Lymphedema Bandaging and Bandages
This page has been updated, please see:
Compression Bandages for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=compression_bandages_for_lymphedema
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Lymphedema
Bandaging
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.
The compression bandage has
the following effects:
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
Materials
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.
Absorption Layer
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.
Equalization Layer
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.
Compression Layer
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.
Tape
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.
Cost
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.
Technique
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.
Lower Leg Bandaging
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.
Step 1
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.
Step 2
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.
Step 3
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.
Step 3a
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.
Step 4
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.
Step 5
Start just above the ankle with the 10cm bandage, using the herringbone
and
while maintaining 2/3rd overlap.
Step 6
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.
Full Leg Bandage
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.
Step 7
Apply the absorption layer material on the thigh, partially overlapping
the
lower leg bandage.
Step 8
Apply the equalization material, partially overlapping the lower leg
bandage. If
desired, additional padding may be added behind the knee joint.
Step 9
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.
Step 10
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.
Step 11
Apply this layer identical to the layer in step 9. Start right above
the patella
again and use the herringbone technique.
Step 12
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.
Upper Extremity Bandaging
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.
Step 1
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.
Step 2
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.
Step 3
Apply the padding material in a spiral fashion with 50% overlap.
Additional
material may be added to protect the inside of the elbow.
Step 4
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.
Step 5
Apply an 8 cm bandage starting at the wrist with a herringbone
technique up to
the fore-arm.
Step 6
Apply additional bandages if needed until just below the elbow.
Step 7
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.
Step 8
Add additional bandage to the upper arm until the bandage is firm up to
the
axilla.
Self Bandaging
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.
Link no longer available
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Compression
Bandages
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.
Proper Care
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!
Link no Longer Available
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Short Stretch Bandages
by Paige-Leigh Zazzali
Compression sleeves and stockings may not be comfortable for some
patients with
lymphedema. Short stretch bandages provide relief and alleviate
swelling in the
affected limb or area. Bandages also allow more flexibility for the
patient.
Short Stretch Bandages can remain on the affected area all day and
night as long
as you still feel comfortable. Patients may use soft cotton padding
underneath
the bandage if they have sensitive skin. Bandages over 6 months old
should not
be used. It is ideal to have two sets of short stretch bandages, and
replace
them every 2-3 months.
Wear And Care For Short
Stretch Bandages
Your doctor or lymphedema therapist assistant will be able to provide
you with
the correct bandages. He/she will also walk you through proper fitting
and
caring practices for your garments. Bandages should be firm. Wash them
everyday
in a mild detergent (Ivory or Dreft-- NOT Woolite) in a laundry bag if
lymph
fluid leaks through the skin.
Short stretch bandages are usually not covered by your insurance
company. Once
you know the specific types of bandages you use, you may purchase them
online.
Many companies provide a wide selection of brand name bandages. They
offer fast
delivery and low prices, with all orders being safe and secure.
Link no longer available
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Compression
Bandages in the treatment of
Lymphoedema
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.
How to Choose and Apply
Correct Pressure Bandages
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.
The principles of bandaging
for lymphoedema should be
carefully followed:
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.
Care of Bandages
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.
Bandages suitable for
Lymphoedema
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.
Low Stretch - see suppliers (outer bandage)
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.
Finger bandages - see
suppliers.
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.
Abdominal bandaging
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
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.
The Order of Bandaging is:
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.
Suppliers of Bandages are listed elsewhere.
Some vital points for the maintenance of bandages are listed elsewhere.
This document was last amended on 26 March , 2002.
The Lymphoedema Association
of Australia
http://www.lymphoedema.org.au/index.htm
..........................
COMPRESSION BANDAGING and
GARMENTS
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.
How Gradient Compression is
Achieved:
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.
Objectives:
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)
Objectives:
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.
Compression Bandages:
A. 15 minutes - 30 minutes
B. Allow additional time if more than one limb or large difficult limbs.
Link and domain No Longer Valid
..............................
| A Randomized,
Controlled, Parallel-Group Clinical Trial Comparing Multilayer
Bandaging Followed by Hosiery versus Hosiery Alone in the Treatment of
Patients with Lymphedema of the Limb
Caroline M. A. Badger,
PH.D.1, Janet L. Peacock, PH.D.2, Peter S. Mortimer, M.D.3 |
..............................
