Traditionally the term bandaging has been used to described this part of lymphedema treatment. Recently the term wrapping has replaced the use of that term.

We view this is a very healthy change. The word "bandage" bring to mind protecting wounds and injuries. In contrast, wrapping describes a treatment modality that is an active part of the treatment of lymphedema. Because "bandaging" has been widely used for so long, we will continue to include it in articles -- and we will begin to introduce wrapping as the preferred term.

Introduction

Learning self-bandaging is an important skill.

Bandages are effective because they can:

* Accommodate changes in the limb as the swelling decreases.

* Provide pressure to continue the reduction of the swollen limb.

* Control additional swelling.

* Soften fibrotic tissues.

* Increase resistance during activity and force greater muscle pump efficiency.

* Be safely worn day and night because low resting pressure is exerted when the muscle is inactive and relaxed.

When is Bandaging Used

Not all lymphedema patients require bandaging. If treatment is started during lymphedema stage one, bandaging is not always necessary. Treatment of stages two and three lymphedema commonly require bandaging at least during early treatment.

During an intensive, bandages are worn 23 hours a day for 7 days a week throughout this phase of treatment. See Starting Treatment: The Intensive

After the intensive, many patients are able to replace bandages with a compression garment for daytime wear and a compression aid for night use. Some patients must bandage over the compression aid.

Other patients must continue bandaging at night. These patients become very proficient at applying the bandages and are able to manage this with a minimum of inconvenience.

Exceptions to Bandaging

If the area to be bandaged is infected, do not bandage this area until the infection has been treated and the infection has been brought under control.

If an open wound is present, ask your therapist about the special bandaging precautions that should be taken.

If you have other health conditions such as a heart condition, lipedema, or pregnancy do not bandage until you have learned about the special precautions that should be taken.

Bandaging Guideline

• The purpose of bandaging is to provide additional support to the tissues affected by lymphedema so that the muscle pumps can work more effectively.
• Bandages also aids in maintaining the reduction after fluid has been removed through MLD treatment.
• Never use bandaging to “squeeze” the limb in an effort to remove more fluid.
• Bandaging that is too tight causes a tourniquet effect that can further damage already compromised lymph vessels.

Bandaging Basics

Learn and follow the bandaging technique recommended by your therapist. Every detail is important, so pay close attention. If you have questions, ask for written instructions.

It is often desirable to have a family member also learn how to do the bandaging. You may need their help in applying the bandages properly. It also is a good idea to have your helper made a video of the therapist providing these instructions.

Bandaging Supplies

Bandages are created from four layers of materials. Those listed here are the type of supplies that are most commonly used; however, many different bandaging techniques are used.

Stockinette

The first layer is a tubular gauze bandage, known as stockinette. This absorbent material absorbs excess perspiration and protects the skin from being rubbed by other layers that are placed on top of it.

For the leg, the stockinette extends from the base of the toes upward as high as you need to bandage, For the arm, the stockinette extends from the base of the fingers upward as high on the arm as you need to bandage.

The stockinette is in direct contact with the skin and a fresh piece should be used each time you bandage.

Gauze

Gauze is used to wrap the fingers or toes. A one inch width gauze is commonly used to wrap the fingers. A one-half width gauze, or specialized short-stretch bandages, can be used to wrap the toes.

Gauze bandages do not launder well and fresh gauze must be used each time you bandage. As an alternative, you therapist may suggest other methods of wrapping the fingers or toes.

Padding

The third layer is a felt or foam-type of bandage that is applied to evenly distribute pressure, to soften fibrotic tissues, and to help shape the limb.

This layer may also be used to held small, shaped foam pieces in place. These foam pieces protect indentations such as the inside of the elbow, front of the ankle, and back of the knee. They also protect prominences such as the outside of the elbow, front of the knee or back of the ankle .

This layer can also be used to hold “chip bags” in place. Chip bags, which contain small irregularly shaped pieces of foam, are placed where needed to soften fibrotic tissue.

Short-stretch Bandages

LympheBand

The fourth layer consists of short-stretch bandages that allow for high working pressure and low resting pressure. These bandages are not placed on the fingers or toes.

Short-stretch bandages are placed to provide greatest compression at the far end of the limb and the least compression near the body. Usually a smaller width bandage is used for the hand or foot. Wider bandages are needed in order to accommodate increasing size of the limb toward the trunk.

Short-stretch bandages can be carefully washed, dried flat, and wound for reuse. An electric bandage winder can be a time saving investment.

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