Lymphedema bandaging consists of wrapping the affected limb with multiple layers of materials such as cotton, foam padding and bandages to gently decongest the lymphatic pathways, improve tissue elasticity and to finally reduce the size of the limb. To date, very little research has been carried out to investigate the best combinations of bandages or different bandage application techniques¹. Most of what we know and rely on today has come from clinical experience and tradition.

Bandages are an important part of decongestive lymphatic therapy (DLT) and are used in a variety of contexts, such as:

  • Intense therapy sessions that help reduce swelling so that compression hosiery can be applied
  • Long-term use when certain individuals cannot wear compression garments
  • To help control swelling symptoms in patients with complex medical issues
  • As part of any patients long-term management strategy to control swelling

The ideal compression system for lymphedema patients

An increased understanding of the technology used to make compression materials has helped define ‘best-practise’ for oedema management and has lead to significant improvements in the techniques being used in clinical practice. For patients with chronic lymphedema, the ideal compression system is one that:

  • Provides adequate external force to oppose fluid filtration from blood capillaries into the interstitial tissue space
  • Enhances muscle pump function and promotes the lymphatic and venous return
  • Provides and maintains effective levels of compression during walking and rest
  • Uses ‘stiffer’ materials to produce greater variations in interface pressure

There are two main types of bandages used for compression therapy- long-stretch (elastic) and short-stretch (inelastic). Clinical experience has shown that compression therapy for lymphedema is based mainly on the use of short-stretch bandages, applied in multiple layers to exert high pressure on the skin. In order to understand why short-stretch bandages are used, it’s important to know how each bandaging type works when in contact with the skin.

Short Stretch or inelastic bandages:

Maintaining effective levels of compression throughout the day is better achieved using short-stretch bandages. These bandages are defined as having low elasticity and have an extensibility of less than 100% to 120%. They are effective in patients with good mobility and are particularly recommended in cases of severe oedema.

Short-stretch bandages are made using stiff materials, which helps create the best balance between working and resting pressures. High working pressure is created when the calf-muscles press against the bandage when the patient is active and walking. These bandages compress the limb at irregular intervals, alternating between high and low pressures. This forms an internal ‘pumping action’ that shifts fluid out of the tissues and back into the vessels of the lymphatic system. Low resting pressure refers to the pressure applied against relaxed muscles (eg: while sleeping). Short-stretch bandages exert a low resting pressure when muscles are inactive and continue to reduce the spaces in tissues where fluid can leak in. This means that they can usually be kept on day and night and are tolerated well by the patient.

Figure 1: Resting and Working Pressures. Left: Resting pressure – the bandage or compression garment applies a constant pressure to the skin when the limb is at rest Right: Working pressure – when muscles contract and expand (eg during exercise) they press against the resisting bandage and the pressure inside the limb increases temporarily.

One thing to note about short-stretch bandages is that the interface pressure drops nearly 50% from its initial value within the first few hours following application (and up to two-thirds of compression loss after 24 hours). This happens at the very start of compression therapy when the volume of the limb and resorption rates are at their greatest2. Clinical experience recommends that patients reapply bandages every few hours in the first week of therapy in order to maintain the correct levels of compression.

Long-stretch or elastic bandages

Long-stretch (or elastic) bandages contain elastic fibres and can be stretched greater than 120% of their original length. These bandages produce a constant pressure on the skin, which is almost the same at rest and at work. This means they often need to be taken off at night time as they are difficult to tolerate while sleeping. The elastic properties in these bandages create a low stiffness level (SSI) and do not produce the same massaging effect on the muscle when the patient is active3When in contact with the skin, long-stretch bandages actually increase in working pressure and stop the venous and lymphatic vessels from adequately filling.

Long-stretch bandages were previously used in oedema management but current clinical evidence shows that these types of bandages are better suited to patients with low mobility (or none) who are incapable of sufficiently activating their calf-muscle pump4, and those who have venous conditions.

Consulting with your lymphedema therapist

If you are followed by a qualified lymphedema therapist, they will be the best person to assist you in getting started with bandaging. They will be able to guide you in choosing the most appropriate materials for your unique condition and make sure you are banding using the correct technique. Your therapist will also be able to show you how to care properly for your bandages.

Before starting any type of compression therapy, it is also recommended to consult with a vascular specialist and undergo a comprehensive clinical assessment to check ankle brachial pressure index (ABPI) or toe brachial pressure index (TBPI) for any arterial insufficiency. Compression therapy is contraindicated in individuals with certain diseases and conditions, so it’s best to check that you don’t fall into any of these categories before you start bandaging.

For those people who are not followed by a lymphedema therapist, we still recommend getting in contact with someone who can show you the proper bandaging technique. Some places (such as hospitals and compression garment suppliers) offer workshops on lymphedema bandaging. We highly recommend attending one of these workshops so that you can get your bandaging off to the right start!

 

References:

1: Lymphoedema Framework. BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA – 2ND EDITION. 2012.

2: Lymphoedema Framework. Template for Practice: compression hosiery in lymphoedema. London: MEP Ltd, 2006.

3,4: URGO Medical. Veno-lymphatic compression: The best type of bandages. Loughborough, 2015.

Image consent: We would like to thank the International Lymphoedema Framework, for their kind permission to reproduce Figure 1: Resting and Working Pressures.

 

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