Short Stretch Bandages are for Leg Lymphedema

Short Stretch Bandages are for Leg Lymphedema
The short stretch bandage is a wrap used in the treatment of lymphedema. It is called “short strech” because of it rating on elasticity. These bandages are rated at approximately 70%, which means they can stretch up to 70% beyond their actual non extended length. Because of this, they are able to provide continual compression on the lymphedema limb. They work inconjunction with your muscles to help not only prevent additional swelling, but to help lymph flow.

Short strech bandages are used extensively for both the treatment phase and management phase of lymphedema.

Pat

Wear And Care For Short Stretch Bandages

Your doctor or lymphedema therapist assistant will be able to provide you with the correct bandages. He/she will also walk you through proper fitting and caring practices for your garments. Bandages should be firm. Wash them everyday in a mild detergent (Ivory or Dreft– NOT Woolite) in a laundry bag if lymph fluid leaks through the skin. Never put them in a dryer as this will destroy the elasticity. I always hang them in a “z” on a hanger.

Short stretch bandages are usually not covered by your insurance company. Once you know the specific types of bandages you use, you may purchase them online. Many companies provide a wide selection of brand name bandages. They offer fast delivery and low prices, with all orders being safe and secure.

Short Stretch Compression Bandages

Minimally elastic. They compensate for the diminished skin pressure associated with lymphedema, and prevent the reaccumulation of evacuated, stagnating lymph fluid. The more inelastic the bandage is, the greater the potential working pressure (pressure produced when the muscle pump works against the resistance of the bandage, as when exercising). Inelastic and short stretch bandages have advantages over elastic garments because they force a higher working pressure and greater muscle pump efficiency. Conversely, because of the low resting pressure (pressure exerted when the muscle is inactive and relaxed), compression bandages may be worn day and night with good patient compliance.

Compression bandaging is applied in layers. The digits (fingers and toes) are individually wrapped with gauze bandages. A tubular bandage, made of primarily cotton, is worn underneath the compression padding and bandages to protect the skin and absorb excess perspiration. Padding bandages are applied just prior to the actual compression bandages to cushion the limb (especially over skin creases or bony prominences) and to prevent sharp indentations and irritations to the skin. In addition, they serve to distribute the pressure evenly over the limb. The last stage is the actual short stretch compression bandages used to apply the final compression. They are wrapped with mild to moderate tension in an overlapping pattern in a distal to proximal direction.

Short Stretch Bandages FACTS

by Paige-Leigh Zazzali

Compression sleeves and stockings may not be comfortable for some patients with lymphedema. Short stretch bandages provide relief and alleviate swelling in the affected limb or area. Bandages also allow more flexibility for the patient.

Short Stretch Bandages can remain on the affected area all day and night as long as you still feel comfortable. Patients may use soft cotton padding underneath the bandage if they have sensitive skin. Bandages over 6 months old should not be used. It is ideal to have two sets of short stretch bandages, and replace them every 2-3 months.

Why Not Use Ace Wraps?

One should not use ace wraps as an alternative for several reasons. Ace wraps are very elastic, able to stretch to several times their original length. As a result, they are not able to provide the needed compression rating on the limb.

Another problem associated with ace wraps is that they can cause irregularities in the shape of the affected limb. Due to the elasticity, it is almost impossible to have an equal and consistent pressure grade on the limb. This “bunching” or irregularity further hinders lymph flow.

Short Stretch Bandage versus Ace Wraps

Q I am having difficulty wrapping my leg with the compression bandages. I have a friend who has wrapped his ankle for years with ace wraps and he is willing to help me with my bandages. These techniques are basically the same, right?

A: I am glad you are seeking assistance if you are having difficulty with self-bandaging. I applaud your friend for his willingness to assist you. However, I would encourage you to make an appointment for you and your friend with your Certified Lymphedema Therapist.

The compression bandages used for treatment of Lymphedema are not the same as Ace wraps.

