April-June 2005: Wrapping and Garments

LymphLink Question Corner - Archived from April-June 2005
Marcia S. Beck, APRN, BC, CLT-LANA

Q:  I am having difficulty wrapping my leg with the compression bandages. I have a friend who has wrapped his ankle for years with ace wraps and he is willing to help me with my bandages. These techniques are basically the same, right?

A:  I am glad you are seeking assistance if you are having difficulty with self-bandaging. I applaud your friend for his willingness to assist you. However, I would encourage you to make an appointment for you and your friend with your Certified Lymphedema Therapist.

The compression bandages used for treatment of Lymphedema are not the same as Ace wraps. There are two types of pressure at work with compression bandages. The first is "Working Pressure." This is the resistance the bandage places against the muscles when you are active, up walking, doing exercises, etc. It is important for the compression bandages to have a High Working Pressure in order to keep fluid from recollecting in the extremity during activity. The lower the elasticity of the bandage, the higher the Working Pressure. The second pressure is called "Resting Pressure." This pressure depends on the amount of tension (Stretch) used with the bandage. The Resting Pressure is a permanent pressure exerted on the venous and lymphatic vasculature and may cause a tourniquet effect on the extremity. The higher the tension, or stretch, equates to a higher resting pressure.

The Short-Stretch Bandages used for LE have lower elasticity than Ace wraps which are considered a Long-Stretch Bandage. Short-Stretch Bandages have a LOW Resting Pressure, and a HIGH Working Pressure. The High Working Pressure is to support removal of fluid from the affected extremity and further evacuation of fluid from the extremity during the active time. LOW Resting Pressure of Short-Stretch Bandages reduces the changes of the tourniquet effect.

It is important that only trained therapists, or caregivers/friends provided education by a trained therapist, apply Short-Stretch Compression Bandages or assist in the bandaging process. Compression bandages are essential to the successful reduction of fluid and protein from the affected extremity. It is vital that the bandages be applied correctly, with proper tension and padding.

Also, inform your therapist of any specific difficulties you are having with self bandaging. Your therapist may have some tips/techniques that will solve your bandaging difficulties. Notify your therapist that your friend will accompany you to your next appointment to receive education regarding bandaging techniques. This also will allow your therapist to allot the time necessary for the education.

Q:  I had mild (Stage II) lymphedema after an infection in my arm and chest following lumpectomoy and Radiation Therapy. I received antibiotic therapy and CDT, and the swelling has now resolved except for a little firmness around my elbow. Why do I have to continue wearing a support garment?

A:  There currently is no cure for lymphedema. The goal, then, of therapy is to reduce the swelling and maintain that reduction in swelling. Because of your surgery, radiation therapy and subsequent infection, you remain at high risk for the remainder of your life. Following the guidelines of self-management with Complete Decongestive Therapy (CDT) is essential to the maintenance reduction of fluid in your extremity. CDT consists of four (4) components:

  1. Manual Lymphatic Drainage/Therapy
  2. Compression Bandaging
  3. Exercises
  4. Skin Care

Compression bandaging is essential to maintain the decongestive effect and prevent re-accumulation of fluid into the tissues. I have a favorite saying taken from one of my children's movies called 'Fern Gully'. That saying is "Gravity Works!" The skin is a marvelous organ with a great capacity of protection and preventing infections by stretching. In lymphedema, however tissue changes result in increased stretching and elastic insufficiency. This stretching also allows the re-accumulation of fluid in your affected extremity. The Compression garment offsets gravity by increasing the pressure in the tissues, aids in the venous and lymphatic fluid return and improves the muscle and joint pump effectiveness during activity and exercise. The compression garment is an essential part of your self-management care.

The garment should fit well and without discomfort. If your garment is causing redness or irritation, contact your lymphedema therapist. An ill-fitting garment can be worse than no garment. Sudden changes in weight may also affect the proper fit of the garment. Regular wearing and laundering of the garment will gradually decrease the garment's effectiveness. Garments may need to be replaced every 4-6 months for optimum benefit.

If you choose high level activities such as golf or tennis, you many benefit from a higher level of compression in your garment for these activities. A short stretch bandage over the compression garment can also increase compression during these activities.

Please address questions to: Editor c/o NLN, 116 New Montgomery Street, Suite 235, San Francisco, CA 94105 or e-mail: nln [at] lymphnet.org (nln@lymphnet.org). Deadlines for submissions (for the following issue) are: Feb 15, May 15, Aug 15, Nov 15.