The above picture shows my complex bandaging “kit” and the links to the above videos show how the bandaging is done. Please click on the links to view.
Prior to the bandaging a Manual Lymph Drainage is completed to give the limb the best chance of reducing. This procedure can be completed by a qualified Lymphatic therapist, it can be taught to family and friends and can be self administered where possible. There are many other videos on You tube that teach you how. This is especially helpful if local resources are unavailable or there is a lack of health cover for treatment.
“Bandaging consists of four layers: stockinette, cotton wool bandages, foam padding and low stretch bandages, applied in that order.Stockinette protects the skin and absorbs perspiration. Cotton wool bandages also protect the skin and help to produce a regular cylindrical shape to the limb by reducing shape distortions and deep skin folds. Low density foam pads protect potential pressure areas, reduce shape distortions and soften areas of fibrosis. High density foam is used to soften and reshape fibrotic areas. Low stretch bandages are used to apply necessary compression to the limb. They have a high working pressure and a low resting pressure providing a firm but flexible support to the limb, causing tissue pressure variations as the muscles contract and relax against the resistance of the bandages, thereby stimulating the muscle pump. These bandages are applied according to the Law of Laplace in order to provide greater pressure at the distal end of the limb than at the proximal end. Pressure in the tissues is thereby increased, assisting the passage of oedema fluid from the tissues into the lymphatic vessels via the lymphatic capillaries, and lymph flow through the lymphatic vessels to assist drainage. In addition, bandaging helps to soften fibrosis, restore elasticity to the over-stretched skin and re-shape the limb.” Ref.The Adelaide Lymphoedema. Clinic
When I was first diagnosed with Lymphoedema, after much searching, I found a Lymphoedema unit at the Mt Wilga rehabilitation hospital in Hornsby NSW. I spent five weeks driving backwards and forwards everyday, an hour each way, while treatment was done to reduce my Lymphoedema prior to a compression garment being fitted. When I arrived each day at the hospital the bandages were removed and I would have a shower. The therapist then performed MLD prior to replacing all the layers of bandages. I used to feel as if I had a plaster cast on but as the day progressed there would be a little movement possible. On the weekends I bandaged myself, otherwise the bandages were on 24/7 for five weeks. At the end of this time I was measured for a compression garment as it was felt that the leg had reduced as much as possible. I have to say I was very lucky at that time to live in Sydney and to have the help available, also that we had always paid a private health fund as Medicare did not cover this treatment. It is now possible to get five sessions a year covered by Medicare with a special referral from your GP. The importance of the bandaging is to reduce the limb as much as possible, it can be used on a regular basis or when the Lymphoedema flares up due to infection or hot weather etc. I will bandage myself if I am having a problem but I did return to Mt Wilga for a week in 2009 when I had a bad fungal infection that affected the skin. When you have Lymphoedema you are so vulnerable to infections, so it is important to look after the integrity of the skin and the condition if the limb.
The bandaging works by putting pressure on the muscles which creates a stronger pumping of the lymphatics, it also pushes the lymph into the deeper lymphatic vessels rather than those nearer the surface. The bandages are tighter at the bottom than the top therefore pushing the lymph up the limb towards the torso. Having them on 24/7 ensures this process continues day and night and does not swell again during treatment.