"The Michelin-Man Look"
matter what you call it, lymphedema wrapping is something most patients dread.
At least at first. Once you discover how good your
arm can feel when it's supported and experience the rapid
improvement most of us enjoy using this method, you'll be sold on
the technique even if not on the look.
Wrapping is sometimes referred to as "bandaging;" we'll be using the
terms interchangeably here.
couple of words of caution are in order before we begin:
NEVER USE ACE BANDAGES TO WRAP FOR LYMPHEDEMA OR FOR
The outer bandages used for lymphedema wrapping may
like the ordinary ACE-type bandages available at any drug store, but
they're not the same. Lymphedema bandages are called "short stretch"
bandages. They'll stretch if you pull them, but not nearly as far as
an ACE bandage stretches. This more limited stretch applies the
right kind of pressure to your skin to help pump the lymph along,
and it prevents the uneven binding and constricting that can happen
with an ACE bandage.
LYMPHEDEMA WRAPPING SHOULD BE TAUGHT BY A SKILLED AND
Much as we value the proud independence of a self-taught
individualist, lymphedema bandaging in one of those skills that
requires some one-on-one tutoring and supervision to learn.
WHAT IS IT FOR?
Wrapping your arm in layered bandages is the gold standard for
lymphedema compression. It's easy enough to see that wrapping can
contain and control swelling that's already present, but it does
much more as well. The sluggish lymph vessels lie just below the
skin, where they depend on the pressure of the muscles beneath them
to act as a pump in stimulating lymph flow. The bandages apply
gentle and consistent pressure against the skin, providing a surface
for the muscles to press against and enhancing the effect of the
muscles' pumping action. So wearing bandages can actually act to
pump excess fluid out of the arm and reduce the swelling as you go
about your daily activities.
Bandages are wrapped with gradient pressure. That means that they're
wrapped more tightly near the hand and gradually looser as they
spiral up the arm. This gradient pressure pushes lymph in the
direction you want it to go: up and out of your arm.
But there's even more. Layered bandages work as you move to
"massage" any areas of fibrosis (hardened tissue) and keep your arm
soft and supple. Unlike regular compression garments, bandages can
be worn safely day or night because they exert only low pressure
when your muscles are not moving, avoiding the possibility of
constriction and lymph blockage as you sleep. And as a final
benefit, each time you bandage your arm you're adjusting the
compression to the exact shape and size of your limb at that moment,
so there are no worries about size or shape changes with wrapping as
there are with garments made to a pre-determined size.
WHEN IS IT NEEDED?
Because wrapping is so effective at moving lymph fluid out of the
arm, your therapist will generally wrap your arm at each therapy
session, after s/he has done Manual Lymph Drainage (gentle
lymphedema massage) to stimulate lymph flow and redirect it out of
the swollen areas. You'll wear the bandages 23 hours a day, seven
days a week, throughout the therapy period, removing them only to
shower before returning for the next session.
Your therapist should teach you the entire procedure, allowing you
the opportunity to try it yourself on days when you don't see
her/him, and checking the fit and feel of your efforts at your next
When the active therapy phase is finished, you'll continue to wrap
your hand and arm until you can be fitted for compression garments.
Since regular garments can't be worn safely at night when your
muscles are relaxed, you'll need to continue to wrap nightly (unless
you have also been fitted for special night garments.) You'll also
want to wrap your arm to manage the special strains of traveling or
strenuous exercise, or whenever there is a flare-up of swelling
anywhere along your arm or hand.
WHEN SHOULD BANDAGES NOT BE WORN?
Stop bandaging and see your doctor at once at any sign of infection
(redness, warmth to the touch, fever, new itching or tingling, rash,
or unexplained rapid swelling). Compression should not be applied in
presence of an
you have an open wound on your hand or arm, talk to your therapist
about how to care for the wound under bandages.
Congestive heart failure or
the presence of blood clots are both conditions where you'll need to
discuss special precautions about bandaging (or any other form of
compression) with your doctor and therapist.
HOW IS IT DONE?
There are a number of commonly used methods of bandaging your arm
for lymphedema, but all apply the principles of layered wrapping and
gradient pressure. The layers help to protect the skin from
irritation, spread the compression evenly across wide areas, and
allow for high working pressure and low resting pressure to
encourage lymph flow and prevent constriction.
All bandaging starts
with applying lotion to moisturize your skin and keep it healthy.
Keeping your skin well hydrated can prevent minute cracks from
forming and allowing bacteria to enter and cause infection. It can
also prevent skin irritation from the unaccustomed use of layered
Tubular stockinette further protects the skin and provides a
comfortable, breathable basis for wrapping.
your fingers are bandaged, the wrapping of choice will be two or
three rolls of flexible gauze.
cotton-like fabric or thin foam is used
add a layer
that evenly distributes the compression of the outer bandages. It
can also hold in place specially fitted pieces of
flat foam, Swell Spots
or chip bags
to protect tender areas where bones are prominent, or
to reduce fibrosis (tissue hardening).
