LYMPHEDEMA GARMENTS

LYMPHEDEMA GARMENTS, WRAPS, SLEEVES

This page has been updated, please see our new Wiki page:

Compression Garments Stockings for Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=compression_garments_stockings_for_lymphedema

-------------------------------------------

LYMPHEDEMA GARMENTS, WRAPS, SLEEVES

In this section there will be descriptions and uses of various lymphedema garments, sleeves and wraps. As is possible, I am trying to include clinical trials. Otherwise, information will be based on manufacturer information.There are direct links to each of the manufacturers home web site so you can view actual products, learn about measuring and fitting.

Inclusion in this list is for information only and does not mean I either endorse or promote one over the other. This will be a discussion between you, your doctor and your lymphedema therapists in deciding which one is best for you.

..........................

The Various But Wonderful World of Compression Garments

Author: Keith Smiley
Published on: March 11, 2001

Suite 101 University

http://www.suite101.com/article.cfm/lymphedema/62411

...........................................

Elastic Compression Garments

Elastic compression garments help promote venous and lymphatic return by gently compressing the limb with gradient pressure thereby limiting the amount of swelling and maintaining the reduction in swelling achieved following other treatments. Custom and Prefabricated Compression Hosiery: Knee length
Thigh length
Thigh with waist attachment (chap style)
Pantyhose and leotards

Custom and Prefabricated Lymphedema Sleeves: Arm sleeve with glove or gauntlet attached

Arm sleeve with shoulder flap
Arm sleeves, wrist to axilla with or without silicone border

Custom and prefabricated lymphedema gauntlets
Custom and prefabricated lymphedema gloves
Jobst Elvarex® custom lymphedema garments
UlcerCare Stockings, liners and dressings
Lymphedema vests
Hosiery Colors: beige, black, navy, brown, ivory and white
Special Accessories: application gloves and slippers, cold water washing solution, garter belts, It Stays© roll on body adhesive
Lotions and creams compatible for use with elastic hosiery
Stasis Pads
Stocking applicators

..............

Directional Flow Compression Systems

Sleeve-like units filled with hundreds of foam chips, designed with a unique channeling system to help direct the lymphatic flow to alternate pathways and bypass the areas of obstruction. This system is should be used under short-stretch bandages, with a pneumatic compression pump or under an outer compression unit.

..............

Compression Bandages and Supplies
Cotton stockinette
Elastic gauze bandages
High density foam rubber pads and moldings
Padding bandages
Short-stretch compression bandages

------------------------------------------------------------

PinkRibbon.com

Breast Cancer Resource Center

Compression garments or sleeves are necessary for long term use. Measurements for compression garments should be done at the end of treatment when the limb is at its maximum reduction. If the garment is too large, it will allow the limb to swell. They should not be worn while sleeping because they are designed to be worn when an arm is working. You must be measured by a certified custom fitter. Some garments may fit from standard sizes, but others can be custom made by Jobst, the recognized supplier of compression garments. Make sure the garment is comfortable and return it if it isn't. Most custom fitters are aware of the difference, but once I encountered one who insisted I wear a standard size. Individual arms, particularly with large women, like myself, DO NOT WORK. Individual arms are of different sizes and lengths. While these off the counter garments take that into consideration to some extent, it is like expecting a "one size fits all" to actually fit. They seldom do.

Over time, the compression garment looses its stretch. They need to be replace about every six months. Most insurance companies will approve two sets, one to wear and one to wash, every six months. Compression garments are also widely used for treatment of vascular diseases as well as for men with prostate surgery. Fortunately, these are often hidden by trousers and don't stand out the way arm compression garments do. Compression sleeves should be prescribed with a hand cover or gauntlet to prevent swelling in the hand and fingers. The gauntlet may not be adequate therefore many women need a glove. The gauntlet I used first, seemed to actually push the fluid into my hand. A tipless fingered glove worked better for me.

If the edema is in your chest or back, compression vests are also available. Save your old garments for use when swimming.

link no longer available

------------------------------------------------------------

Compression Bandages

http://www.lymphedemazone.com/Compression-Bandages.html

. . . . . .

Compression Stockings

http://www.lymphedemazone.com/Compression-Stockings.html

------------------------------------------------------------

It's All in the Stocking

By Joy C. Cohn, PT, CLT-LANA, and Anne Lowry, MS, PT, CLT-LANA

Lymphedema management has changed dramatically in the United States over the past decade as health care professionals have trained in the European techniques known as complete decongestive therapy or complex decongestive therapy. The treatment of this chronic condition occurs in two phases. Phase one is generally intensive (1–5 days per week for 1–6 weeks) including manual lymphatic drainage, skin care, compressive bandaging, and remedial exercises. At the end of this intensive phase of treatment, when the limb has been “decongested” or reduced in volume, the patient is usually fitted with a compression garment to maintain the reduction. This commences the second (or maintenance) phase during which patients use self-treatment techniques as well as compression garments to maintain the reduction achieved in the first phase. Success in selecting and fitting the compression garment is essential to effective long-term control of edema.

