Use of support and compression in lymphoedema/chronic oedema DEFINITIONS SUPPORT: the retention and control of tissues COMPRESSION: the application of pressure to the skin and tissues (Thomas 1990)

PRINCIPLES SUPPORT: use of low/non extensible garments or bandages. Provides low resting pressure and high working pressures in response to movement

COMPRESSION Use of elastic, extensible garments or bandages Provides sustained pressure

Principles of lymphoedema multi-layer bandaging Use of padding/foam -provide evenly graduated pressures to influence shape. Use of layered short-stretch bandages - low resting and high working pressures - provide rigidity but comfort and movement Bandaging to all swollen areas including toes and upper limb.

BANDAGE PRESSURE THE PRESSURE PRODUCED BY A COMPRESSION BANDAGE CAN BE PREDICTED ACCORDING TO LAPLACE’S LAW: P=TxNx4630 C x W P = sub-bandage pressure T= bandage tension N = number of layers C = limb circumference W = bandage width

LAPLACE’S LAW THIS LAW SHOWS THAT SUB-BANDAGE PRESSURE WILL: Rise with increasing bandage tension and number of bandage layers Decrease with increasing limb circumference and bandage width.

TOE OEDEMA

Indications for multi-layer lymphoedema bandaging Fragile, damaged or ulcerated skin Lymphorrhoea Distortion in shape Limb too large to fit hosiery Deep skin folds Chronic skin changes

Contraindications of multi-layer lymphoedema bandaging Severe arterial insufficiency DVT Uncontrolled heart failure Uncontrolled hypertension Severe peripheral neuropathy Acute inflammatory episode Active TB