Lymphedema is a chronic condition characterized by the abnormal accumulation of protein-rich lymphatic fluid, most commonly causing swelling in the arms or legs. This occurs because the lymphatic system is either congenitally malformed (primary lymphedema) or damaged by factors like surgery, radiation, or trauma (secondary lymphedema). Compression therapy is the foundational treatment, providing external pressure that helps reduce the volume of the affected limb. This pressure facilitates the movement of interstitial fluid back into the capillaries and prevents fluid from re-accumulating, maintaining the size achieved after initial reduction.
Daily Wear Compression Garments
Compression garments are the primary tool for long-term lymphedema maintenance, worn daily after initial swelling has been reduced. These garments provide gradient compression, meaning the pressure is highest at the farthest point of the limb (e.g., ankle or wrist) and gradually decreases toward the body. This gradient helps push fluid away from the extremity and toward the trunk for drainage.
The two main types of fabric construction are circular-knit and flat-knit. Circular-knit garments are seamless, more elastic, and typically reserved for mild edema or limbs with uniform shapes.
Flat-knit garments are constructed with a seam and are less elastic. Due to their stiffness, they provide a higher “working pressure,” which is the resistance offered when muscles contract. This stiffness is crucial for containing swelling and preventing the garment from digging into skin folds. Flat-knit is the preferred choice for moderate to severe lymphedema and irregular limb shapes.
Garments are made primarily from a blend of nylon and spandex. Nylon provides durability and strength, while spandex supplies the necessary elastic recoil to create the measured compression. The choice between ready-to-wear and custom-made options depends on the limb’s shape and size. For limbs with significant circumference differences or unusual contours, a custom-made flat-knit garment is necessary to ensure therapeutic pressure is applied evenly without creating constrictive bands.
Short-Stretch Bandaging and Adjustable Wraps
The initial phase of treatment, known as Complete Decongestive Therapy (CDT), relies on multi-layer short-stretch bandaging to achieve maximum limb volume reduction. Short-stretch bandages have limited elasticity, stretching only about 30 to 90 percent of their length. This low elasticity results in a high working pressure when the patient’s muscles contract during movement, effectively compressing the tissue.
When the limb is at rest, the pressure exerted by the bandages (resting pressure) is relatively low, which is safer for circulation. The multi-layer application involves cotton or foam padding placed over the limb, followed by several layers of short-stretch bandages. These bandages are reapplied daily as the limb size decreases. This intensive process is highly effective at mobilizing large volumes of fluid and softening fibrotic tissue.
Adjustable compression wraps, typically using interlocking Velcro straps, serve as an alternative to multi-layer bandaging. These wraps are considered a bridge between the intensive bandaging phase and the long-term daily garments. They are beneficial for patients who struggle with the dexterity required for self-bandaging. The adjustable nature allows patients to easily tighten or loosen the compression as their limb volume fluctuates, maintaining consistent therapeutic pressure without daily re-application.
Selecting the Appropriate Pressure and Fit
Determining the appropriate compression requires a clinical assessment of lymphedema severity, which dictates the necessary pressure class, measured in millimeters of mercury (mmHg). Compression levels are standardized into classes. Class 1 (20-30 mmHg) is used for mild lymphedema or the upper extremity. Class 2 (30-40 mmHg) is prescribed for moderate lymphedema or the lower extremity, requiring higher pressure to counteract gravity. More severe lymphedema may require Class 3 (40-50 mmHg) garments.
A Certified Lymphedema Therapist determines the appropriate class based on the stage of the condition, tissue consistency, and the patient’s arterial health. The principle of gradient compression is fundamental, ensuring the highest pressure is exerted at the wrist or ankle. Progressively less pressure is applied moving up the limb, which helps move the lymph fluid centrally.
Proper fitting is paramount to the safety and effectiveness of the therapy. Measurements for custom garments are taken at multiple precise points along the limb to ensure the garment matches the individual contours. An improperly fitted garment poses several risks, including the development of a tourniquet effect. This occurs when excessive pressure restricts fluid flow and worsens swelling above the constriction point. Poor fit can also lead to skin irritation or damage, which is a concern for lymphedema patients susceptible to skin breakdown and infection.
Advanced Compression Techniques
Pneumatic Compression Devices (PCDs), commonly known as compression pumps, are adjunctive therapies used to supplement daily garment wear and bandaging. These devices consist of a multi-chamber sleeve worn over the affected limb and connected to a pump. The pump sequentially inflates and deflates the air chambers, starting at the furthest point and moving toward the trunk. This sequential inflation mimics the muscle-pumping action and manual lymphatic drainage, helping to propel excess fluid out of the limb. PCDs are typically prescribed one to two times per day and are useful for patients with significant fibrosis or those needing help maintaining volume reduction. They must be used with other compression methods, as the limb requires a garment or wrap immediately after treatment to contain the fluid reduction.
Nocturnal compression garments are a specialized option, necessary because daytime garments should not be worn while lying down for extended periods. These night garments are typically foam-lined or quilted, providing a low, consistent pressure safe for nighttime wear. The foam inserts create micro-massage effects and pressure differentials as the patient moves. This helps soften hardened, fibrotic tissue and prevents the limb from refilling with fluid overnight.