External compression reduces ultrafiltration from the vasculature, enhances the musculoskeletal pump, increases the resorption of fluid into the venous and lymphatic system, reduces the local volume in the veins, and helps maintain the limb shape.¹ During phase one, compression bandaging with low stretch bandages allows for a precise fit, readily adapting to the changing shape of the limb. However, bandaging is bulky, time consuming to apply, and unattractive. Garments offer considerably more freedom of movement in a more attractive form.

CHOOSING THE RIGHT GARMENT

Selecting an appropriate compression garment is probably the most challenging task in lymphedema treatment. It is important to begin the discussion of garments early in the course of treatment. It often takes time for patients to adjust to the fact that they will need a garment. In many instances, patients must pay all or part of the cost of the garment, and they will need to plan in advance for the expenditure.

Important factors to consider when choosing a compression garment are: coverage, compression class, appearance, custom-made versus ready-made, material, construction, suspension, skin condition/sensitivity, donning/doffing, and cost and source of payment.

When considering coverage, preventing edema distally or proximally to the garment is important. During the decongestive phase of lymphedema treatment, the therapist will have learned whether, for instance, a bandage to the knee has caused an increase in knee or thigh volume. In that case, the patient will need a garment to the thigh or perhaps to the waist. Usually an arm sleeve will be accompanied by a separate glove or gauntlet to prevent trapping fluid in the hand. Some individuals never experience significant edema in the hand. If therapists back off on bandaging the hand during treatment and the patient does not experience any additional edema, this guides the decision as to whether to order a gauntlet, which just covers the back of the hand, or a full glove with edema control for all of the fingers. Some patients find they can even do without any hand garment, but in our practice, we always order at least a gauntlet since it is very difficult to predict exactly how every patient will respond.

Medical grade garments are available in various compression classes measured in millimeters of mercury (mmHg). These are standardized as:

Class I: 20-30 mmHg
Class II: 30-40 mmHg
Class III: 40-50 mmHg
Class IV: 50-60 mmHg

In a stocking, these numbers are the compression at the ankle with a gradually decreasing compression gradient to the top of the garment. Many ready-made stockings have a higher stretch fabric over the upper thigh called a mantissa. Even garments with the same fabric throughout will give lower compression over a larger diameter body part. Arm sleeves are generally Class I or II, and gloves and gauntlets are typically Class I. Lower extremity garments are generally Class II or III. Additional compression for the leg can be gained by using a higher compression class of garment or by layering a knee-high stocking under or over a longer stocking.

READY-MADE VS CUSTOM

Often the question of a custom-made versus a ready-made garment answers itself. Ready-made garments come in various girths, lengths, fabrics, and compression classes. They are made for a limb of average proportions, although some ready-made stockings do allow for an extra-wide calf and/or thigh. A patient with a disproportionate limb or who needs a higher compression class will require a custom garment.

Ready-made garments are less expensive, quicker to obtain, and easier to replace. They are usually made of relatively thin fabrics with few or no seams, making them cosmetically more acceptable to many patients. Their disadvantages are that they are less precise in fit, are more likely to roll at the top, and may not provide enough support.

Patients are always concerned about the appearance of the garment, particularly when the arm and hand are involved. Some garments are made only in beige, which has a medical connotation to some people, and which does not match the skin tone of darker-complected individuals. A garment may be ideal from a therapeutic point of view, but if the patient will not wear it for cosmetic reasons, it is useless. Sometimes the therapist has to choose a less effective garment that is acceptable to the patient. Some patients prefer a cosmetically desirable garment for public times, and a “workhorse” garment for sport or heavy activity.

FABRIC CONSIDERATIONS

Garments can be made of elastic or nonelastic fabrics. In general, the elastic fabrics are for daytime wear, while nonelastic ones can be worn day or night. Nonelastic garments provide compression by means of a series of hook and loop straps along the length of the garment. The wearer tightens the straps to the appropriate tension. Nonelastic arm sleeves and thigh-high leg garments are well padded with foam. They are comfortable, but too bulky for most daytime activities. Some lower leg garments are thin enough to be worn for walking. Nonelastic garments can be used in place of bandaging by patients who cannot bandage themselves.

The fibers used in elastic compression garments are generally latex rubber, synthetic rubbers, nylon, polyester, cotton, or a blend of these. Some are lined with cotton or silk for comfort. Fabrics can be thick or thin, depending on the fibers used and the amount of compression provided. In general, higher compressions mean heavier fabrics.

