Lymphoedema and Compression Therapy
Compression Therapy is used in the management of Lymphoedema. This is achieved through a combination of Multi Layer Lymphoedema Bandages and/or Compression Garments which compensate for the lack of elasticity in the tissues caused by Lymphoedema. The aim of Compression Therapy is to reduce swelling in affected limbs and to maintain this reduction.
Multi Layer Lymphoedema Bandages
Bandages are used as part of the initial intensive phase of management known as Combined/Complex/Complete Decongestive Therapy (CDT) also known as Complex Physical Therapy (CPT). They are made from cotton and have very little stretch therefore they are called short stretch bandages. During rest they exert relatively little pressure against the tissues due to the lack of elastic properties, whereas during exercise bandages provide resistance against the tissues when the muscles contract and expand. As they press against the bandage the pressure inside the limb increases and stimulates the movement of fluid from the tissues into Lymphatic vessels and the pumping of fluid along Lymphatic vessels.
Multi Layers – Several layers of bandages are used.
Fingers and toes are individually wrapped with a conforming bandage to prevent or reduce swelling.
A tubular cotton liner is applied to the limb and acts as a protective, absorbent layer between the skin and the overlying compression bandages.
Soft synthetic wool padding or foam rolls or sheets are used to protect bony prominences, assist with softening areas of hard tissue and scar tissue and provide a cylindrical shape to allow easier application of the short stretch bandages.
Short stretch bandages are applied in several layers starting from the base of the fingers or toes. Pressure is greatest at these areas and reduces as the bandages go up the limb. This provides graduated compression and encourages fluid to move towards the heart via Lymphatic and Blood Vessels. Tape is used to secure bandages as pins or bandage clips can damage skin.
This initial phase of CDT is carried out daily for a period of between 2 -4 weeks or until there is no change in the volume or size of the limb. The bandages are worn all day and during the night. They are only removed for bathing then reapplied by a Qualified Lymphoedema Therapist. Bandages lose their elasticity after a few applications and this can be restored by washing with a liquid detergent. Two sets of bandages are usually required.
These are used in the second or maintenance phase of CDT to maintain the reduction achieved in the initial stage or can be used instead of bandages depending on the severity of Lymphoedema. Garments may also be worn to assist with reducing the risk of developing Lymphoedema. They have the same effect on the tissues as Compression bandages.
There are two types of Compression Garment – Circular Knit and Flat Knit.
Circular Knit is manufactured by continuously knitting on a cylinder. They are thinner, more aesthetically acceptable and are available as readymade garments. Flat Knit is made as a flat piece to specific measurements then joined by a seam. They are usually custom made and are more suited to irregular shaped limbs.
Garments come in different levels of compression known as Classes and this is dependent on the severity of the Lymphoedema. Some people have to wear their compression garments during the day or when only doing exercise and some may have to wear them up to 24 hours a day. They should be replaced approximately every 6 months or sooner if they lose their elasticity. Sleeves and stockings should be cared for as per the manufacturer’s instructions. Generally 2 sets of garments are required to allow for washing. Care needs to be taken with compression garments as creams can damage their elastic properties therefore do not moisturise skin immediately prior to donning garments.
Compression Therapy is not suitable if infection is present; there is poor arterial circulation in the limb, uncontrolled heart failure, presence of Deep Vein Thrombosis or lack of sensation of the fingers or toes.
If you require advice on Compression Bandaging/ Garments or any aspect regarding Lymphoedema Therapy then please feel free to contact me.
Registered Nurse, Lymphoedma & Massage Therapist
12-18 Seddon Street
mobile: 021 142 9338
By appointment only