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Standard Treatment of Lymphedema--Wrapping and Bandaging

Wrapping/Bandaging

"Wrapped Wonder"

"The Michelin-Man Look"

"Mummy Dear"

No 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.

A couple of words of caution are in order before we begin:

First, NEVER USE ACE BANDAGES TO WRAP FOR LYMPHEDEMA OR FOR LYMPHEDEMA PREVENTION. The outer bandages used for lymphedema wrapping may look 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.

And second, LYMPHEDEMA WRAPPING SHOULD BE TAUGHT BY A SKILLED AND EXPERIENCED THERAPIST. 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 session.

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 the presence of an active infection.

If 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 bandages.

Tubular stockinette further protects the skin and provides a comfortable, breathable basis for wrapping.

If your fingers are bandaged, the wrapping of choice will be two or three rolls of flexible gauze.

 

 

Next, felted cotton-like fabric or thin foam is used to add a layer of padding 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 deep breath. Pick up your bandages and try 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 it'll 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 little easier:

  •          Have all your supplies laid out and close at hand, including pre-cut strips of tape to hold the ends of one layer 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.

  •          If 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 SUPPLIES?

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 sure to ask anyway.

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 experience

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 instructions the manufacturer or your therapist. Here are some that others 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.

    • Another handy way to wash bandages without them getting all tangled in the washer is a standard netting laundry bag and using hem tape sew channels into the bag.

     

  •          Gauze is reusable, though gauze rolls won't last as long as the short-stretch bandages. After laundering in lingerie bags, spread them flat with your fingers, then hang them to dry.

  •          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.

  •          If you use 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.

  •          Stockinette 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 dryer.

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 Breast Compression, Swell Spots™ and Foam Padding, and Breast Binders.

 

Bandaging/Wrapping
for Lymphedema
Short note here: there really shouldn't be any foam showing under the 6 cm wrap at the wrist. The author has had some pressure points on the heel of her hand, so she tends to avoid that area as much as possible.

Linda Lou shares her tip on hand wrapping with foam: When I was doing the intensive day and night wrapping of my hand I had to use lots of cut out foam pieces for my fingers, front and back of my hand. I had a lot of fibrosis which caused limited range of motion. Having my therapist do the wrapping was ok, but when I had to try to do the wrapping myself at home it was another matter. Having to apply multiple little foam pieces and keep them all in place while trying to wrap with one good hand was very difficult. Like others I also tended to get irritation between my fingers with the finger wraps. So I came up with a solution that worked for me. Maybe others will find it useful information.

I went to Walgreens and bought a pair of their soft cotton gloves they sell for around $3.00

 

 

 

 

I put them on inside out so the seams were on the outside and then I used scissors to cut the finger tips out of the gloves

 

 

 

 

I then found some iron-on Velcro specifically designed for fabrics and cut the soft velcro portion into the size and shapes I needed to apply to the cotton glove.  The SOFT portion of the Velcro has to be applied to the glove so that it can easily be laundered without catching against other fabrics. The Velcro I applied to the foam pieces was a stick-on type Velcro that is not intended to be laundered.  It is the harsher LOOPED side of the Velcro that goes on the foam pieces.  Care must be taken that the looped Velcro is cut slightly smaller than the size of the soft pieces of Velcro on the glove.  This is to avoid having the looped Velcro pressing into the hand and causing irritation when wrapping over it with compression bandages.

 

When it was time to wrap my hand I would slip on the glove, apply the foam pieces in the appropriate spots and then could easily wrap my hand and fingers without having to hold everything in place. Made it much quicker plus the cotton glove helped protect the skin between my fingers from getting irritated.
 

 

Here are some videos from You-Tube showing various wrapping techniques:

Video #1 demonstrates wrapping of the arm, without a finger wrap

http://www.youtube.com/watch?v=tDCwTodmGqE&NR=1

Video#2  is a home video of a finger wrap

 

Video #3 is an over-view of lymphedema from the Komen Foundation and shows wrapping, exercises and explains lymphedema

http://www.youtube.com/watch?v=Di5E_KXbAnU&feature=related 

Video #4 Michigan State University: Lymphedema Compression Bandaging - Part 1: Arm

Video #5 Michigan State University: Lymphedema Compression Bandaging - Part 2: Half Leg

Video #6 Michigan State University: Lymphedema Compression Bandaging - Part 3: Whole Leg

 

Page Last Modified 02/16/2014

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