Finally, short-stretch bandages are applied, with narrower bandages
across the hand and wider strips spiraling up the arm. The number of
bandages needed to wrap will depend on the size and length of the
arm and the level of compression desired. These bandages are applied
with carefully graded compression, more pressure at the hand end
(distal), decreasing as it moves upward toward the body (proximal).
WHY SHOULD YOU LEARN TO DO IT?
Unless you're planning to keep a lymphedema therapist in your
pocket, or to limit your travels to a 20-mile radius around your
therapist's office, you need to know how to do this yourself.
Wrapping is a lymphedema self-care tool you'll use again and again
to regain control after a flare-up, or to prevent that flare-up from
happening in the first place.
Frustrating? You betcha!
It's okay to storm. It's okay to toss bandages around the room
(though unless you vacuumed recently you may have to pick the pet
hair off of them before you can roll them up and start over.) Take a
your bandages and
again. You can do it!
Yes! Even if you drop the rolled up part and it unrolls all over the
floor. (Next time, sit in the middle of your bed where
stay close if you drop it.)
Yes! Even if the arm you're wrapping is your dominant arm, so you're
all thumbs trying to do it with your clumsier hand.
Yes! Even if your lymphedema is bilateral and you have to wrap them
both. (Try wrapping the dominant arm first no point trying to wrap
with your clumsy side already wrapped.)
Here are some tips to make it all a
and close at hand, including pre-cut strips of tape to hold the
in place until you can apply the next.
Set the stage for success. Give yourself plenty of time, at a time
of day when you're not already stressed. Calming music in the
background can help, as well as a promise to yourself to reward a
successful wrap with your favorite small indulgence.
Keep the instructions handy while you wrap, even if you're pretty
sure you remember every step. A simple list of all the supplies, in
the order that you'll use them, can help you remember the routine
from one time to the next.
you know someone patient and kind, enlist their help with wrapping,
especially during the learning period. They can prompt you when you
forget where you are or leave out a step, watch the areas on the
back of your arm for proper overlap, hold bandage ends in place
while you fuss with the next step, and act as your cheering section
if your frustration level starts to rise.
Even if you're no longer wrapping daily (or nightly), mark a date on
your calendar every month to wrap your arm for the day. It'll keep
your skills sharp and allow you an opportunity to check over your
supplies and order whatever you need.
HOW DO YOU SHOP FOR BANDAGING
Chances are your lymphedema therapist will supply your first set of
bandages, but after that you're on your own to purchase
replacements. Most insurance will not cover these supplies, but be
Short stretch bandages need to be replaced every six months with
daily use, less often if you use them only occasionally. You'll
probably be able to tell by the feel of them when the stretch
becomes too loose
to be effective.
When you get new ones, write the purchase date on the hard, narrow
end of the roll in permanent marker to help you keep track of when to re-order.
Lymphedema supplies can't be purchased at your corner drugstore.
Your therapist may help with wholesale orders, or order them
yourself from the many special bandage suppliers, either on-line or
by phone or snail-mail. Comparison shopping at several suppliers
will provide the best current prices. Put your name on the mailing
lists of several so you'll be sure to receive their sale notices.
Here are some reliable suppliers, and you'll find others as you gain
Ask your therapist for the
names, brands and sizes of all the supplies s/he has taught you to
use. Keep the list with your bandaging instructions, and add to it
as you find new products that work for you.
Proper care of your bandaging supplies can insure that they'll last
as long as possible before needing to be replaced. Follow any
the manufacturer or your therapist.
Here are some that
have used successfully.
Short-stretch bandages should be laundered only when necessary. The
one that wraps your hand may need laundering (and replacing) more
often than the arm bandages, since your hands are more likely to get
dirty. Wash short-stretch bandages with a gentle cycle in warm water
and a mild detergent (such as Dreft or Ivory Snow). Be sure to use a
lingerie bag or risk spending an hour untangling it from the inner
workings of your washing machine. Remove them from the washer and
smooth them by rolling them up while they're still damp. Unroll them
over the shower bar to dry
thoroughly. Re-roll them before
storing them or putting them back on.
Gauze is reusable, though
won't last as long as the short-stretch bandages. After laundering
in lingerie bags, spread them flat with your fingers, then hang them
Rolls of felted cotton-like material such as Artiflex can be reused
and even laundered gently and smoothed like the gauze. Be sure to
replace them, though, when they show any signs of thinning or wear.
rolls or sheets of foam
under your bandages, they can be used indefinitely. Store them
completely covered from any light to avoid discoloration or
weakening of the foam.
can be washed in warm water in the washing machine along with your
regular clothes, and it retains its shape best if it's dried in the
WHAT ABOUT WRAPPING YOUR BREAST OR CHEST?
Wrapping is most effective for lymphedema in arms or legs. The torso
is not normally wrapped, as the bandages slip and shift with our
breathing and other movements. Compression can be helpful for chest
and breast lymphedema, but this generally takes the form of breast
binders, compression bras, or even tight sports shirts such as Body
Armor. For more information on breast/chest lymphedema, please see
our pages on
and Foam Padding,