Total Pageviews

Monday, March 5, 2012

Compression Bandages for Lymphedema Management

Compression Bandages for Lymphedema Management

Multilayer Compression Bandaging of the Lymphedema Leg

The goal of compression wrapping is to build a “custom fitted” compression garment for the affected limb(s), applied daily by patient and caregiver, which will help to massage the fluid out of the affected area during normal movement and keep out the additional fluid. The wrapped limb should look uniform and smooth ll the way up with few bulges and hollows as possible.

1.) Assemble all material in area you will be using to wrap

2.) Be comfortable. Sit or lie while wrapping foot.

3.) Stockinette goes on first.

4.) The gauze (Elastomull) toe/foot wrap goes on second

a. The first round is an “anchoring” wrap. Start with the tail under the roll, laying the tail on the top of the foot and bringing the roll completely around the arch back to the top of the foot to catch the end. Then go back around the foot again back to your starting point.

b. Bring the gauze up to the tip of the first toe. The first round on the toe angles up close to but not over the tip. Wrap each toe until covered, 1-4 rounds, spiraling down toward foot. Do not allow to bunch behind the toes. Do not pull tight.

c. Anchor around foot after each toe is covered. Coming off the back of the toe, bring the gauze around sole to the top of the foot and proceed to the top of the next toe.

d. Finish remaining toes in same manner. Wind left over gauze around foot loosely, spiraling toward ankle.

5. If used, apply white fluffy padding (Artiflex) now. Wrap entire leg, putting several layers around knee. Cover heel well also.

6. If used, foam pad goes on top of the foot so the edge rests at the base of the toes. You might have enough gauze left from wrapping toes to secure the foam piece.

7. If used, place foam pads over ankle bones. Padding might also be recommended over the front of the ankle. This fills in the hollows. Wrap over foam.

8. Place the additional pieces of foam, chip bags, or other padding where they have been determined to be the most effective. Vary the formula for filling in spaces.

9. Brown (Comprilan) bandaging goes on last. Do not wrap toes. Start with an 8cm wrap on the foot at the base of the toes. Toes should be pointing up, foot pulled toward body (flexed).

10. You will probably use 2 of the 8cm rolls on the foot and ankle. Roll around the foot once or twice, then roll around the ankle, around the foot angling up and down to form the herringbone pattern. Continue until you have covered foot and ankle. Keep loose, especially across front of ankle.

11. After the ankle roll, start with 1-3 rolls of 10 cm bandage. This should cover upto or just over the knee. Continue up the thigh with 2-6 (or more for very large areas) rolls of 12cm bandage. Remember to pad behind the knee.

12. If slipping down of bandages is a problem, especially in the thigh area, a roll of white bandage (Isoband) can be spiraled around the limb, like a foundation, to which the brown bandages can cling.

13. You may tape ends of bandages to secure. As you become more experienced, you may be able to use less tape. Tape only to the brown bandages.

14. Alternate the direction of each wrap as you add it.

15. Bandage Knee

a. On the lower leg, complete the bandage to just below the knee.

b. The next bandage, roll one time around the lower leg just below the knee

c. Complete the circle around the thigh, above the knee

d. Bring the bandage down at an angle across the patella (Knee cap) to below the knee

e. Circle the lower leg completely, returning to the front of the leg. Angle the bandage up across the patella (knee cap)

f. Each bandage is about 1/2 inch lower than the previous pass on the thigh, and about 1/2 inch higher than the previous pass on the lower leg.

g. Complete the instructions 3 through 7 until you have used up the bandage. One entire bandage is used to “cage” in the knee.

h. Start the next bandage belowe the knee on the lower leg. Spiral up over the baandaged knee, this time widening your spacing to about 1”.

16. Avoid wrinkles, bunching, gapping and loose ends in the wraps.

17. You may give small tugs as you bandage to keep the wraps firm. Do not pull the bandage roll as you may wrap too tight. Check the uniformity of the compression by plucking at the wraps and comparing the tension.

18. Wrap all the way to the groin, capturing the fluid at the top of the thigh as much as possible. Bandages are more likely to stay up if the leg is wrapped up to the junction between the leg and body.

19. Tape securely at the top and cover all with stretch fishnet (Tubigauze/Elastinet)

20. You should sleep in your wraps. Wear your wraps 22 hours per day, off only to bathe, lotion, dress and allow skin to “breath” for about 2 hours per day. After you have completed the intensive phase of therapy you may sleep in your wraps and wear a compression garment during the day.

**Special thanks to Healthsouth Lakeshore Rehabilitation Hospital - Birmingham, Alabama**


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.

Friday, March 2, 2012

Systematic review: conservative treatments for secondary lymphedema.

Systematic review: conservative treatments for secondary lymphedema.

Jan 2012



Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments.


We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups) that reported primary effectiveness data on conservative treatments for secondarylymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies.


Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under six months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatmentcomparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare (<1% incidence) and mostly minor (e.g., headache, arm pain).


The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.


Comprehensive decongestive therapy in postmastectomy lymphedema: An Indian perspective.

Comprehensive decongestive therapy in postmastectomy lymphedema: An Indian perspective.

Oct 2011


Department of Surgery, JIPMER, Puducherry, India.



Lymphedema following breast cancer treatment is one of the most morbid conditions affecting breast cancer survivors. Currently, no therapy completely cures this condition. Comprehensive Decongestive Therapy (CDT), a novel physiotherapeutic method offers promising results in managing this condition. This therapy is being widely used in the West. Till date, there are no studies evaluating the effectiveness and feasibility of this therapy in the east.

Materials and Methods:

The therapeutic responses of 25 patients with postmastectomy lymphedema were analyzed prospectively in this study. Each patient received an intensive phase of therapy for eight days from trained physiotherapists, which included manual lymphatic drainage, multi layered compression bandaging, exercises, and skin care. Instruction in self management techniques were given to the patients on completion of intensive therapy. The patients were followed up for three months. Changes in the volume of the edematous limb were assessed with a geometric approximation derived from serial circumference measurements of the limb and by water displacement volumetry. Changes in skin and sub cutis thickness were assessed using high frequency ultrasound.


The reduction in limb volume observed after therapy was 32.3% and 42% of the excess, by measurement and volumetry, respectively. The maximum reduction was obtained after the intensive phase. The reduction in skin and subcutis thickness of the edematous limb followed the same pattern as volume reduction. Patients could maintain the reduction obtained by strictly following the protocols of the maintenance phase.


CDT combined with long-term self management is effective in treating post mastectomy lymphedema. The tropical climate is a major factor limiting the regular use of bandages by the patients.

Indian Cancer