No matter which way you look at it, lymphedema bandaging is not the most fashionable trend one could hope to find themselves wearing! Wrapping yourself in multiple layers of foam, cotton, padding and bandages and ending up with a leg or arm that looks twice as big as before you started is pretty depressing! The thing is, that bandaging is one of the most important management practices you can undertake to help control and reduce your swelling.
Bandaging starts to become an important treatment tool for people who have lymphedema stages 2 and onwards. It involves wrapping the affected limb in multiple layers of materials to gently move fluid from the area and improve tissue elasticity.
For those of you who are new to bandaging (or just need to brush up on your skills), we have put together a complete list of the essential items you need to get started (which applies to both arms and legs). A list of online stores has been provided at the end of this article to help you find all the listed materials.
A brief overview of why you should bandage
Becoming proficient in the art of bandaging your lymphie limb is a must. It’s a self-care tool that you will use time and time again to help control flare-ups and during decongestion periods. You may even choose to use it as part of your daily routine to help manage your swelling. It takes time and practice to get it right, but once you master the bandaging technique, you will be thankful that you spent the time to do so.
There are a few main reasons why bandaging is important for lymphedema management.
- It directly improves the function of the veins and lymphatics in the underlying tissue by impacting resting and working pressure.
- It reduces capillary fluid filtration because tissue pressure is increased
- When used with foams and padding, bandaging can help loosen and break up tissue fibrosis which softens and improves the elasticity of the skin.
- It enhances muscle pumps by applying a gentle external pressure on the skin, which helps to move excess fluid out of the limbs.
- The overall shape of the limb is improved.
- It helps direct the flow of lymph in the direction you want- up and out of the affected area- thanks to gradient compression.
For a more in-depth look at why bandaging is important for lymphedema, read our article here.
The essential items you need for lymphedema bandaging
1Skin care: moisturiser
Moisturising is the first step in bandaging your limbs, whether it’s your arm or leg. Applying a proper moisturising cream before bandaging helps to keep your skin healthy and hydrated. Don’t underestimate how important this step is! Healthy skin that is free from cracks, sores and irritations is the first line of defence against infections like cellulitis.
The best type of cream to buy is an emollient moisturiser. Emollients soothe and hydrate by covering the skin with a protective barrier that traps moisture. There are plenty of different types of emollients available in the pharmacy or supermarket, just be sure to find one that isn’t perfumed because they can dry out your skin.
2Cotton tubular stocking
The first layer you will apply in bandaging is a tubular cotton stocking. These protect the skin, absorb any perspiration and create a base to hold the other materials in place. A fresh stocking should be used every time you bandage to ensure things are kept clean and hygienic. Cotton stockings accommodate various limb sizes and can be very thin or thick if extra skin protection is needed.
3Gauze bandaging for the fingers and/or toes
For those of you who experience swelling in your fingers and/or toes, you will need to wrap them with gauze bandages. These kinds of bandages are soft and flexible and give a gentle compression to the digits. Two types of gauze bandages can be used- open and closed weave bandages. Open weave gauze bandages conform easily to the contours of the body and closed weave bandages create a bit more compression for digits that really need it. These gauze bandages are also suitable for controlling genital oedema.
Special foams that are breathable and permeable to moisture are used as the next layer in lymphedema bandaging. Foam padding has a few special roles to play: firstly, it creates an ideal base for bandages and helps to prevent slippage. Secondly, foams can be designed with special ridges and channels in them, which assists in the directional upwards movement of lymphatic fluid. When in contact with the skin, they move slightly and create a mini massage effect that stimulates the superficial lymphatic system to move. This micro-massage also helps to break down tissue fibrosis. Lastly, foam padding helps to evenly distribute the pressure on the tissues, resulting in a better-shaped limb once the bandages are removed.
5Short Stretch Bandages
Short-stretch cotton bandages are the most suitable type of bandages to use for lymphedema management. They are called ‘short-stretch’ because they have low elasticity (non-elastic) and have an extensibility of less than 100% to 120%. They significantly improve venous return and lymphatic drainage thanks to their low resting pressure and high working pressure. Working pressure means that these bandages help to create a massage-like effect on the calf-muscle when the patient is walking or exercising. This massage enhances the muscle pump by pushing the venous blood flow from the superficial network to the deep network¹. The low working pressure makes them suitable for night use as they exert a lower pressure, making them tolerable to wear while sleeping.
Different sized bandages are needed for different sections of the arm or leg. Your lymphedema therapist can advise you on what lengths you need to buy and how many layers of bandages you require.
There are a couple of options when it comes to securing your bandages. Firstly, you can use a good quality adhesive tape that adheres well to the bandages but leaves little residue when removed. Another option is to use a cohesive bandage product like Handygauze Cohesive (BSN Medical), that wraps around the top of your bandages and holds them firmly in place without adding any additional pressure. Surgifix (a soft elastic net bandage) is another interesting product that ensures the bandage is held firmly in position, without restricting patient movement.
You may also find materials in your house that can help keep bandages attached and in place. For example, lycra bicycle pants are good to hold the top of bandages in place (as long as they are not too tight around the stomach or upper leg), or regular panty hose (that are not compressive) can be put over the top to stop bandages from unrolling.
7Optional: Focus padding
Specific placement of focus padding can help decrease fibrous tissue and improve the softness and shape of the limb. These are applied before the application of short stretch bandages (if needed). There are a variety of focus padding items available for different parts of the body:
- For problem areas like the ankles, elbows and knees, it’s possible to buy pre-cut shapes that create definition around these bony areas by applying spot pressure.
- Similar to the pre-cut shapes, it’s possible to buy ankle support socks that have silicon moulds already integrated into the sides of the sock (for example, a Malleotrain by Bauerfeind or Activmove Talomotion from BSN Medical).
- Mobiderm- small chunks of foam that are encased in a soft cotton roll which assist in breaking tissue fibrosis.
- Foam sheets with micro-massaging channels.
- Closed cell, medium density foams.
- It’s possible to create custom shapes from foam sheets if you can’t find something that suits your needs.
A final word on getting started with bandaging
Getting started with bandaging is much easier if you have a qualified lymphedema therapist to help show you the ropes, so we do recommend consulting with your therapist before going ahead and attempting to bandage your own limb. As with anything in the lymphedema world, it’s important to get the ‘all clear’ before bandaging as there are contraindications for bandaging if you possess certain health issues.
Your therapist can also help guide you on the correct materials needed for your personal circumstances. Once you have all this information, you will be set to start this amazing self-management practice!
Where to buy bandaging supplies
Below we have included a list of online vendors that stock bandaging supplies. Note: It’s possible to buy bandaging kits with all these components already inside which makes it easier and convenient to use!
Performance health in Canada has a great video from Lohmann & Rauscher which gives an overview of the materials needed for bandaging as well as a demonstration on how to bandage upper extremity lymphedema.
1: Urgo Medical 2009. http://www.urgo.co.uk/293-the-different-types-of-bandages