
A. 15 minutes - 30 minutes
B. Allow additional time if more than one limb or large difficult limbs.
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Caroline M. A. Badger, PH.D.1, Janet L. Peacock, PH.D.2, Peter S. Mortimer, M.D.31 Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom. 2 Department of Public Health Sciences, St. George's Hospital Medical School, London, United Kingdom. 3 Lymphedema Clinic, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.
BACKGROUND. Multilayered, low stretch bandages (MLB) combined with exercises, skin care, and manual lymphatic drainage therapy are recommended as an intensive phase of treatment for lymphedema patients. The relative efficacy of each of the components of this comprehensive treatment program have not been determined. This study aimed to compare the effect of multilayer bandaging as an initial phase of lymphedema treatment followed by elastic hosiery versus hosiery alone.
METHODS. A randomized, controlled, parallel-group trial was undertaken in the setting of the Lymphedema Clinic, The Royal Marsden Hospital, London. Ninety women with unilateral lymphedema (of the upper or lower limbs) were enrolled in the study. The interventions consisted of 18 days of multilayer bandaging followed by elastic hosiery or hosiery alone, each for a total period of 24 weeks. The main outcome measure was the percentage reduction in excess limb volume.
RESULTS. The reduction in limb volume by MLB followed by hosiery was approximately double that from hosiery alone and was sustained over the 24-week period. The mean overall percentage reduction at 24 weeks was 31% (n = 32) for MLB versus 15.8% (n = 46) for hosiery alone, for a mean difference of 15.2% (95% confidence interval, 6.2-24.2) (P = 0.001).
CONCLUSIONS. Multilayer bandaging as an initial phase of treatment for lymphedema patients, followed by hosiery, achieves greater and more sustained limb volume reduction than hosiery alone.
Margaret L. McNeely Department of Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, CanadaDavid J. Magee Faculty of Rehabilitation Medicine, Department of Physical Therapy, Cross Cancer Institute, Edmonton, Alberta, CanadaAlan W. Lees Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Faculty of Medicine, Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, CanadaKeith M. Bagnall Faculty of Medicine, Division of Anatomy, Cross Cancer Institute, Edmonton, Alberta, CanadaMark Haykowsky Faculty of Rehabilitation Medicine, Department of Physical Therapy, Cross Cancer Institute, Edmonton, Alberta, CanadaJohn Hanson Division of Epidemiology, Cross Cancer Institute, Edmonton, Alberta, CanadaAbstractPurpose. The purpose of this investigation was to compare the reduction in arm lymphedema volume achieved from manual lymph drainage massage (MLD) in combination with multi-layered compression bandaging (CB) to that achieved by CB alone.Methods and materials. Fifty women with lymphedema (mean age of 59 years ± 13 years) were randomly assigned to 4 weeks of combined MLD/CB or CB alone.The primary study endpoint was the reduction in arm lymphedema volume, which was determined by water displacement volumetry and measurement of circumference. Independent assessors, blinded to subject treatment assignment, performed the outcome measurements.Results. Arm lymphedema volume decreased significantly after 4 weeks irrespective of treatment assignment (p < 0.001).Individuals with mild lymphedema receiving combined MLD/CB had a significantly larger percentage reduction in volume compared to individuals with mild lymphedema receiving CB alone, and compared to individuals with moderate or severe lymphedema receiving either treatment.Conclusion. These findings indicate that CB, with or without MLD, is an effective intervention in reducing arm lymphedema volume.The findings suggest that CB on its own should be considered as a primary treatment option in reducing arm lymphedema volume.There may be an additional benefit from the application of MLD for women with mild lymphedema; however, this finding will need to be further examined in the research setting.Breast Cancer Research and Treatment 86 (2): 95-106, July 2004
Wrapping/Bandaging StepUp SpeakOut 2011
Compression bandaging: types and skills used in practical application. June 2011 Internurse.com