In selecting the fabric of an elastic garment, skin sensitivities are a paramount consideration. The compressive force in these garments comes from latex or synthetic rubber, so the therapist must know if the patient is allergic to latex. Most garments containing latex are knitted from a thread consisting of a latex core wrapped with nylon or cotton. A patient or helper at home who is severely sensitive to latex (eg, has a respiratory response to it) may not be able to use garments containing latex. Patients who have only a local allergic response may be able to wear them if an underliner is used.

There are three basic styles of garment construction: circular knit, flat knit, and cut and sew. Circular knit fabrics are seamless, but have a tendency to roll down at the top, especially if the area it covers is very fleshy. This creates a tourniquet effect, obstructing flow of fluid from the limb. In a flat knit garment, a flat piece of fabric is knitted to the patient’s measurements, and seamed up the back. These garments may roll less at the top. In addition, some flat knit garments are made of a coarse-textured fabric, which can provide a mini-massage to the skin, promoting improved fluid uptake and transport. A cut and sew garment is made of several pieces seamed together. More porous fabrics are cooler to wear, an important consideration for patient comfort.

To be effective and comfortable, the garment has to stay in place. Some will stay up by themselves. Some options are a silicone band inside the top edge or a few longitudinal (not circular) stripes of a clear body adhesive. For stockings, a garter belt, suspenders, or an extension of the garment to the waist are available. Arm sleeves can have extensions over the shoulder, which attach to a bra strap or a diagonal strap across the chest.

SKIN SENSITIVITIES

The condition of the patient’s skin will affect the choice of garment. Patients may have wounds or very fragile or sensitive skin. Pulling a tight garment over the skin can cause damage from shearing. In those cases, an understocking (even an ordinary thin nylon) will protect the skin, hold any wound dressings in place, and help the compression stocking slip on more easily. To decrease the friction of donning and doffing, custom garments and some ready-made garments can have zippers. Many patients ask for zippers in the garment. Zippers work well if patients have very narrow ankles or a paralyzed limb. We rarely recommend zippers because they do not eliminate the need to get the garment over the heel, they make the garment bulkier and less attractive, and many patients have difficulty closing the zipper once the garment is fitted on the limb.

For patients who need edema control for both legs, compressive panty hose can be difficult to don. An alternative can be a pair of thigh-high compression stockings with a compression bike pant over them. This arrangement is easier for most patients to manage, and is often more acceptable to men than a panty-hose style garment.

Compression garments are quite expensive, ranging in our area from about $50 for a pair of ready-made knee-high stockings to more than $500 for a custom-made waist-high garment. Some insurers will pay the supplier directly for the garments, some will reimburse the patient for all or part of the cost after the patient pays and submits a claim, but some insurers will not pay anything toward a compression garment. The only garments Medicare covers at present are stockings for patients who have been hospitalized with recurrent ulcers. Insurance plans differ widely and change frequently—another reason to open a discussion with the patient on reimbursment early in the treatment course.

USAGE

Garments are ordered when the patient experiences a plateau in volume reduction, when the limb is not edematous, and in certain instances, for reducing the risk of developing lymphedema. Compression garments are very uncomfortable when applied to an edematous extremity, and they rarely produce significant reduction when used alone.² Measurement for garments should be done as early in the day as possible, when the limb is at its smallest. Treating therapists usually do the measuring themselves, although nontherapist fitters can be used.

Contraindications to the use of compressive garments are:^1,3 acute infections/inflammation, cardiac edema, malignant lymphedema (relative), arterial disease, and acute vascular blockages (superior vena cava syndrome, acute deep venous thrombosis).

Extra precautions should be used in the case of: uncontrolled hypertension; paralysis; insensate limb; diabetes due to the high incidence of small vessel disease; and latex allergy (do not forget that the gloves used to don garments may have latex).

It is very important to educate patients in the proper use of their garments. We have seen many patients who have rejected garments in the past due to difficulty in donning or wearing them throughout the day but who successfully wear them with education. The education should include written and verbal instruction in don/doff procedures (including alternatives), care of the garments, and wearing and replacement schedules.

Donning and doffing are one of the major obstacles faced by many patients due to other conditions that limit their ability to reach their feet or to pull on a garment due to limited hand strength or pain. Rubber gloves and patience in applying the garment in stages are the hallmarks of success. There are several devices available from garment manufacturers that can help the patient get the garment onto the foot and over the heel or hand. These include frames to hold the garment open, slippery covers for the limb, and silicone-based products that make the skin more slippery. Cornstarch has also worked well for us. We avoid powders with talc due to the risk of skin irritation. Most garment manufacturers warn against the use of petroleum-based ointments because the fibers (especially latex rubber) can be weakened by exposure to these products. When patients require a higher compression class than they are able to don easily, we will try layering the garments to achieve effec-tive control.

All garment manufacturers recommend replacement of the garments every 4 to 6 months. The actual interval is based on considerations such as wear due to use, severity of the edema, and type of fabric. Many patients buy two garments to have one to wash while the other is worn. Garment manufacturers include care instructions with their garments. In all cases, we recommend daily washing by hand with mild liquid detergents (for example, Ivory or Dreft) and squeezing gently in a rolled-up towel and hanging to dry.

