Several current studies indicate approximately 20 percent of women who have axillary lymph nodes removed in breast cancer treatments have the potential to develop Lymphedema on the same side the lymph nodes were removed from. These numbers do not include patients who may also develop Lymphedema from other sources, and medications and surgeries for this ailment have been largely unsuccessful in curing Lymphedema.
Conservative Compression Treatments:
Physical Therapists can offer Conservative Compression Treatments designed to reduce and control the amount of swelling in effected limbs, and to help restore the function and cosmetic appearance of these body parts.
Other methods Physical Therapists have included in Lymphedema treatments are elastic and nonelastic garments, compression pumps, upper extremity elevations, massage therapies, active, resistence, and isometric exercises, and ultrasounds.
Compression garments, also known as compression stockings, are worn after the patient has been treated for Lymphedema, and the affected limb is reduced as far as it can be through MLD, manual lymph drainage, or CDT, Complex Decongestive Therapy. These garments can be custom made to properly fit the exact measurements of the patient’s limbs.
Factors To Be Considered In Compression Garments:
Factors to be considered in compression garments are their compression classification, the appearance of the garment, the material they are made from, their suspension, skin sensitivity, and the coverage they provide, because preventing Lymphedema proximally or distally to the garment is important.
Decongestive Phase Of Treatment:
During the typically intensive decongestive phase of Lymphedema treatment, which can include 1 to 5 days a week, for as many as 6 weeks, the Physical Therapist has an opportunity to learn such things as if a bandage to the knee causes increased volume of lymph fluid in the leg, and if the patient will therefore require a compression garment fitted to the waist.
Standardized Class Sizes Of Compression Garments:
Medical grade compression garments are available in four standardized class sizes which are measured in the amount of mercury found in them. These classifications are designed as the necessary compression needed at the ankle, then decreasing the compression requirements to the top of the garment. The grade classes of these compression garments are broken down as Class I: 20 to 30mmHg, Class II: 30 to 40mmHg, Class III: 40 to 50mmHg, and Class IV: 50 to 60mmHg. Arm sleeves are usually Class I or Class II grades. Gloves are typically Class I. Lower extremity garments are normally Class II or Class III.
A Concern Of Some Patients:
The color of compression garments seems to be a concern for many Lymphedema patients. Some of these garments are only available in beige, and there are those patients who bulk at wearing them for outward, public appearance, cosmetic reasons which can make the unworn garments much less effective. Patients need to stop and ask themselves the simple question of which is more important to me, cosmetic looks or the effectiveness of these garments?
Nonelastic Compression Garments:
Nonelastic garments provide compression by a series of hook and loop straps along the length of the garment. These comfortable, but bulky, compression garments are tightened to the necessary tension by the wearer of the garment.
Elastic Compression Garments:
Elastic compression garment fibers are latex rubber, synthetic rubber, nylon, polyester, cotton, or a blend of these different materials, and are some times lined with cotton or silk, for comfort. The fabrics of elastic garments can be thick or thin depending on the compression they provide. Patients who are allergic to latex may not be able to wear these garments if they have a respiratory reaction to latex. Some patients with latex sensitivities can wear elastic garments if they use a garment underliner as well.
Circular Knit Compression Garments:
Circular knit compression garment fabrics are seamless, but tend to roll down at the top, if the covered area is very fleshy. This can create a tourniquet effect that obstructs lymph fluid movement from the limb.
Flat Knit Compression Garments:
Flat knit compression garments are knitted to fit the patient’s measurements and seamed up the back. These garments may roll less at the top then circular knit compression garments tend to. Some flat knit compression garments are made of coarse-textured fabrics that provide a mini message to the skin of the wearer and promote lymph fluid uptake and transport.
Cut And Sewn Compression Garments:
Cut and sewn compression garments are made of several pieces sewn together with more porous fabrics making them cooler to wear.
To help keep these compression garments in place at the top, try using a silicone band inside the top edge, or clear-body adhesive strips. For stockings with this problem try using a garter belt, suspenders, or waist extensions that are available for these garments. For arm sleeves patients should know there are over the shoulder extensions available they may want to try using.
The patient’s skin condition will dictate the choice of compression garments available for them to wear. Placing tight fitting garments over very fragile, sensitive, or wounded skin can further damage the skin due to shearing. Understockings may help protect the skin of these patients. Wound dressings must be held in place and the garments carefully put on.
Fitting Compression Garments:
Compression garments are best fitted when the patient has experienced volume reduction in the limb and the limb is not edematous. Compression garment measurements should be taken as early in the morning as possible while the limb is the smallest it will be all day.
Previously: Suggested Lymphedema Risk Reduction Practices.
Next Time: Sudden Onset Lymphedema.