WHAT IS WRAPPING FOR?
Wrapping your arm in layered bandages is the gold standard for lymphedema compression. It’s easy enough to see that wrapping can contain and control swelling that’s already present, but it does much more as well. The sluggish lymph vessels lie just below the skin, where they depend on the pressure of the muscles beneath them to act as a pump in stimulating lymph flow. The bandages apply gentle and consistent pressure against the skin, providing a surface for the muscles to press against and enhancing the effect of the muscles’ pumping action. So wearing bandages can actually act to pump excess fluid out of the arm and reduce the swelling as you go about your daily activities.
The lymph fluid also contains proteins. These proteins become gel-like when they sit in the tissues too long. This protein enriched fluid then makes the limb heavier and thicker. With wrapping, these hardened and thickened areas are broken down and become soft and pliable. The heaviness of the limb is then reduced.
Bandages are wrapped with gradient pressure. That means that they’re wrapped more tightly near the hand and gradually loosen as they spiral up the arm. This gradient pressure pushes lymph in the direction you want it to go: up and out of your arm.
But there’s even more. Layered bandages work as you move to “massage” any areas of fibrosis (hardened tissue) and keep your arm soft and pliable. Unlike regular compression garments, bandages can be worn safely day or night because they exert only low pressure when your muscles are not moving, avoiding the possibility of constriction and lymph blockage as you sleep. And as a final benefit, each time you bandage your arm you’re adjusting the compression to the exact shape and size of your limb at that moment, so there are no worries about size or shape changes with wrapping as there are with garments made to a pre-determined size.
WHEN IS IT NEEDED?
Because wrapping is so effective at moving lymph fluid out of the body, your therapist will generally wrap your affected area at each therapy session, after s/he has done Manual Lymph Drainage (gentle lymphedema massage) to stimulate lymph flow and redirect it out of the swollen areas. You’ll wear the bandages 23 hours a day, seven days a week, throughout the therapy period, removing them only to shower before returning for the next session.
Your therapist should teach you the entire procedure, allowing you the opportunity to try it yourself on days when you don’t see her/him, and checking the fit and feel of your efforts at your next session.
When the active therapy phase is finished, you’ll continue to wrap your hand and arm until you can be fitted for compression garments. Since regular garments can’t be worn safely at night when your muscles are relaxed, you’ll need to continue to wrap nightly (unless you have also been fitted for special night garments.) You’ll also want to wrap your arm to manage the special strains of traveling or strenuous exercise, or whenever there is a flare-up of swelling anywhere along your arm or hand.
WHEN SHOULD BANDAGES NOT BE WORN?
Stop bandaging and see your doctor at once at any sign of infection (redness, warmth to the touch, fever, new itching or tingling, rash, or unexplained rapid swelling). Compression should not be applied in the presence of an active infection.
If you have an open wound near the affected area, talk to your therapist about how to care for the wound under bandages.
Congestive heart failure or the presence of blood clots are both conditions where you’ll need to discuss special precautions about bandaging (or any other form of compression) with your doctor and therapist.
HOW IS IT DONE?
There are a number of commonly used methods of bandaging your arm for lymphedema, but all apply the principles of layered wrapping and gradient pressure. The layers help to protect the skin from irritation, spread the compression evenly across wide areas, and allow for high working pressure and low resting pressure to encourage lymph flow and prevent constriction.
All bandaging starts with applying lotion to moisturize your skin and keep it healthy. Keeping your skin well hydrated can prevent minute cracks from forming and allowing bacteria to enter and cause infection. It can also prevent skin irritation from the unaccustomed use of layered bandages. A ph lotion is recommended.
Tubular stockinette further protects the skin and provides a comfortable, breathable basis for wrapping.
If your fingers or toes are bandaged, the wrapping of choice will be two or three rolls of flexible gauze.
Next, felted cotton-like fabric or thin foam is used to add a layer of padding that evenly distributes the compression of the outer bandages. It can also hold in place specially fitted pieces of flat foam, Swell Spots™ or chip bags to protect tender areas where bones are prominent, or to reduce fibrosis (tissue hardening due to proteins settling in the tissues).
Finally, short-stretch bandages are applied, with narrower bandages across the hand or foot and wider strips spiraling up the arm or leg. The number of bandages needed to wrap will depend on the size and length of the individual and the level of compression desired. These bandages are applied with carefully graded compression, more pressure at the hand end (distal), decreasing as it moves upward toward the body (proximal).
WHY SHOULD YOU LEARN TO DO IT?
Unless you’re planning to keep a lymphedema therapist in your pocket, or to limit your travels to a 20-mile radius around your therapist’s office, you need to know how to do this yourself. Wrapping is a lymphedema self-care tool you’ll use again and again to regain control after a flare-up, or to prevent that flare-up from happening in the first place.
By working together with your therapist and being proactive with your health, lymphedema can be manageable. Take the time to learn self-care wrapping to manage your lymphedema and experience full quality of life!
First, NEVER USE ACE BANDAGES TO WRAP FOR LYMPHEDEMA OR FOR LYMPHEDEMA PREVENTION. The outer bandages used for lymphedema wrapping may look like the ordinary ACE-type bandages available at any drug store, but they’re not the same. Lymphedema bandages are called “short stretch” bandages. They’ll stretch if you pull them, but not nearly as far as an ACE bandage stretches. This more limited stretch applies the right kind of pressure to your skin to help pump the lymph along, and it prevents the uneven binding and constricting that can happen with an ACE bandage.
Second, LYMPHEDEMA WRAPPING SHOULD BE TAUGHT BY A SKILLED AND EXPERIENCED THERAPIST. Much as we value the proud independence of a self-taught individualist, lymphedema bandaging is one of those skills that requires some one-on-one tutoring and supervision to learn. If the bandages are not layered correctly, the skin could be irritated and open, exposing you to a higher risk of infection.