Finally, patients are encouraged to don their garments as soon as is practical in the morning, when the limb is at its smallest. Many patients alter their lifestyle to shower in the evening so they can don their garments over dry skin first thing in the morning.

Given the long-term use of garments by most lymphedema patients, it is imperative that the treating therapist give a great deal of thought to choosing the appropriate garment and educating the patient in its use. This is crucial to successful treatment of patients with a chronic condition.

REFERENCES

Casley–Smith JR, Casley–Smith JR. Modern Treatment for Lymphoedema. 5th ed. Adelaide, Australia: Lymphoedema Association of Australia; 1997:174-175, 178.
Johansson K, Lie E, Ekdahl J, Lindfeldt J. A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema. Lymphology. 1998;31:56-64.
Hohlbaum GG, ed. The Medical Compression Stocking. New York: Schauttauer; 1989:56.

Joy C. Cohn, PT, CLT-LANA, and Anne Lowry, MS, PT, CLT-LANA, are certified lymphedema therapists in the lymphedema treatment program at Chestnut Hill Rehabilitation Hospital in Wyndmoor, Pa.

------------------------------------------------------------

Compression Garments for the Treatment of Lymphoedema

by: Judith R. Casley-Smith & J.R. Casley-Smith (L.A.A., University of Adelaide)

Compression garments and compression bandages, 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 in 1987 in Australia , when we introduced Complex Physical Therapy (C.P.T., Complex Lymphatic or Lymphedema Therapy - C.L.T.). They are absolutely essential for maintaining the great reductions achieved by this combination of treatments.

Compression garments are necessary

1. to prevent lymphoedema occurring or increasing,

2. to try to maintain the size of the limb when treatment is unavailable or unaffordable,

3. to maintain the reduction achieved after treatment, and to continue the remodelling of the limb.

1. Prophylaxis - Prevention of Lymphoedema

If a limb is a risk (e.g. after a mastectomy, operation for melanoma, etc.) then a correctly fitting garment should be kept on hand for immediate wearing, e.g., after an injury, during an aircraft flight (even for just one hour!), or excessive work causing aching and leading to swelling, etc. Prevention is of the utmost priority, because it is much easier to prevent lymphoedema than to treat it! However the garments in this situation should be no more than 30 mm Hg for arms and 40 mm Hg for legs (much higher pressures can, and should be used after a course of C.P.T.

2. Garments used as the only Treatment

If no other treatment is used, good compression garments will limit the amount of swelling and thereby slow the advancement of lymphoedema. Some patients even get reductions in their limbs using just such garments and the L.A.A. exercises. However, this is far from the ideal. Again, the pressure must be less than if the limb had been reduced with (C.P.T.).

3. After Therapy

For reasons already mentioned, these are essential after C.P.T. If patients do not wear and maintain garments correctly they just throw time, effort and money away!

The Choice of a Garment

Availability is almost as important as efficacy. There is no point in treating a patient by C.P.T., and then having to wait weeks for a suitable garment to arrive. A patient, alone, is often not able to bandage themselves as is done in the clinic (especially post-mastectomy patients). In fact it is hard enough for some to put on a pressure garment. This means that the choice of appropriate bandages and sleeves/stockings depends very greatly on good suppliers. If the garment has to be custom made, it is helpful to have a local seamstress who can do any fine alterations necessary. (However if this is done the garment guarantee is often invalidated.)

Once a therapist is experienced, they find that almost all of the reduction occurs in the first 7-10 days. When they are confident of this, a suitably-fitting garment may possibly be ordered at this point if a made-to-measure one is required. In this regard, it is essential that measurement of the patient in the clinic or by a supplier is done absolutely correctly. Mistakes can be made, but it should not be the patient who has to bear that cost.

Choice is also limited by whether a patient can actually be fitted with a ready-made garment, or whether they need a custom-made one. Children and many patients with primary lymphoedema can only be fitted with custom-made ones. Use of a regular (standard) garment is advised if the patient correctly fits the measurement parameters. This overcomes the possibility of mistakes in the size or fit of a made-to-measure garment; it is also cheaper. We stress that the regular garment must fit correctly and comfortably. However a made-to-measure garment may be still more comfortable to wear.

The quality of the fabric is also important. These garments must last at least 4 months. They need to be changed and washed daily, especially in a hot climate. Patients must follow the manufacturer's washing instructions and should never allow them to dry in the sun or in a drier. Jobst-Beiersdorf supplies Jobst 'Jolastic' a special washing solution for elastic garments, but there are other suitable mild detergents.