The Addition of Manual Lymph Drainage to Compression Therapy For Breast Cancer Related Lymphedema: a Randomized Controlled Trial Margaret L. McNeely Department of Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada David J. Magee Faculty of Rehabilitation Medicine, Department of Physical Therapy, Cross Cancer Institute, Edmonton, Alberta, Canada Alan W. Lees Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Faculty of Medicine, Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada Keith M. Bagnall Faculty of Medicine, Division of Anatomy, Cross Cancer Institute, Edmonton, Alberta, Canada Mark Haykowsky Faculty of Rehabilitation Medicine, Department of Physical Therapy, Cross Cancer Institute, Edmonton, Alberta, Canada John Hanson Division of Epidemiology, Cross Cancer Institute, Edmonton, Alberta, Canada Abstract Purpose. 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 http://www.annieappleseedproject.org/ ombancontri.html |
Bandages Plus
http://www.bandagesplus.com/ssen/hartco-ss5.html
...........................
Academy of Lymphatic Studies
- Academy Store
http://www.acols.com/store.html
.............................
Allegro Medical
http://www.allegromedical.com/home/default.asp
.............................
Discount Surgical Stockings
http://www.discountsurgical.com/
.............................
Kinesio Taping
http://kinesiotaping.com/Page.asp?CustComKey=35549&CategoryKey=35551
.............................
.............................
Bio Concepts Inc
.............................
Jobst
http://www.store.yahoo.com/support-hose-store/jolyba.html
.............................
Drapers Fitness - Lymphedema Bandages
http://www.drapersfitness.com/
............................
eWellness
http://ewellness.com/search/129
............................
First Aid Direct
http://www.firstaid-direct.co.uk/short-stretch-bandages.htm
=======================================================
For information about Lymphedema
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For information about Lymphedema Treatment Options
http://www.lymphedemapeople.com/thesite/lymphedema_treatment_options_revised.htm
For information about Children's Lymphedema
http://www.lymphedemapeople.com/thesite/lymphedema_childrens_pediatric.htm
===================================================
Lymphedema Glossary
http://www.lymphedemapeople.com/forum/topic.asp?TOPIC_ID=247
=======================================================
Index of articles of LYMPHEDEMA TREATMENT OPTIONS
Lymphedema Treatment Options
http://www.lymphedemapeople.com/thesite/lymphedema_treatment_options_revised.htm
Acupuncture Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_acupuncture_treatment.htm
Benzopyrones Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_benzopyrones_treatmen.htm
Compression Pump Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_compression_pump_ther.htm
Decongestive Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_decongestive_therapy.htm
Diuretics Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_diuretics_treatment.htm
Endermologie Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_and_endermologie_therapy.htm
Kinesiology Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_and_kinesiology_therapy.htm
Laser Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_laser_treatment.htm
Laser Treatment - Sara's Experience
http://www.lymphedemapeople.com/thesite/lymphedema_laser_treatment_saras_experience.htm
Liposuction Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_liposuction_treatment.htm
Reflexology Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_and_reflexology_therapy.htm
Lymphedema Surgeries
http://www.lymphedemapeople.com/thesite/lymphedema_surgeries.htm
Lymphedema Treatments are Poorly Utilized
ttp:ttp://www.lymphedemapeople.com/thesite/lymphedema_treatments_are_poorly_utilized.htm
Lymphedema Treatment Programs Canada
http://www.lymphedemapeople.com/thesite/lymphedema_treatment_programs_canada.htm
Wholistic Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_wholistic_treatment.htm
Microsurgeries
http://www.lymphedemapeople.com/thesite/lymphedema_and_microsurgery.htm
Homeopathy
http://www.lymphedemapeople.com/thesite/lymphedema_and_homeopathy.htm
Short Stretch Bandages
http://www.lymphedemapeople.com/thesite/lymphedema_short_stretch_bandages.htm
Aromatherapy
http://www.lymphedemapeople.com/thesite/lymphedema_and_aromatherapy.htm
Magnetic Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_and_magnetic_therapy.htm
Light Beam Generator Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_and_light_beam_generator_therapy.htm
Lymphobiology
http://www.lymphedemapeople.com/thesite/lymphedema_and_lymphobiology.htm
Kinesio Taping (R)
http://www.lymphedemapeople.com/thesite/lymphedema_and_kinesio_taping.htm
Chi Machine
http://www.lymphedemapeople.com/thesite/lymphedema_and_the_chi_machine.htm
================================================
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