Gradient compression helps maintain limb volume
During the maintenance phase of CDT, most patients will be transitioned into a gradient compression stocking or armsleeve and glove or gauntlet to manage their lymphedema daily. As you and your therapist start talking about which garment might work best for you, you will probably hear words like “flat-knit vs. circular-knit” and “custom vs. ready-to-wear.” It’s important to understand the different types of compression garments when deciding the best choice for your lymphedema care.
Flat-knitted garments are custom garments that are knitted on specially made machines that have a double row of needles facing each other at a 90-degree angle. The advantage of flat knitting is that exceedingly complex shapes can be knitted. Additionally, flat-knit garments have less stretch, and so generally provide better edema control than circular knit garments. Flat knit garments usually require custom fitting and manufacture for optimal results. These garments come out of the machine in a flat format and must be sewn together at a later stage.
Once sewn together, the garments will look just like your arm or leg! Flat-knitted garments are extremely well suited for larger or unusually shaped limbs and for those patients with difficult-to-manage swelling. The flat-knitting process allows for garments to bridge the gaps of any skin fold or crease preventing the garment from digging in and irritating the skin.
Circular-knit garments are those that are knitted on a round cylinder. Circular knitting has been around for a very long time and is basically an automated version of the Knitting Nancy. These machines have a fixed number of needles – the more needles a machine has, the wider the garment. These garments are seamless and more tubular shaped versus custom garments. Circular knitted garments have a bit more stretch and are best suited for patients with mild to moderate lymphedema with normally shaped limbs.
Gradient compression stockings and armsleeves can come in standard “off-the-shelf” sizes. Meaning, they are predetermined sizes such as small, medium and large. If you have mild to moderate edema and normally shaped limbs, you may be able to fit into a RTW garment. However, if your swelling is difficult to manage, or you have an abnormally shaped limb, you may be best suited in a custom-made garment. The benefit of a RTW garment is that it is immediately available to you as it is sold directly from your therapist or at your local Durable Medical Equipment (DME) store.
Custom-made gradient compression garments are those that are knitted specifically to your limb shape and size. Nothing fits better than a garment created especially for you! Your therapist, or another fitter specifically trained to measure and fit for custom garments, will take a series of circumferential and length measurements that will, in essence, design the garment to fit your limb. Since a properly fitting garment is essential to its comfort and effectiveness, it is important that it be measured by someone who has been professionally trained.
Donning and Doffing
Putting on and taking off your compression garments might be a little difficult. There are some general rules to live by that can help you as you begin wearing your garments:
› Avoid sticking your fingernails into the knitted material of the garment when pulling it on.
› Do not overstretch the material.
› Do not wear jewelry while putting on or taking off your garments.
› Many patients find using rubber gloves makes it easier to put on and take off the garment.
Follow these steps when putting on your armsleeve garment:
1. Fold the top of the armsleeve down and inside-out so that the top of the armsleeve meets the bottom.
2. Holding the fold, slip your hand into the garment and pull up until the bottom of the garment is just above the wrist. If you are having a difficult time pulling your hand through the garment, you can continue folding the garment down till you are able pull the garment to your wrist.
3. Once the garment is in place on the bottom half of your arm, unfold the garment by pulling the top of the armsleeve up your arm. It may be helpful to brace your hand against a wall to pull the sleeve into position. The sleeve is properly in place when it is situated smoothly on the arm without any creases.
Follow these steps when putting on your glove:
1. Slip your hand through the wrist of the glove and into the fingers.
2. Adjust the fingers by carefully pulling on the fabric until the glove fits snugly into the web spaces between your fingers.
3. Be sure the fabric is smoothed out over the fingers and hand.
Follow these steps when putting on your knee-high garment:
1. Start with the garment inside out. Tuck the foot portion inside up to the heel and hold it with both hands, seams facing down, creating a toe tunnel.
2. Stretch your garment as wide as possible and slip your foot into the garment, pulling it onto your foot.
3. Put the heel pocket over the back of your heel.
4. Take hold of the fabric just past your toes (always grasp the garment at the sides, never at the seams).
5. Pull it up over your foot past the ankle. The garment should now be right side out. Adjust the garment so that the heel is in place.
6. Adjust the toe area for comfort by pulling the garment toward your toes and releasing.
7. Now work the garment all the way up to your knee, smoothing creases as yougo. For most knee-high garments, you want it to end about one inch below the bend of the knee.
Follow the same instructions as the knee-high, working the garment all the way up to your groin.
Follow the same instructions for knee and thigh-high garments and then complete these steps:
1. Stand up and grab a handful of fabric with both hands, pulling the garment up to your waist.
2. Fit it snugly, but comfortably over the groin area.
3. Adjust your garment so that it is snug at your midsection. This will help keep the garment from sliding down. Pull the midsection to its proper height.
4. Slip your hands, palm out, into the back and lift the fabric up and away from your skin. Let the fabric fall back to fit snugly over the buttocks.
CARING FOR YOUR GARMENTS
Most compression garments can be machine washed on a gentle cycle in lukewarm water (104 degrees) with a mild detergent. After washing the garment, lay it on a thick towel, roll it up and squeeze it hard to remove excess water. You can hang the garment straight or lay it flat to dry, keeping the garment out of direct sunlight. Never use fabric softeners or bleach. Follow the care instructions provided by the manufacturer.
Consider these helpful tips when donning and caring for your garment:
› Keep your regular check-ups with your healthcare provider.
› Most garments are built to last up to six months, but always examine your garments for signs of wear to ensure they are still effective.
› Any open wounds should be covered with a sterile dressing prior to putting on compression garments.
› Since the garment should be washed daily, you may find it helpful to have several pairs of garments. This way you have one garment to wear while the other is being washed.
› Do not cut any loose threads or snags as this may cause runs or holes in the garments.
› If wearing a lower extremity garment, appropriate footwear must be worn when walking to prevent falls.