When it comes to choosing the right compression for lymphedema, there are a variety of manufacturers & options which can be overwhelming for a trained therapist let alone a patient. This blog will introduce a series of upcoming blogs highlighting well-known manufacturers & some of their most popular lymphedema compression options. We’ll also feature a few helpful donning aids.
What types of long-term compression are available? Hose & sleeves used to be the daytime options with self-bandaging recommended at night. This is still the “gold standard” in lymphedema, but now there are hybrid garments which have Velcro & alternative options for night compression.
There are numerous factors to consider when deciding whether to go the traditional route or consider an alternative. Does a person have help to put on a garment? Is strength an issue? Is arterial blood flow compromised? Is cost a factor? Is the condition pure lymphedema or is it a combination form (such as venous insufficiency or dependent positioning)? Is tissue hypersensitive? Is custom needed? Answering some of these questions will help in determining which garment might work the best in your particular situation. For our purposes, there are three categories of compression garments: Flat-Knit, Circular-Knit & Velcro/Other. Here is a brief overview:
- Flat-Knit – Most lymphedema garments (for pure lymphedema cases) are going to be flat-knit. This means that the garment is sewn in a flat manner & then stitched together (so a seam is visible). They are standard protocol for lymphedema because they affect the tissue in a manner similar to short-stretch bandaging. (Short-stretch bandages used in treatment not only maintain the volume that has been lost, but they have a massaging-effect on the tissue when the muscles are moving such as during exercise.) These are typically made in Europe, are more expensive than other types of compression & come in European compression class levels (Class I: 18-21 mmHg, Class 2: 23-32 mmHg, Class 3: 34-46 mmHg, Class 4: 49+mmHg) which require a prescription.
- Circular-Knit – Some combination-form lymphedema patients will benefit from this type of garment. This garment is sewn on a tubular machine which knits them in a circular manner. While they are cheaper to make & less expensive to buy, there are pros & cons to this garment. Because of how they are sewn, there is no seam, making them more esthetically attractive. They are also thinner & more stretchable. However, they have a tendency to roll & will readily bunch up & create pressure which can cause a wound. This typically happens in areas which have movement (joints such as the ankle or behind the knee). These garments affect the tissue in a manner similar to long-stretch bandages often used in wound care or venous disease. Long-stretch & ACE bandages work differently than short-stretch bandages. Long-stretch bandages have a longer stretch (they can be stretched out further) & higher pressure at rest (when a person isn’t moving). However, when a person is active (such as during exercise), the bandages easily stretch & do not have the same “massaging-effect” that short-stretch bandages do. People who sit at a desk all day or who have problems with their veins working properly will benefit the most from this type of compression garment.
- Velcro/Other – In more recent years, a hybrid form of compression has been created. This primarily includes Velcro options on a material more similar to short-stretch bandages. It’s a popular garment in wound care as the Velcro can be readily removed for dressing changes. These can be worn at night also & work well although they are not superior to bandaging. This is more cost-effective for many patients who cannot afford both day & night compression. The “other” category would be night garments with foam which are slipped over an extremity & provide compression or allow bandaging with fewer steps.
In the next blog, we’ll finish our introduction by talking about additional areas to consider before choosing the right compression garment such as the style, the use of silver & compression class.