Advice from "Zhan Mitrev" Clinic: Treatment of chronic lymphedema

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The basic therapy in the treatment of lymphedema and its complications is compression therapy. It is performed using various elastic and inelastic materials. Due to their peculiarities, they create active or passive compression in the patient both during movement and/or at rest. The choice of bandage depends on the degree of severity of the lymphedema.

Compression materials

To carry out compression therapy, different materials with different specifications are used, such as elastic or non-elastic bandages, through which the necessary compression is achieved to carry out the therapy.

*Long elastic bandages – they stretch by more than 100 percent and provide active compression both in motion and at rest. Circular compression socks work in the same way.

*Short elastic bandages – they have a similar function as the long-elastic ones, but their stretch is slightly less than 100 percent.

*Inelastic materials – they are used at rest, when patients are not moving, because they provide very low or no compressive function at all. If the patient moves, during muscle contractions the inelastic materials are stiff, the bandages are the ones that are effective.

Compression bandages

At rest, pressures under the bandage are pressures that create passive compression. When the patient moves, the pressures under the bandage are called working pressures, ie. active compression. Those pressures are different for elastic and inelastic materials. With long-elastic bandages, the pressure/compression under the bandage is somewhere around 40 mm/Hg, and at rest 30 mm/Hg. At rest, the strength of pressure under the bandage or stockings is high and undesirable, so they should be removed when the patient is not moving. With short-elastic bandages, the pressures at rest are somewhere up to 15 mm/Hg immediately after placement, and then, due to the stretching of the bandage, it decreases even more.

However, when the patient moves, the active compression due to the stretching of the bandage is very high, reaching up to 50 – 75 mm/Hg.
The pressure under the bandage depends not only on the material but also on the number of layers, on the force used during bandaging, on the method of bandaging (eight or circular) and on mutual overlapping of the bandage.

Multi-layer systems of different materials with different elasticity/extensibility are used for bandaging in case of lymphedema. In this way, we influence the pressure under the bandage. We are talking about a compression system when we use at least two different bandages, which are placed one above the other along the entire length of the tire.

One of the key properties of the systems is the stiffness index, which is defined as an increase in pressure under the bend per centimeter, which, in turn, occurs due to an increase in the volume of the limb. An increase in volume occurs when we move from a lying position to a standing position. The circumference of the lower legs also changes when we move our feet up and down from a sitting position. The static stiffness index SSI is the difference between those two pressures. When the pressure increases by more than 10 mm/Hg between lying/standing position, then the SSI is high. This happens when using inelastic materials. In elastic materials the difference is in pressures below 10 mm/Hg and they have a low SSI. In stage I lymphedema, both long-elastic and short-elastic bandages can be used. In stages II and III, only short elastic bandages are used.

Compression therapy with short elastic bandages is the basic therapy for lymphedema and edema of other etiology. It is used for compression in the decongestion phase in order to reduce edema. It is performed with long-elastic or short-elastic bandages, depending on the stage of lymphedema. In the second phase – to maintain edema – non-adhesive short-elastic bandages or medical compression stockings can be used for compression.

Olgica Dimitrov, graduated physiotherapist

At the "Zhan Mitrev" clinical hospital, the team of physiotherapists, who are properly educated in the treatment of lymphedema and its complications, are at your disposal. Treatments are performed with special compression bandages from the Lochmann and Rauscher product range. To schedule an appointment that suits you, call 02/3091-484.

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