Patients must be shown how to put on the sleeve/stocking so as to cause minimum stress on it. Rubber gloves with a raised pattern on the finger tips should be used. (Sigvaris supply these, or certain washing-up gloves are suitable.) Such gloves will:

protect the garment from fingernails, rings, etc.,
make them easier to get on,
allow the garment to be adjusted evenly over the limb and fit it correctly.

Care must be taken in the use of skin preparations when wearing a garment. Although some have been recommended for use under garments (Com-pat Body Lotion - Jobst), the manufacturers do not guarantee that they will not affect the life of the garments. Of course wearing a bandage at night allows suitable skin care products to be used easily.

We also stress the importance of skin care. Be aware of the list of products from Hamilton Laboratories and from certain other manufacturers. Particularly recommended are: Hamilton's Body Wash, plus Shower Oil as a moisturiser. These are much preferable to soap for lymphoedema. Other useful products are: Dimethicream or Skin Repair for general moisturising, Urederm for the treatment of chronic dry skin and Dermex 7A as a protection and moisturiser while swimming or during hydrotherapy in pools. Castellani's Solution can be used on any moist 'folds' (ask your pharmacist for it); 'Minidine' also works well. Remember protective sunscreens. Lodema (coumarin) powder is very good under a garment. Lodema (coumarin) ointment can however only be used under bandages or if a garment is not used at night; it is also good for bites, stings cuts, burns or bruises.

The comfort, and therefore the patient's compliance, is of great importance for maintaining the gains made during therapy. Hence much depends on the fit of the garment and the material used.

Some patients have allergy problems to synthetic materials and a cotton coating of the elastic fibres is then very important. Some garments 'breathe' more than others, giving greater comfort and compliance. A new garment may cause pressure or irritation at a joint or under the arm; a lining in the garment at this point or powder or a smooth adhesive dressing (e.g. 'Fixomull', Jobst) may alleviate this.

It is useful for the patient to wear the garment for the last few days of treatment so that all the above problems can be checked. It will also give a good indication as to whether the compression is adequate. If not, a second, lower grade, over-garment will be needed also.

A number of patients need gloves or mittens. The gauntlet variety (i.e. attached to, and part of the sleeve) are preferable in that they reduce the risk of a pressure band at the overlap. This is difficult with a stocking. Separate bandaging of the toes and distal part of the foot may be needed.

Garments should be able to be worn easily and stay in place without slipping. A woman with a prosthesis often cannot maintain an arm sleeve in place with a support strap attached to her bra strap on that side. It may be more comfortable to wear a chest garment incorporating a bra and sleeve, joined with a slit under the arm to allow for breathing and perspiration. A wide strap around the chest below the other breast may work.

Many bands used on garments are too narrow to be comfortable and need to be replaced by something wider. Similarly, a waist band to support a leg stocking may slip - allowing the stocking to slip down. In this case a pantyhose arrangement, with one leg cut off (if only one is lymphoedematous) and a slit at the crutch, feels more secure and a lot more comfortable.

After a mastectomy a well fitted bra should always be worn. The straps should not cut into the shoulders, nor should wire under a cup cause red lines or indentations. These will both restrict lymphatic drainage. Realize that the opposite breast is also 'at risk' of swelling due to overloading of the natural collateral drainage. Similarly with a lumpectomy plus radiotherapy, the breast on which this was performed is also 'at risk' and should be properly supported.

There are solutions available which have been specially made to stick the garment to the limb (e.g. 'It Sticks!' from Jobst and 'It Sticks' from Sigvaris). These must be used with care and applied as a number of vertical stripes. If they are applied horizontally in a ring around the limb, they can shrink as they dry. They pull the garment with them and so cause a band of excess pressure at the top of the limb, which will restrict lymphatic drainage. So be careful!

One needs to be wary of a stocking or sleeve that stops too short of the top end of the limb, or that causes a pressure band at that (or any other) point. This will reduce lymphatic drainage as well as causing a band of fibrous tissue to form which also later reduces this.

Patients also need to be aware of the amount of exercise that they should do. If too much is attempted, the limb will swell further; then the garment becomes uncomfortable. The patient then feels it is too tight and so takes it off, then the limb swells still further and a new garment is required of a larger size! Some patients also like to remove their garments for long periods of time (e.g. at night). Then the limb again swells and the patient feels that the garment was the wrong size and may wrongly blame the clinic or the supplier!

These principles also apply to the treatment of acute injury and to oedemas (usually lymphoedemas) caused by paralysis or confinement to wheel chairs.

Similarly, venous oedemas (including chronic venous insufficiency and during pregnancy) should be treated with compression stockings, but of a lower grade (18 - 48 mm Hg is usually recommended by the manufacturers and therapists).

Patients with a lympho-venous shunt, diabetes or arterial insufficiency can only tolerate a garment with a lower pressure than usual. This also applies to untreated patients.

