March 2022

Lymphedema Management

Joachim E. Zuther, Lymphedema Specialist, Founder Academy of Lymphatic Studies

If you’re reading this, you already know that compression garments are an important component of lymphedema management and phase two of Complete Decongestive Therapy (CDT). But, do you know why quality compression matters? Joachim E. Zuther, Lymphedema Specialist, is the Founder the Academy of Lymphatic Studies and author of the "Lymphedema Management" textbook. He also is a strong proponent of quality compression garments to help effectively manage lymphedema – because he knows it works. Keep reading to learn why quality is important and how to avoid a setback due to a bad garment.

Properly fitted and comfortable medical compression garments prevent the re-accumulation of fluid and preserve the treatment success achieved in the first phase of CDT. It is important to understand that compression garments will not, by themselves, reduce swelling or Lymphedema, and must not be worn on an untreated and swollen extremity.

The correct choice of garments should only be made by trained individuals with a full understanding of the pathology of Lymphedema and its related conditions; these individuals can be the certified lymphedema therapist, a trained and certified garment fitter, or the treating physician.

Many potential problems and special needs of the individual patient must be considered and addressed in order to arrive at a comfortable and supportive garment solution. Ill-fitted and ineffective compression garments not only produce poor results but can also be dangerous to the patient.

Compression garments are available as sleeves, gauntlets or stockings for the extremities, and brassieres and vests for the trunkal portion of the body. They are manufactured in several sizes and variations (such as flat or circular knit). Garments are also available in several colors and can be ordered in standard sizes or be custom-made. Since compression garments are worn daily, patients should consider purchasing at least two garments, one to wear and one to wash, and in view of the fact that over time these garments loose some of the compressive benefits as a result of wear an stretch, compression garments should be replaced every six months.

A number of donning and doffing devices are available for those individuals with difficulties putting on or taking off compression garments.

It is of utmost importance that the correct compression level, or compression class is chosen for each individual patient. Compression levels establish the compressive value the garments produce on the skin surface and are measured in millimeters of mercury (mm/Hg) – there are 4 levels, 1 being the lowest with 20-30 mm/Hg, and 4 the strongest compression with more than 50 mm/Hg. Compression classes 1 through 3 are available in custom and ready-made, or off-the-shelf sizes, whereas compression level 4 can only be custom ordered.

In order to determine the correct compression level, many factors must be considered, such as age, activity level, skin integrity, as well as possible co-morbidities, such as congestive heart failure (CHF), diabetes, paralysis, or wound issues.

Compression Garments versus Support Stockings

Support socks, also known as over-the-counter (OTC) socks, or anti-embolism stockings that are available in pharmacy chains or big-box retailers, are not suitable to treat or maintain Lymphedema. These garments have compression values of much less than 20mm/Hg – Lymphedema, however, requires a minimum of 20mm/Hg to be efficient.

Support stockings, or sleeves may provide some support, which may be sufficient for swellings following minor injuries, such as sprains, but do not even come close to provide the support necessary to maintain the swelling associated with Lymphedema, which necessitates medical compression that adheres to the highest levels of therapeutic effectiveness. These garments may be less expensive than compression garments, but do not work. They simply do not contain Lymphedema. Ineffective compression results in further complications and often results in frustration on the patients’ side, reducing compliance.

Quality compression garments are available at certified brick and mortar retail locations or can be ordered through online stores. Certified retailers can be located using Juzo’s “Find a Retailer” page, or on Lymphedema Blog, where individuals can locate a certified lymphedema therapist close to where the patient is located by using the “Find a Therapist” button in the menu bar.

There are also some compression garments resources providing garments free of charge, such as the NLN Marylin Westbrook Garment Fund, Ninjas Fighting Lymphedema, Susan B. Komen (Breast Cancer related), Pretty in Pink, or Brylan's Feat Foundation (Children only).


Want more tips? Find out how to optimize compression therapy lymphedema and get the most out of your garment in this Juzo article. To learn more about Juzo products and programs we support, follow us on Instagram, @JuzoCompression, and Facebook.

 
 

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