Lymphedema is a chronic condition characterized by persistent swelling, typically in the limbs, caused by the lymphatic system’s inability to drain fluid effectively. This failure leads to the accumulation of protein-rich fluid in the tissues, causing enlargement of the affected area. Compression therapy is a foundational, non-surgical treatment that physically contains the swelling and prevents disease progression. By applying controlled pressure, compression helps reduce limb volume and maintain the reduction achieved through other therapies.
Standard Elastic Compression Garments
Elastic compression garments are the primary tool used for the long-term, daily management of lymphedema after the initial swelling has been reduced. These garments work by exerting a continuous, graduated pressure that is tightest at the extremity and decreases toward the body’s core, which encourages the movement of fluid out of the limb. The garments are broadly categorized by their knitting style, which determines their stiffness and containment properties.
Flat-knit garments are constructed by knitting a flat piece of fabric that is then sewn together, creating a seam. This method allows for precise shaping to accommodate irregular limb contours, such as skin folds or significant differences in circumference. The resulting fabric is typically much stiffer, providing high working pressure and containment without creating constrictive bands. Flat-knit garments are often required for more advanced Stage 2 or Stage 3 lymphedema and are frequently custom-made to ensure a perfect fit.
In contrast, circular-knit garments are produced seamlessly in a tube shape and are more elastic and less robust. These are generally used for milder edema, chronic venous issues, or early-stage lymphedema where the limb shape is relatively normal and the fluid is easily reducible. Compression strength is measured in millimeters of mercury (mmHg) and follows a standardized grading system, such as Class 1 (20–30 mmHg) or Class 2 (30–40 mmHg). This classification indicates the pressure applied at the most distal point, such as the ankle or wrist.
Inelastic Bandaging and Adjustable Wraps
The initial, intensive phase of lymphedema treatment, known as Complete Decongestive Therapy (CDT), focuses on rapidly reducing the volume of the swollen limb. This reduction phase relies heavily on multi-layer, short-stretch bandaging, which is applied by a certified lymphedema therapist. Short-stretch bandages are made from materials with limited elasticity.
This low elasticity is beneficial because it creates a low resting pressure when the limb is still, but a very high working pressure when the muscles contract during movement. The muscle contraction against the firm, unyielding bandage creates an internal pumping action that effectively pushes the lymphatic fluid out of the limb. Short-stretch bandages provide safe, controlled compression that adapts to the daily volume reduction occurring during the intensive phase.
Following the intensive bandaging period, or as an alternative for maintenance, patients may use non-elastic adjustable compression wrap systems. These devices typically use hook-and-loop fasteners, such as Velcro, to secure inelastic bands around the limb. Adjustable wraps offer stiff containment similar to short-stretch bandages but are designed for easier donning and doffing, allowing patients to manage compression independently and adjust it as limb volume fluctuates.
Sequential Pneumatic Compression Pumps
Sequential pneumatic compression pumps (SPCPs) are mechanical devices used as an adjunctive treatment that supplements manual therapy and garments. The system consists of an electric pump and an inflatable garment or sleeve that covers the affected limb. This sleeve is segmented into multiple chambers that inflate in a timed, sequential manner, starting at the hand or foot and progressing toward the body’s trunk.
This wave-like inflation pattern mimics the action of manual lymphatic drainage by pushing the excess lymph fluid proximally, toward the core, where it can be processed by the remaining functional lymphatics. While effective for mobilizing fluid and softening fibrotic tissue, these pumps are not typically a standalone therapy, as they do not provide the continuous containment needed throughout the day. Their use requires careful supervision, and they are generally avoided in patients with uncontrolled congestive heart failure or an active infection in the limb.
Determining the Appropriate Compression Level and Type
The optimal choice of compression is highly individualized and depends entirely on the patient’s specific circumstances. The selection process begins with the phase of treatment: the goal of volume reduction requires the highly rigid containment of multi-layer bandaging or adjustable wraps. Once the limb volume is stable, the focus shifts to the maintenance phase, which requires all-day use of elastic compression garments to prevent fluid re-accumulation.
The stage of lymphedema is a primary determinant of the garment type and pressure level prescribed. Early Stage 1 lymphedema, where swelling is still soft and pitting, may be managed with lower-pressure, ready-to-wear circular-knit garments. The presence of skin changes, fibrosis, or significant limb shape irregularities, characteristic of Stage 2 and Stage 3, necessitates the stiffer, custom-measured containment provided by flat-knit garments.
Patient factors also heavily influence the final selection, as compliance is necessary for long-term success. A patient’s dexterity and strength, for example, may make a highly rigid flat-knit garment difficult to don and doff, suggesting that a simpler adjustable wrap system might be a more practical alternative. Ultimately, compression is a medical prescription, and the selection of pressure, knitting technology, and device type is a complex decision made by a certified lymphedema therapist based on the patient’s clinical needs and lifestyle.