Lymphedema is a chronic condition characterized by persistent swelling, typically in the arms or legs, resulting from the lymphatic system’s failure to adequately drain protein-rich fluid from the body’s tissues. This impairment leads to fluid accumulation, causing the affected limb to feel heavy and tight. Compression garments are a fundamental component of lymphedema management, applying external pressure to the limb. This consistent pressure helps reduce fluid accumulation, supports tissue structure, and encourages lymphatic fluid movement back toward the center of the body for drainage. While these garments are the standard of care for controlling swelling, their misuse or improper selection can exacerbate lymphedema symptoms.
How Improper Compression Can Worsen Lymphedema
Compression garments become detrimental when they fail to provide the necessary pressure gradient. This design feature requires pressure to be highest at the farthest point of the limb and gradually decrease closer to the torso. If a garment is non-graded or applies equal pressure throughout, it can unintentionally push fluid toward the upper part of the limb. This failure to guide fluid proximally causes swelling to build up just above the garment’s edge, known as the tourniquet effect. This constriction blocks the drainage pathway, causing the limb volume to increase and the condition to worsen.
Applying excessive pressure can also damage the fragile superficial lymphatic vessels, impeding their already compromised function. Garments that are too tight may irritate the skin, cause discomfort, or lead to localized skin breakdown, increasing the risk of infection, such as cellulitis. Overly aggressive compression can also impede arterial circulation or cause nerve damage, though this is usually due to an incorrect fit.
The choice of garment material is also a common factor in treatment failure. Most general-use compression stockings use circular-knit fabric, which is highly elastic but provides insufficient containment for the dense, protein-rich fluid of lymphedema. This material tends to bunch or roll, creating high-pressure rings that function as a localized tourniquet. Specialized lymphedema garments are typically flat-knit, offering a stiffer, less-elastic fabric that provides the necessary working pressure and maintains a stable limb circumference.
Essential Requirements for Safe Garment Use
The foundation of safe compression therapy is a professional assessment and fitting by a Certified Lymphedema Therapist (CLT). A CLT measures the limb precisely when swelling is lowest, often after intensive bandaging, to ensure the garment accurately reflects the limb’s reduced volume. These measurements determine the exact size and length needed. This is important because off-the-shelf sizes may not fit the unique contours of a lymphedema-affected limb.
The therapist prescribes the appropriate compression class, measured in millimeters of mercury (mmHg). Classes range from Class 1 (20–30 mmHg) for mild swelling to Class 3 (40–50 mmHg) for more severe cases. The pressure level must be carefully calibrated; too little pressure will not control swelling, while too much pressure can cause adverse effects. Selecting the correct pressure ensures the garment provides therapeutic containment without restricting circulation.
Proper maintenance is necessary to sustain the garment’s therapeutic effectiveness. Compression fabrics lose elasticity over time due to wear, washing, and body oils, meaning the garment eventually fails to deliver the prescribed pressure. Garments should be replaced approximately every four to six months, even if they appear structurally intact. Using donning aids, such as silk sleeves or frames, helps ensure the garment is pulled on smoothly, preventing wrinkles or folds that create harmful pressure points.
Recognizing Signs of Adverse Effects
Patients should be vigilant for specific physical signs indicating that their compression regimen is causing harm. Persistent pain, numbness, or tingling sensations in the compressed limb are warning signs, suggesting potential nerve compression or restricted blood flow. These symptoms are not a normal part of wearing a properly fitted garment, which should feel snug but not painful.
Skin changes are an immediate indicator of a problem, particularly localized redness, blistering, or irritation like contact dermatitis. Garments that are too tight or bunching at the joints can cause mechanical trauma to the skin, potentially leading to open sores or an entry point for infection. Any new or increasing swelling that appears directly above the edge of the garment, especially near the groin or shoulder, confirms the presence of a tourniquet effect.
It is important to monitor the overall limb volume. If the limb size is rapidly increasing, or if the skin texture becomes harder, the compression is failing to control the fluid dynamics. Any adverse signs, including a feeling of general malaise or the onset of fever accompanying redness, warrant immediate removal of the garment and contact with the prescribing lymphedema therapist or physician for urgent re-evaluation.