Compression Bandages

Types of bandages

There are two types of bandages: short-stretch and long-stretch bandages.

• Short-stretch bandages are woven in a way that allows for higher compression than long-stretch bandages. They are applied at full-stretch and do not tend to expand. Short-stretch bandages are the preferred ones for lymphedema treatment as they help to transport the lymph fluid to the center of your body.
• Long-stretch bandages are more elastic and stretch when swelling increases. Therefore, long-stretch bandages are mainly used to treat strains, e.g. after sports injuries.

Bandaging systems

Bandages are an integral part of Complex Decongestive Therapy (CDT). There are different types of bandaging systems.

Multilayer Lymphedema Bandaging (MLLB) is a compression system of several bandage layers. It is the standard approach for CDT. There are 4-5 components of MLLB:

• Finger/toe gauze bandages: These are of soft and stretchable material for comfortable wear. They have to absorbe moisture to help avoid infections. Since the fingers and toes move often throughout the day, these bandages must fit well without slipping.
• Tubular stockinette: Lightweight stockinettes to protect the skin under the other layers of compression.
• Soft padding bandage:  These products help ensure even distribution of pressure from the short-stretch bandage layer and provide skin protection.
• Foam pads/pieces: Important for hard (fibrotic). Foam pads can also be used to protect the skin and fill out any skin folds for a better shape for the next layer to be applied.
• Short-stretch bandage layer: This is the final layer of bandaging. Short-strech bandages are specially made to provide higher working pressure and lower resting pressure.

The combination with pads increases the pressure on your affected limb and maintains the pressure better than compression bandages without pads. This is especially helpful in areas with hard (fibrotic) tissue. Pads are also more comfortable and are less likely to cause skin problems.

Two-layer bandaging systems are an alternative to MLLB. They are lighter, less bulky, allow for more flexibility, and are less slippery compared to MLLB. The two layers are:

• Layer one: A padding bandage for slight compression and to distribute the pressure evenly. This layer also protects bony areas. It is specially designed with a coating on the one side to prevent the bandages from slipping.
• Layer two: Short-stretch bandage that can be worn up to seven days straight without removal.

What are the benefits of bandages?

Bandages can be applied, removed, and then reapplied as needed – every day or every few days. They can be adjusted to changes in your limb's size and shape as soon as the swelling decreases. This is especially helpful when you are treated for moderate or severe lymphedema. Therefore, bandages are mainly used during Complex Decongestive Therapy (CDT) and before you can be measured for compression garments or stockings.

The bandaging process

Only experienced practitioners with appropriate training should apply compression bandages. Bandaging usually involves your affected limb and may also include the adjacent hand or foot. The bandages can be bulky but should still allow free movement of your limb. Depending on the severity of your lymphedema, the bandages are applied 2-4 times per week for 2-6 weeks. Once your swelling has reduced sufficiently, your limb can be measured for appropriate compression garments.

Who can benefit from using bandages?

Your healthcare professional should be able to advise you on whether MLLB is a suitable and/or required therapy to manage your symptoms.