If a patient finds it too difficult to put on a high compression garment, then two lower compression ones - on top of each other - may be preferable. But a 40 mmHg plus a 30 mm Hg one do NOT give 70 mm Hg, but approximately 55 mm Hg.

For lymphoedema of the leg, unlike for chronic venous insufficiency or varicose veins, a full thigh-high stocking is essential to prevent just pushing the lymphoedema above the knee. In venous oedema, a calf stocking of lower pressure is sufficient unless lymphoedema is also present.

When choosing a garment or sock, it is very important that it does not cause constriction just below the knee - thus preventing drainage and leading to swelling. Some socks are not long enough for taller people and slip when walking; if so, get one that comes to mid-thigh (which will also alleviate the problem of a 'tourniquet' effect below the knee.

Good communications and suggestions between the patient and therapist, and between the therapist and the supplier are essential to provide the best possible service for the patient. Pressure sometimes needs to be applied to the manufacturer to actually supply the patient's need and thereby to give an efficient service. A patient with problems should always return to their therapist. Analgesics should never be taken just to overcome constant pain from an ill-fitting bandage or garment. Manufacturers try hard to accommodate customer requirements, but need feed-back to understand.

Suppliers of Compression Garments are listed elsewhere.
An excellent book for for doctors and therapists who wish further more detailed information is:
Hohlbaum GG. The Medical Compression Stocking. Stuttgart & New York, Schattauer, 1989.

Vital Points on Compression Bandages and Garments

Treatment for lymphoedema is a continual process. It is not cured by one course of treatment. While a therapist can reduce the swelling initially, the patient is responsible for maintaining that reduction. What follows are a few simple rules, all are vital!:

1. The bandages or garments must be worn all day and all night.

2. Each set of bandages, or a garment, must be changed and washed at least every couple of days.

3. Care must be exercised when putting on bandages or garments.

4. Bandages or garments must be replaced if they lose elasticity or are damaged.

5. At least two sets of bandages or garments must be owned.

6. Order a new garment well before an old one has worn out.

7. The manufacturer's washing instructions must be followed and they must not be dried in the sun or in a drier.

8. The therapist must be consulted if a limb becomes painful or discoloured (e.g. blue toes), or if a garment chafes or is too loose or too tight.

9. Nights are more restful if the patient changes bandages or garments before sleeping.

10. Wash the limb thoroughly when changing bandages.

Lymphoedema Association of Australia

http://www.lymphoedema.org.au/index.htm

------------------------------------------------------------

COMPRESSION GARMENTS

Lymphedema is a condition that we cannot cure, but our goal at ProRehab, PC is to teach you how to manage the swelling in your limb.

Compression garments are used once the extremity has reduced in size. At that time your therapist who is a certified fitter will measure you for your compression garment.

Compression garments are comfortable and provide pressure to prevent re-accumulation of swelling in the affected extremity.

Compression garments are to be worn daily. We recommend that your garment be put on first thing in the morning, after your shower or bath. You should keep your garment on during all waking hours, except bathing, and remove for sleep.

Your therapist may make the recommendation that you continue to bandage your extremity for your sleeping hours. If you are bandaging at night, it is beneficial to take off your garment then immediately bandage your extremity. It is advantageous to perform your exercises when you have your bandages in place.

Only one compression garment is ordered at first. This is to ensure that it’s fitting properly and controlling your swelling. Once you and your therapist are satisfied with the fit, you can order a second garment. This allows you to always have a clean garment.

CARE OF YOUR COMPRESSION GARMENT

Your compression garment is manufactured from the highest quality materials, and can be washed in warm water with a mild detergent. Do not use fabric softener or bleach. After washing, lay your garment on a thick towel, roll it up and squeeze any excess water. Then, lay your garment out to dry. Do not dry in a dryer or in direct sunlight.

Note: Some materials are dryer-safe; please check with your therapist/fitter.

It is recommended that the garment be washed out daily. Do not exceed 2-3 days without proper cleaning. Do not cut any loose threads or snares, as this may result in holes or runs in the garment! This may ruin your garment.

Depending on how hard you are on your garment and how well you care for your garment will depend on how often you will have to replace them. At the maximum, your garment should be replaced every six months. If you have an increase or decrease of five or more pounds, this can alter the fit of your garment.

CONTACT YOUR THERAPIST OR THE CERTIFIED FITTER IF YOU NEED TO REORDER YOUR GARMENT. REMEMBER IF YOU REQUIRE A CUSTOM FIT GARMENT, IT MAY TAKE 2-3 WEEKS TO GET YOUR GARMENT – SO DON’T WAIT!

HELPFUL POINTS WHEN
APPLYING YOUR GARMENT

The use of rubber gloves

Using common household rubber gloves simplifies the procedure of applying your garment. Rubber gloves allow you to smooth out the fabric with a minimum effort and grip the material. Rubber gloves also protect the fabric from runs/snags caused by fingernails.

