Complete decongestive therapy (CDT) is the standard of care for the treatment of lymphedema. This includes skin and wound care, manual lymphatic drainage, remedial exercises, and compression therapy. In the active decongestive phase, compression therapy typically involves the use of a multi-layered, short stretch compression bandage with open celled-foam. For optimal outcomes patients wear the bandage for 23–24 hours per day and have it reapplied 3–5 times a week by a trained lymphedema therapist.1
What are the options when challenges arise when your patient has:
- mobility or transportation issues and can’t make it to the clinic 3–5 times a week,
- incontinence issues and frequently soils the bandages,
- financial issues and can’t afford both the bandages for decongestion and the compression garment that will be necessary to maintain the achieved limb volume reduction, or
- limb shape challenges and the bandage slips down or completely off after only a few hours?
Jane had many of these issues. Her self–reported medical history included morbid obesity, gastric bypass surgery, left lower extremity (LE) traumatic above the knee amputation (AKA), bilateral LE lymphedema, chronic stasis ulceration at the distal end of the AKA, and limited mobility with use of a motorized wheelchair. Jane wanted to address the lymphedema in her left AKA in hopes to heal the wound and eventually be able to be fitted for a prosthetic limb. Her lymphedema therapist decided to bandage the AKA with a multiple-layered short stretch compression bandage with foam but it often became soiled during toileting, and repeatedly slipped off within hours of being applied. Jane also began having difficulty with transportation to the clinic, and her limited mobility made it difficult to learn to self-bandage. Despite her and her therapist’s best efforts, her edema was not lessening and her wound was not healing.
So, what is the next option for Jane?
A look into the literature shows that a viable alternative to compression bandaging is the use of adjustable compression wraps (ACW). These devices are made of low-elastic, short stretch material that secure with hook and loop fasteners and are designed for self-application. Several studies have found ACWs to be significantly cheaper and just as effective at healing stasis ulcerations as multilayer compression bandaging.2–4 Adjustable compression wraps have also been found to:
- reduce both the visit time and number of visits needed in the clinic,2–5
- allow patients more flexibility with wound and skin hygiene,3–5
- be more comfortable due to self-adjustability by the patient or caregiver,3–5 and
- be effective at reducing edema and maintaining sub-bandage pressure again due to adjustability.4
Jane was fitted with an ACW with a lobule attachment that was modified to contain the distal aspect of her AKA. She was taught to don, doff, and care for the product and was seen once per week for limb volume assessment and modification to the ACW as needed. In 7 weeks, Jane’s AKA limb volume decreased by 4,390 mL and the ulceration resolved. At her 1-month follow-up, she had been able to maintain the reduction with the ACW and had begun working with a prosthetist.
Hence, adjustable compression wraps should be considered as a viable option when factors such as cost, time, mobility limitations, hygiene concerns and limb shape make multi-layered compression bandaging and traditional CDT difficult.
Erin Fazzari, MPT, CLT, CWS received her Masters of Physical Therapy from the University of the Sciences in Philadelphia in 2002. She has a well-rounded skill set having worked in a variety of settings including outpatient orthopedics, acute care, skilled nursing, and inpatient rehab. She specializes in the treatment of patients with lymphedema, cancer-related fatigue, and chronic wounds. (View biography source here.)
1. Lasinski B, Thrift KM, Squire D, et al. A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011. PM&R. 2012; 4(8):580-601
2. Mosti G, Mancini S, Bruni S, et al. Adjustable compression wrap devices are cheaper and more effective than inelastic bandages for venous leg ulcer healing: a multicentric Italian randomized clinical experience. Phlebology. 2020 Mar;35(2):124-133.
3. Lee N. An evaluation on the use of adjustable compression wrapping devices as an alternative to compression bandaging in lower leg wounds. Wounds Int. 2018; 9(4):12-19.
4. Williams A. A review of the evidence for adjustable compression wrap devices. J Wound Care. 2016 May;25(5):242-7.
5. Petkovska G. Protocol development: comparing compression wraps against compression bandages for the management of bariatric clients with venous leg ulcers. J Nurse Practitioners. 2017; 13(7): 336.