There are two types of pressure at work with compression bandages. The first is “Working Pressure.” This is the resistance the bandage places against the muscles when you are active, up walking, doing exercises, etc. It is important for the compression bandages to have a High Working Pressure in order to keep fluid from recollecting in the extremity during activity. The lower the elasticity of the bandage, the higher the Working Pressure. The second pressure is called “Resting Pressure.” This pressure depends on the amount of tension (Stretch) used with the bandage. The Resting Pressure is a permanent pressure exerted on the venous and lymphatic vasculature and may cause a tourniquet effect on the extremity. The higher the tension, or stretch, equates to a higher resting pressure.The Short-Stretch Bandages used for LE have lower elasticity than Ace wraps which are considered a Long-Stretch Bandage. Short-Stretch Bandages have a LOW Resting Pressure, and a HIGH Working Pressure. The High Working Pressure is to support removal of fluid from the affected extremity and further evacuation of fluid from the extremity during the active time. LOW Resting Pressure of Short-Stretch Bandages reduces the changes of the tourniquet effect.

It is important that only trained therapists, or caregivers/friends provided education by a trained therapist, apply Short-Stretch Compression Bandages or assist in the bandaging process. Compression bandages are essential to the successful reduction of fluid and protein from the affected extremity. It is vital that the bandages be applied correctly, with proper tension and padding.

Also, inform your therapist of any specific difficulties you are having with self bandaging. Your therapist may have some tips/techniques that will solve your bandaging difficulties. Notify your therapist that your friend will accompany you to your next appointment to receive education regarding bandaging techniques. This also will allow your therapist to allot the time necessary for the education.

NLN LymphLink Question Corner

Examples of short-stretch bandages

Examples of short-stretch bandages are Unna's paste bandage and Comprilan® (Beiersdorf Medical, Charlotte, NC). Ace® bandages are inappropriate as a treatment of venous ulceration. Prescription compression stockings can be used in the maintenance phase of treatment. Prescription compression stockings can be used in the maintenance phase of treatment.

Generally calf length stockings are used with 30-40 mmHg or 40-50 mmHg. It is easier for some patients to apply a zippered stocking over a cotton liner (Jobst Ulcercare®; Jobst-A Beiersdorf Company, Charlotte, NC) or to superimpose two 20-30 mmHg stockings (yielding 40 mmHg). Consider intermittent pneumatic compression in patients who don't respond to standard compression measures and in patients who are not ambulatory.

Compression leads to increased venous flow, decreased pathological reflux while walking, and increased ejection volume with activation of the calf pump. Tissue pressure is increased which favors resorption of edema fluid. In order to achieve maximum benefit from compression the patient needs to ambulate.

Phlebology.org

A prospective randomised trial of four-layer versus short stretch compression bandages for the treatment of venous leg ulcers.

Scriven JM, Taylor LE, Wood AJ, Bell PR, Naylor AR, London NJ.
Department of Surgery, University of Leicester.

This trial was undertaken to examine the safety and efficacy of four-layer compared with short stretch compression bandages for the treatment of venous leg ulcers within the confines of a prospective, randomised, ethically approved trial. Fifty-three patients were recruited from a dedicated venous ulcer assessment clinic and their individual ulcerated limbs were randomised to receive either a four-layer bandage (FLB)(n = 32) or a short stretch bandage (SSB)(n = 32). The endpoint was a completely healed ulcer. However, if after 12 weeks of compression therapy no healing had been achieved, that limb was withdrawn from the study and deemed to have failed to heal with the prescribed bandage. Leg volume was measured using the multiple disc model at the first bandaging visit, 4 weeks later, and on ulcer healing. Complications arising during the study were recorded. Data from all limbs were analysed on an intention to treat basis; thus the three limbs not completing the protocol were included in the analysis. Of the 53 patients, 50 completed the protocol. At 1 year the healing rate was FLB 55% and SSB 57% (chi 2 = 0.0, df = 1, P = 1.0). Limbs in the FLB arm of the study sustained one minor complication, whereas SSB limbs sustained four significant complications. Leg volumes reduced significantly after 4 weeks of compression, but subsequent volume changes were insignificant. Ulcer healing rates were not influenced by the presence of deep venous reflux, post-thrombotic deep vein changes nor by ulcer duration. Although larger ulcers took longer to heal, the overall healing rates for large (> 10 cm2) and small (10 cm2 or less) ulcers were comparable. Four-layer and short stretch bandages were equally efficacious in healing venous ulcers independent of pattern of venous reflux, ulcer area or duration. FLB limbs sustained fewer complications than SSB.

