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can be reduced in such patients, provided that the compression stockings are worn regularly. Compression bandages are recommended after manual lymphatic drainage in order to reduce the pain. The compressive forces required are often not tolerated without preparatory decongestive treatment. For advanced lipolymphedema, strong, seamed compression stockings of class II or III should only be prescribed after several weeks of intensive decongestive treatment. Such treatment starts with bandaging and continues until there is no further pain. The duration of the treatment depends on the severity of the disorder. Additional knee-high compression stockings (class II or III) may have to be prescribed for localized distal lymphedema. Although a reduction in volume is often not possible in the case of severe stage III lipolymphedema in older patients, it is nevertheless advisable to prescribe compression hosiery. They do not chafe and may allow the patient to walk more easily, thus adding the therapeutic effect of exercise on the peripheral lymphedema. Some practical tips on compression garments Compression garments should ideally be made-to-measure when treating lymphatic edemas. The limb proportions can vary considerably from one person to the next, due to the edema and secondary tissue changes. The measurement procedure is facilitated by use of preprinted forms. There are no binding rules as to how
exactly measurements should be taken. In view of the numerous individual differences, the therapist’s experience therefore plays a decisive part. However, the extremity must always be measured after maximum prior reduction of the edema via intensive decongestive therapy, and ideally, first thing in the morning. Those with edema in the toes are fitted with a made-to-measure compressive toe caps with toe compression of class I or II, depending on the severity of the edema . Secondary leg and genital edemas (e.g. after carcinoma of the prostate) may be treated with compression half-tights. The band on the leg without a stocking must never constrict the vessels, otherwise an edema could be artificially created. Trouser braces with shoulder pads may be useful, as they prevent the stocking from slipping. Whichever method is used, the stocking must not be allowed to slip and crease in the back of the knee as this may lead to recurrence or worsening of the edema. It may be very difficult or even impossible for patients to pull up a compression
stocking if they have a co-morbidity or disability, such as coexisting arthritis. A two-part stocking may be much easier to pull on; for example: a compression panty followed by a compression stocking which is secured to the panty. Finding the right compression garment for a particular patient requires understanding of the pathology. In challenging cases the physician may wish to consult a lymphedema therapist who will be able to advise on the right prescription. LP References 1. Lymphoedema Framework. Best practice for the management of lymphoedema: International Consensus. London: MEP Ltd; 2006. 2. Weissleder H, Schuchhardt C. Lymphedema Diagnosis and Therapy. 4th ed. Essen, Germany: Viavital; 2008. Editor’s Note: *Most custom compression garments for lymphedema are made in Germany or in the USA. German standards are: Class I, 18 31mmHg; Class 2, 2332mmHg; Class 3, 34-46mmHg and Class IV, >49mmHg. There are no national standards for compression garments in the USA. The compression classification used most widely there is: Class 1 20-30mmHg; Class 2 30-40mmHg; Class 3 40-50mmHg and Class 4 50-60mmHg. (ref: Lymphedema Framework, 2006).
You Are Not Alone You have access to information, resources, contacts and support from people who know what you’re going through from their own personal experience. You have the following organizations on your side. Alberta: Alberta Lymphedema Association
www.albertalymphedema.com
British Columbia: BC Lymphedema Association
www.bclymph.org
Manitoba: Lymphedema Association of Manitoba
www.lymphmanitoba.ca
Ontario: Lymphedema Association of Ontario
www.lymphontario.ca
Quebec: Lymphedema Association of Quebec
www.infolympho.ca
Saskatchewan: Lymphedema Association of Saskatchewan
www.sasklymph.ca
Summer 2012
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