What are the therapy options for managing lymphedema?
The goals of lymphedema therapy are quite basic: reduce the size of the limb, then maintain that decreased size. How this is done, on the other hand, can be quite involved. But don’t worry, we are here to walk you through all the different management options out there in the world of lymphedema.
COMPRESSION IS AN IMPORTANT PART OF LYMPHEDEMA TREATMENT
Once your lymphatic vessels have been “awakened” with MLD, compression is applied to help move the extra fluid out of the limb, and to keep it from coming back into the limb. The idea behind compression therapy is to assist the tissue by applying pressure from the outside, which helps move the fluid into the lymphatic system, where it is filtered, concentrated, and returned to your body.
There are many difffferent types of products that are used for compression. In the Decongestive phase of CDT, the compression types commonly used are:
› Multi-Layer Bandaging
› 2-Layer Bandaging
› Short Stretch Compression Wraps
Once the level of decreased edema has been achieved in Phase I, medical compression garments help maintain that decreased level. Since we know the swelling will come back without compression, it is imperative to wear some sort of gradient compression product. There are many different options offered to manage edema during the Maintenance phase:
› Compression Garments
› Short Stretch Compression Wraps
› Chipped Foam-based Products
Why bandage ?
Bandaging is an important part of lymphedema treatment that can be used during the decongestive (Phase I) and maintenance phase (Phase II). Short-stretch bandages are used to reduce your swelling and help prevent fluid reaccumulation. Short-stretch bandages are applied at or near end-stretch, so once applied they help resist your limb from reswelling safely.
MULTI-LAYER LYMPHEDEMA BANDAGING (MLLB)
Traditional bandaging for lymphedema is Multi-Layer Lymphedema Bandaging, or MLLB. There are usually 4-5 components of MLLB:
› Finger/toe gauze bandages: Non-adhesive, oven weave bandages are often used on the fingers and toes. These products are generally soft and stretchable for comfortable wear. They should be good at absorbing moisture to help avoid infections. Since the fingers and toes move often throughout the day, these bandages must fit well without slipping.
› Tubular stockinette: These lightweight stockinettes are used to protect the skin under the other layers of compression. Since they are placed directly on the skin, they should also be absorbent to help aid in infection prevention. You can cut a few pieces at a time so that you can wash them often and make sure you are always wearing a clean stockinette next to your skin.
› Soft padding bandage: The next layer applied is a comfortable padding bandage that provides optimal skin protection. These products help ensure even distribution of pressure from the short-stretch bandage layer. They also provide padding around bony areas such as your ankle or wrist bones.
› Foam pads/pieces: Often times lymphedema can be hard, or fifibrotic. Special foam pieces can be used in these difficult areas to soften fibrotic tissue. Foam pads can also be used to protect the skin and fill in any gaps or indentations in order to make a nice shape for the next bandage layer to be applied. Foam pads can also be used to protect the skin and fill out any dips or indentions to make a nice shape for the next layer to be applied.
› Short-stretch bandage layer: This is the final layer of bandaging. Short-stretch bandages are bandages used specifically for lymphedema. While these may look a lot like the ACE® bandage that you see in your local pharmacy, they are quite difffferent. They are specially made to provide higher compression when you’re moving (walking, exercising) compared to when you are at rest. They come in different widths and lengths and your CLT will often instruct you to change the size depending on what area of your limb you are wrapping. Expect to use multiple bandages to cover your limb.
2-layer bandaging is often used when a wound is present or to increase patient compliance. This system of compression bandaging consists of only two layers:
› Layer one: a padding bandage that exerts a slight compression force and helps to distribute the pressure evenly. This layer also protects bony areas. It is specially designed with a coating on the one side to prevent the bandages from slipping.
› Layer two: this second layer is a cohesive (sticks to itself) short-stretch bandage that is applied over the padding bandage. This bandage system can be worn up to seven days straight without removal.
Make daily compliance more manageable
Over the past few years, bandage alternative products have become more and more popular to manage lymphedema. They can be an alternative solution, especially if you have a difficult time putting on bandages or garments on your own.
SHORT STRETCH COMPRESSION WRAPS
Bandage alternatives such as short-stretch compression wraps are often used in the Decongestion phase of CDT. These short-stretch wraps attach with Velcro® which makes them adjustable and easy to put on and take off. Some wrap products are able to be trimmed and made smaller as your arm or leg decreases in size. Wraps can be really useful if you get a lot of reduction during the day and find that your bandages are slipping off by nighttime. Bandaging is a skill that takes some time to master and can be difficult depending on the place you are bandaging. Short-stretch wraps can provide a nice alternative.
Short-stretch compression wraps are also extremely useful during the Maintenance phase of lymphedema therapy. These products are highly suitable for use at night instead of bandaging. Also, there may be times when your arm or leg swells for some reason. These products are great to help get your limb back to normal size to fit back in your compression stocking or sleeve. Many clinicians feel that short-stretch compression wraps should be the next choice for patients who cannot wear compression stockings or sleeves for their maintenance compression.