PubMed

Physical properties of short-stretch compression bandages used to treat lymphedema.
King TI, Droessler JL.

Occupational Therapy Department, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, Wisconsin 53201, USA.

This study examined the physical properties of six common brands of short-stretch compression bandages used to treat lymphedema. The physical properties examined were (a) maintenance of pressure over a 12-hr period, (b) variability of pressure across the width of the bandages, and © variability of pressure when the bandages were wrapped with a 50% overlap. The results of the study indicate that all six brands of bandages tested maintain pressure well over a 12-hr period. Each has a variance of pressure between the middle and edge of the bandage, with the edges measuring (in mmHg) between 6% and 28% lower than the middle. When the bandages were wrapped with an 50% overlap, all six brands measured fairly consistently in pressure readings (in mmHg) across the width. These results indicate that the six brands of short-stretch compression bandages tested have similar physical characteristics.

PMID: 14601819 [PubMed - indexed for MEDLINE]

A comparison of multilayer bandage systems during rest, exercise, and over 2 days of wear time.

Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, CH8091 Zurich, Switzerland.

Hafner J, Botonakis I, Burg G.

jhafner@derm.unizh.ch

OBJECTIVE: To study the interface pressure between the leg and 8 different multilayer bandage systems during postural changes, exercise (walking), and over 2 days of wear time.

DESIGN: Comparison of 8 different compression bandages under standardized conditions.

SETTING: Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.

PARTICIPANTS: A series of 10 healthy volunteers, 5 females and 5 males, aged 26 to 65 years.

INTERVENTION: An electropneumatic device was used to measure interface pressure at 12 points of the leg.

MAIN OUTCOME MEASURES:

(1) Pressure changes from the standing to the sitting and supine position at rest,

(2) pressure amplitude during exercise (200-m treadmill walk at 3.2 m/s, 0 degrees incline), and

(3) pressure decrease over 2 days of wear time.

RESULTS: Results are given as median with the 10% to 90% confidence intervals. Multilayer bandages of short and medium stretch showed a larger pressure decrease when the patient was supine (eg, 3 short stretch bandages: 18.0 mm Hg [reference range, 15.5-19.5 mm Hg]) than systems of medium and long stretch bandages (eg, 4-layer bandage, 6.0 mm Hg [reference range, 4.5-7.0 mm Hg]) (P=.005). The amplitude of pressure waves during exercise was comparable among most multilayer bandage systems. The pressure loss over time was the smallest in elastic bandages (eg, 4-layer bandage, 6.0 mm Hg [reference range, 0.0-10.5 mm Hg]), compared with short stretch bandages (eg, 3 short stretch bandages, 18.0 mm Hg [reference range, 16.5-20.5 mm Hg]) (P=.005).

CONCLUSIONS: Highly elastic multilayer bandage systems showed the smallest pressure loss over several days, but the small pressure decrease when the patient was supine makes them potentially hazardous to patients with arterial occlusive disease. Short stretch bandages and the Unna boot with an inelastic zinc plaster bandage generate large pressure waves while walking and showed a marked pressure decrease when the patient was supine, but they lose a lot of their pressure within the first hours of wear. Multilayer systems composed of short stretch and cohesive medium stretch bandages represent a good compromise between elastic and inelastic bandage systems (moderate pressure loss over time, large pressure decrease on lying down). The clinical effectiveness of the different types of compression still remains to be studied.

PMID: 10890987 [PubMed - indexed for MEDLINE]

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