Bandaging basics

I’m still trying to understand how my doctor prescribed me with the incorrect bandages for Lymphedema treatment. As a health professional, I would have assumed he knew what he was doing. More so, it worries me that other people may have been given the wrong bandages to wrap their limbs and are actually doing more harm than good. With each day that goes by, I become more and more passionate about seeing a movement towards improving the training of medical practitioners in the treatment of LE (not just people who work with Lymphedema patients but general physicians too). There is too much inconsistency and misinformation.

So today’s blog is aimed at understanding how short-stretch and long-stretch bandaging systems differ.

I didn’t realise this before, but different bandaging systems have different effects on the venous and arterial systems and ultimately on edema. Current understanding of how compression works on patients with chronic oedema and lymphoedema remains poor and relies heavily on venous research. However, this is closely related to the lymphatic side.

Lymphedema bandages are known as “short stretch” bandages. They stretch a little bit if you pull them but not nearly as far as my old bandages did (they were very stretchy). Really stretchy bandages aren’t good for Lymphedema patients. A 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 a long stretch bandage.

I took the following information from this website as it explains well how short stretch bandages work.

Roughly 60% to 80% of the body’s total blood volume resides in the venous circulation, ranging from 60 to 150 mL. The 2012 International Lymphoedema Framework’s position document for compression therapy states that blood pressure in the foot veins is 10 to 20 mm Hg in a supine position and 80 to 100 mm Hg in a standing position. During ambulation, when the calf muscle pump is functioning and vein valves are competent, blood pressure decreases to 30 mm Hg.

During walking or weight shifting, calf-muscle contraction is the primary means of returning blood to the heart through the veins. Pressure generated from the calf muscle can reach up to 300 mm Hg, propelling 60% of venous volume proximally with each contraction. Multilayered short-stretch bandages create an external force against calf-muscle contraction. They cause generation of inward pressure because they don’t allow calf muscles to bulge outward when they contract and shorten. This force compresses and pumps the veins, propelling blood toward the heart; graduated compression of bandages (more pressure at the ankle than calf) prevents backward blood regurgitation through incompetent veins. This is called working pressure. Thus, multilayered short-stretch bandaging systems cause high working pressure. Multilayered short-stretch bandages also act as a semirigid force to prevent expansion of edema. They offer excellent containment of all forms of edema.

In contrast, long-stretch bandages stretch as edema increases. They also provide little resistance to calf-muscle contraction. Therefore, they have low working pressure, don’t promote the calf-muscle pump, and provide poor edema containment.

Voila. There you have it.

Again, I want to wrap things up by saying: always continue to ask questions to your doctors and if something doesn’t seem right, get a second opinion. Don’t “just accept” the fat leg (or arm!), because there is much more that can be done to treat it than we are lead to believe.

Some other links worth checking out:

International Lymphoedema Framework’s consensus document for compression therapy.