The use of slip on aids

Sometimes garments slide down the arm or leg. Sliding or rolling of the fabric can reduce the effectiveness of the compression garment and be bothersome to you. This problem can be eliminated with the use of adhesive lotion. If this is a problem with you, talk to your therapist.

To use adhesive lotion, put the garment on and turn the top of the border over and apply the adhesive lotion to the area where the garment ends. Allow 3-4 minutes for the lotion to become tacky. Then turn the garment border back over.

ProRehab, PC has certified fitters for Juzo, Jobst & CircAid.

http://www.prorehab-pc.com/what/lymphedema/garments.htm

------------------------------------------------------------

The Reid Sleeve

How does the Reid Sleeve Work?

Clinical Research on the Reid Sleeve - Results of Treatment with the Reid Sleeve

Results in patients with moderate to severe edema

Results of Clinical Trial - The Reid Sleeve is an Effective Treatment for Lymphedema

Summary of Results

Analysis of the Patients Feelings about Treatment with the Reid Sleeve.

Summary of results.

Treatment Recommendations

Office Protocol

Frequently asked Questions about the Reid Sleeve

Reid Sleeve for the lower extremity.

Advantages of The Reid Sleeve

http://www.uhealth.net/Sleeve.htm

...........................................

Penninsula Medical - The Reid Sleeve People

Visit the home site for a extended on all Peninsula products

http://www.lymphedema.com/

...........................................

Reidsleeve Classic

http://www.lymphedema.com/rsleeve.htm

...........................................

OptiFlow Rm - arm

http://www.lymphedema.com/optirm.htm

...........................................

Optiflow EC - arm

http://www.lymphedema.com/optiec.htm

...........................................

The Contour

http://www.lymphedema.com/contour.htm

..............................................

Unna's Boot - Used in Wound Care

http://www.fpnotebook.com/surgery/pharm/unsbt.htm

...........................................

A prospective, randomized trial of Unna's boot versus Duoderm CGF

http://www.jvascsurg.org/article/0741-5214(92)90186-C/abstract

...........................................

Unna's boot vs polyurethane foam dressings for the treatment of venous ulceration. A randomized prospective study

Abstract

http://archsurg.ama-assn.org/cgi/content/abstract/125/4/489

..............................................

CircAid® Products

http://www.circaid.com/

...........................................

Directional Flow Compression Systems

Sleeve-like units filled with hundreds of foam chips, designed with a
unique channeling system to help direct the lymphatic flow to
alternate pathways and bypass the areas of obstruction. This system is
should be used under short-stretch bandages, with a pneumatic
compression pump or under an outer compression unit.

...........................................

Other Circaid Products

Compression Bandages and Supplies
bullet Cotton stockinette
bullet Elastic gauze bandages
bullet High density foam rubber pads and moldings
bullet Padding bandages
bullet Short-stretch compression bandages

.....................................................

Jobst Elvarex® custom lymphedema garments

Compression stockings, includes compression gloves for hands

http://www.jobst-usa.com/en/products/lymphedema/customelvarex/page.html

...........................................

LYMPHEDEMA GARMENTS

Jobst and Juso - illustrations

http://www.womanspersonalhealth.com/lymphedema_garments.asp

...........................................

Frequently Asked Questions - Lymphedema Garments

http://www.lymphedema-therapy.com/FAQ.htm

...........................................

JoViPAk - Lymphedema Garments, Sleeves, Gloves - arm

http://www.jovipak.com/armtemplate3.html

JoViPAk - Lymphedema Garments, Sleeves, - leg

http://www.jovipak.com/lowerleg.html

...........................................

Jovi Measuring Chart - Panty/Brief

http://www.jovipak.com/index.shtml

..................................................

Lympha Press "Lymphedema" Garments

http://www.lympha-press.com/medical4.htm

Products Page:

http://www.lympha-press.com/lympha-press-optimal.html

...........................................

I was able to get information on name brand compression stockings available at less than half the cost of what local medical supply stores are selling them for. These two companies not only provide Jobst, Juzo, Medi and other top name brands at a fraction of what everyone else charges, but they send you a pair of the blue rubber gloves and cleaning solution as well free of charge. The information is as follows:

Support Sock Shop

www.supportsockshop.com

1-877-330-5900

Hope this helps!!!

Cyndi Ortiz, CCT
Nevada Vascular, LLC
702-897-0841

............................................

NATIONAL LYMPHEDEMA NETWORK Question Corner

Bonnie B. Lasinski, MA, PT, CLT

Q: Please give me some guidelines on how long we can use compression bandages before replacing. Also, how should they be washed?

A: Your therapist probably has specific instructions for you, but here are some general guidelines that I follow. After compression bandages have been worn, they become wrinkled and over stretched with each wearing. If they are not washed before the next application, the edges may be stretched unevenly, which would result in uneven pressure on your limb as you apply them. Washing bandages after each use restores elasticity and removes wrinkles, thereby assuring a smoother application the next time they are used.

Also, if you exercise effectively while wearing them, they become damp with perspiration; regular washing maintains the bandages and supports good personal hygiene.

The life span of compression bandages depends on many factors, including how tightly they are pulled during the wrapping process, how large and fibrotic a limb they are holding/reshaping, and how carefully they are laundered (warm water, mild soap such as Ivory Snow or Dreft, gentle cycle, gentle reshaping/ wrinkle removal, air drying, careful re-rolling). For example, a young patient of mine bandages his leg nightly, rotating two sets of bandages, and replaces them every 3-4 months

.....................................................

Q: I just started my CDP program and have had ongoing problems with terrible itching from the bandages. I literally have to take them off in the middle of the night because they are so irritating. What can I do? I know how important it is to keep them on. Any suggestions?

A: Are you using a "Stockinette" sleeve and proper padding under the bandages? These products can be obtained in synthetic materials which should avoid any allergic reaction. Are bandages being applied tightly enough to prevent slight movement and, therefore, skin abrasion (rubbing)? Are you moisturizing your limb before the application of the bandages? This will prevent dryness. It may be the heat of the bandage layer that is producing the irritation. Try to keep the limb as cool as possible and, if you wake up in the night, exercise it a little. Do try to keep your bandages on, or you will not get the desired reduction.

.............................................................

Question Corner
July-September 2002 LymphLink

Marcia Beck, RN, CS, CLT-LANA, NLN Medical Advisory Committee Member

Q: I've been denied coverage for my garments by my HMO insurance provider, but I've heard that I can appeal this decision. Do you have any specific guidelines for doing this?

A: You are certainly not alone in your struggle. The problem with garments and bandages is that most insurance providers consider them "Durable Medical Equipment," the same category as wheelchairs and walkers. We need to educate our medical communities and legislators about Complete Decongestive Therapy and its four essential components:

Manual Lymphatic Drainage

Compression Therapy (which should include bandages and garments)

Meticulous Skin Care (to prevent the real risk of infection, cellulitis)

Exercises

Certainly DO appeal this decision through your provider! Here are my suggestions:

Ask to speak to the Medical Director about the issue; Find out if the Medical Director's expertise is in Lymphedema.
Get to know your state and US representatives and senators. Share your information and opinions. Your vote counts!
Some garments have a "Letter of Medical Necessity" packet that can be filled out by your physician to provide more information, indicating the need for long-term therapy and the need for replacement.

Bob Weiss and his wife were successful in gaining coverage for bandages in California as have been a number of other patients and advocates (see the "Letters to the Editor" section in this issue). We need many more to appeal and follow the chain of legislative command to convince our politicians. We would like to form a subcommittee to address the growing legislative concerns. If you are interested in this grassroots effort, please contact the NLN office!

................................................................

Question Corner

Bonnie B. Lasinski, PT

Q: I have swelling in both legs from cancer surgery. I always had large thighs and have great difficulty keeping up my bandages. I am aware of the great benefits of walking with the bandages on, but am embarrassed when they fall down to my ankles. Any suggestions would be wonderful.

A: You are not alone! I am certain that many people (both men and women) reading this question are so happy that you brought it up. It is a challenge and there are many ways to look at this problem. The most positive is that if your bandages fall down after prolonged walking, maybe you are reducing your legs so much that it is causing the slippage! If that is not the case and they are slipping right away, you may want to try several things:

(1) A panty girdle or "bike shorts" can help to hold them up.

(2) Are you bandaging over a stockinet? The stockinet can help to decrease slippage. Make sure that it is long enough at the top to fold over the bandages several inches. Pull it up smoothly so that you are not bandaging over wrinkles which will shift immediately when you move.

(3) If your thighs are (excuse the expression!) flabby, I find that if you bandage to just above the knee, then begin the next bandage at the top of the thigh, spiraling it around evenly to completely encase the thigh from the groin to the knee, that the first bandage firms up the thigh and forms a better base to now continue the leg bandage from just above the knee to the groin.

(4) Generous use of paper masking tape on each layer of bandages, especially around the knee, can keep the layers from separating and slipping.

(5) Try wearing snug leggings or stretch pants over the bandages to decrease the friction of the bandages rubbing together between the thighs.

(6) Perhaps (and this is not a criticism) a review of your particular bandaging technique with an experienced therapist may help you to pinpoint other ways you could improve your bandage. This might just be the ticket to better "staying power!"

Good luck and hope this helps.

================================================

Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe:

AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

===========================

Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe:

AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

===========================

For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

===========================

Lymphedema People - Support Groups

-----------------------------------------------

Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

......................

Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

......................

MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

......................

All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

......................

Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

===========================

Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet? Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more. Come and take a stroll!

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema

Arm Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema

Leg Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema

Acute Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema

The Lymphedema Diet

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet