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Joachim Zuther, Lymphedema Specialist. Read more
Solaris
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Compression Garments for Lymphedema – Custom or Ready-Made?

 

Although lymphedema can be reduced to a normal or near normal size using proper treatment techniques, the lymphatic vessels are never normal again after lymphedema was present. In addition, once lymphedema has been reduced, skin elasticity may never be regained completely since the elastic fibers in the skin are damaged from the swelling present in lymphedema.
External support is therefore an essential component of lymphedema

Loss of skin elasticity following successful reduction of lymphedema

management following successful reduction of the swelling. The primary goal of compression garments is to maintain the reduction achieved during the intensive phase of Complete Decongestive Therapy (CDT); it is imperative to understand that compression garments are not designed to further reduce lymphedema.

Patients are fitted for garments directly following the intensive phase of CDT by someone who is experienced, or even better, certified in taking measurements for compression garments.

The measurements should be taken in the morning when the limb is smallest; it is highly recommended to measure directly following the removal of the padded compression bandages, which are used until the garments are ready to be worn.

Selecting an appropriate compression garment is a challenging task, and many important factors, such as mobility and activity level, age, coverage area, general shape of the limb/body part, compression class, material, appearance, cost, skin sensitivity/integrity, possible presence of arterial diseases and donning/doffing issues need to be considered. Some of these factors play a major role in the process to determine if a custom-made or ready-made compression garment would be the better choice for the individual.

What is the difference between custom-made and ready-made garments?

The major difference between a higher quality compression garment and a garment of lesser quality (OTC, or over-the-counter products) is the presence of an inlay thread (red yarn in picture left), generally made of Lycra or rubber, which provides a high level of compression consistency. Both custom and ready-made garments used in lymphedema therapy contain this thread, which is woven into the material in a continuous manner. The different compression levels are achieved by adjusting the tension of this inlay thread.

Knee-high ready-made stocking with silicone border

Ready-made or off-the-shelf garments are made from relatively thin and sheer fabrics that are continually knitted in a circular fashion on a cylinder and thus have no seam; varying stitch height and yarn tension create the appropriate shape and size. Generally, these garments tend to be more cosmetic (no seam) and lighter in weight.

Ready-made garments are less expensive, easier to replace and quicker to obtain than custom-made garments and come in a variety of girths, lengths, fabrics and compression classes (please refer to an earlier entry: The Role of Compression Garments in the Treatment of Lymphedema).

Disadvantages of ready-made garments are that they may not provide enough support and are not as precise in fit as a garment, which is custom-made to the individuals’ exact measurements. They also have a tendency to roll at the top if a silicone border is not added on the inside of the upper part.

Custom-made stocking with toe cap

Custom-made compression garments are generally made from thicker (but breathable) materials and knitted row by row as a flat piece, which is shaped and produced by adding or removing needles during the production process, according to the exact measurements of the patient; the flat piece is then joined by a seam to form the garment. Custom garments can be made to fit any shape, and are available in all four compression classes.

The heavier knit materials provide greater stiffness resulting in greater resistance and better containment of the swelling than ready-made garments (so-called stiffness factor).


Factors that determine the choice between a Custom and Ready-made garment:

Shape – although ready-made garments are available in a wide variety of sizes from most manufacturers, they are generally made for a limb of

Custom-made compression pantyhose

average proportion and length. Although some ready-made garments allow for an extra-wide calf/elbow and thigh/upper arm, a patient with a distorted or disproportionate limb will generally require a custom-made garment. Even if the individual circumferential measurements fall within the range of a specific ready-made garment size, some patients may have a disproportionate large calf, with measurements at the top end of the range and a relatively thin ankle with measurements on the low end of the range. The result would be a looser fit around the ankle area, which could result in a “ballooning” effect with fluid accumulating in the ankle area.

For very obese patients, custom-made garments are often the only available option; however, some ready-made pregnancy garments, which can be obtained at a much lower cost, may accommodate the measurements of these individuals.

Compression classes – the level of compression within the different classes is determined by the value of pressure the garments produce on the skin (please refer to an earlier entry on compression levels: The Role of Compression Garments in the Treatment of Lymphedema).

Ready-made garments are available in compression classes I through III, custom garments are available in all four compression levels. The highest level, compression class IV is reserved for the more severe and challenging cases of lymphedema.

Given the high compression of these garments, it is important that the ankle-brachial index (ABI) of the individual is tested by a health care professional. The ABI compares the blood pressure of the ankle to that of the arm, and is used to determine if peripheral arterial disease (PAD) is present. While an ABI index of less than 0.5 presents a general contraindication for compression therapy, the ABI should be greater than 0.8 if a compression class IV garment is prescribed.

A normal resting ankle-brachial index ranges between 0.9 and 1.3, which means that the blood pressure in the ankle area is the same or greater than the pressure in the arm.

Donning issues - some patients may have difficulty in donning a garment, especially a compression class IV garment (age, mobility). In these

Layering of two compression garments

cases it is possible to layer two garments of lesser compression – for example, two compression class I garments on top of each other can be used to achieve up to 40 millimeters of mercury (mm/Hg) pressure. With the first garment applying 20-30 mm/Hg, the second garment will add about two thirds of the pressure applied by the first garment. Layering of two compression garments also increases the stiffness factor, which results in greater resistance and better containment.

A second, less desirable option, would be the addition of a zipper to aid donning of compression garments. The disadvantages of zippers are that they are difficult to close once the garment is in place; they make the garment more bulky and the cosmetic results are less desirable. Another important issue is wearability of a zippered garment – zippers do not stretch which makes these compression garments less comfortable to wear.

Skin integrity – if wounds or other skin conditions are present, it may be better to go with a more breathable custom garment. In some cases it may be necessary to apply an under-stocking (silk, cotton) to avoid slippage of wound dressings while donning the garment. Compression garments containing silver may present a very good option; silver threads woven into the garment have naturally antimicrobial properties, prevent odor and are commonly used in the treatment of wounds.

In some cases, a zipper option may be considered if wounds are present.

Cosmetics – appearance of a garment is very important for many patients. In some cases it may be necessary to choose a less desirable option (no seam, garment color issues, less bulky garment) to further patient compliance. It is important to understand that there is no therapeutic value in a compression garment, which is not worn by the patient for cosmetic reasons.

More on compression garments in following postings, such as care of compression garments and tips on donning and doffing and how to hold garments and bandages in place in challenging cases.

Additional Resources:
Compression Hosiery in Lymphedema

Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more

48 comments to Compression Garments for Lymphedema – Custom or Ready-Made?

  • Deb Curlee

    I have been wearing Juzo full foot panty hose 40-50mmhg daily for 3 years now. They are costly and I was wondering if there is any way to get Medicare to help with the cost. Thank you

    • Jan

      Did you know that when you get a rip or tear in your stocking you can mend it? Use regular thread & hand sew the run or hole. The co. that makes the stockings began making them sheer on the bottom, where they get the most wear so they will wear out more quickly. Nice! One stocking got a hole in it after just 2 wearings. $600 a month in stockings is unaffordable, so something had to be done.

    • jen

      to Deb Curlee Unfortunatly there is no way to get Medicare to pay for pantihose; they will cover 30-40 mmhg to 40-50 mmhg knee highs only as long as you have venouse insufficiency with venouse stasis ulcers and debridement, they will not cover any other pressure or length for that matter. You can try to appeal a claim with Medicare and send all chart notes and progress notes from your doctor and do up a letter from yourself and see if your doctor will also do a letter that is detailed as to the problem with your legs the longevity (most of the time it is lifelong) other steps you have taken to help with the swelling or other symptoms such as Manual Lymphedema Drainage through a PT and wrappings; there are some secondaries to Medicare that will cover the compression stockings even if Medicare does not, they will cover as the prime just depending what your plan is. Always send your bills to Medicare or ask the Company who is supplying the garnment to send it unassigned for you and follow up later with Medicare and your supplemental insurance carrier to see what further action you may need to take to get some kind of reimbursement back.

  • Betty Sword

    I have been using a custom garment on my right arm for 9 months. I also have a REED sleeve that I use at night. My day garment has the silver thread in it and it is controling my arm fairly well. I have had lymphademis for 6 years now following breast cancer.

  • Bob Weiss

    Deb,

    Some Medicare beneficiaries are receiving payment for their compression garments. But you have to appeal every denial and then have your case heard by an Administrative Law Judge. The process does not cost anything, but may take two years to receive your reimbursement. Contact LymphActivist@aol.com for help in filing your appeal.

  • Roberta Ellen

    Bob Weiss has been great in handling the appeal for my custom garment. If appeals are not filed again and again, these garments will never be covered.

  • Dolores Niebergall

    I am a PT, CHT. Do you have any references for evidence based efficacy of neck/head garments? This would be useful in cases of insurance denial. Thanks!

  • nancy roach

    This was very interesting – I didn’t understand how custom garments were made.

    How often do you suggest that custom garments be replaced? What are the characteristics of garments that need to be replaced? Also, does washing them by hand (as opposed to “handwash cycle” by washing machine) allow them to last longer?

    Thank you again for donig this blog.

    • Joachim Zuther

      Dear Nancy:
      The elastic fibers of a compression garment will break down with wear. While proper care will increase the lifespan of garments, they will need to replaced about every six months or when the garment shows signs of wear that could adversely affect the compressive properties of the garment. As a general rule, if the garment no longer returns to its original shape after washing, has runs or holes in the material, no longer feels compressive, and if the garment becomes easy to put on, it probably needs to be replaced.
      Garments may be machine or hand washed, depending on the preference of the user. Daily washing is recommended, especially if lotions or creams are being used (moisturizing lotion can break down the fibers in compression garments and should be applied only at night when the garment is removed). When washing garments in a machine it is recommended to place the garment in a mesh laundry bag in order to protect the fabric during the washing cycle (the gentle cycle should be utilized).

  • Diana

    Was wondering what you think about the Solaris custom garments to replace night time bandaging. How effective are they, approx. cost, etc. thanks

  • Joann

    I have worn a Jobst custom support garment for the last 21 years for lymthdema in my leg do to having melemona. I wear the highest compression since I do work full time and I stand on my feet for the whole 8 hour day. I may have been one of the lucky ones because I haven’t had any problems with my leg and the sock and over night garment does work wonders.

  • [...] the quality of your compression garment. If you have more than one garment, take the extra one with you as a back up. If your destination [...]

  • Jan Martin

    I have been wearing Profore dressings for almost 5 years and would kill to be able to wear stockings and shoes. I have a natural bracelet around my right ankle and short legs. Four years ago I was deemed ready for compression knee-high stockings. Although the original prescription was for the highest compression level we tried several levels and I also asked about custom-made. In every case within less than an hour the stocking material had gathered in my ankle resulting in a white foot with no palpable pulse. The only suggestion the fitter had was to don my neon blue gloves every 15 minutes and remove and replace the left stocking. I work in a busy ICU – there is no way I can do that! Do you have any suggestions?

    • Judy

      Jan,
      Have u considered getting pockets made around the ankle so you can insert foam/pad to make the area around the ankle to have more weight so it will pull away from your skin rather than it cutting into the creases. Mediven (pockets/liner) and Jobst(pockets and profile for their Elvarex stockings
      Im a certified garment fitter and their are many options available .
      Judy

  • Nick

    I have worn compression stockings for about 7 years and recently, Juzo Varin is now Juzo Dynamic 30-40mm. HAs anyone else noticed a difference of quality? Anyone know where I can find a “thicker” material that the varin used to be? Thanks and good luck to everyone!

  • Shante

    @Nick, I thought I was the only one. I’ve been wearing Juzo stockings for about 18 years with no problem but recently got a new pair and they are different. Not as effective. I called Juzo and they told me they changed the machines they use to make the stockings. If you know of a better stocking please let me know. Summer is the worst season not to have the best compression.

  • Karen

    I have been diagnosed with Lipedema alone. Best we can figure I came about it genetically and then expedited it after my gastric bypass by having extensive skin removed from my thighs with a thigh lift, along with 2 rounds of traditional liposuction, and bilateral knee replacements. I am currently considering CDT and my massage therapist told me that for LIPEDEMA, i should not expect much, if any decrease in the size of my legs as I would if I had LYPMHEDEMA. That raised a concern in me. If that is in fact the case, than while I can still see the benefit of MLD (Vodder) massage itself, and of keeping compression on after a session, wouldnt I be able to consider something like your Solaris Readyware after the massage instead of paying to be bandaged everyday? Since my legs wont decrease much and the readywear has ~a 15mm velcro adjustable range, with a 50% overlap with graduated compression, so I can keep the fluid from returning between sessions and at the end of the month. Consider too that after the Vodder massage I will be responsible for my doing self MLD, compression thigh highs by day, decongestive exercises, deep breathing, and wearing a garment to sleep like the readywear anyway, do I still need to be bandaged daily? Why not put on the ready wear after the massage and measure at the end of the treatment it to see if perhaps I sized into a smaller daily garment? It isnt likely that I would size into a different readywear. In fact, wouldn’t I also be better off taking off the readywear to get into my therapy pool to exercise everyday and then putting them back on considering the exercise would probably enhance the MLD by further stimulating the lymph system? Anyone have advice for me on this one?

  • [...] achieved during treatment with Complete Decongestive Therapy (CDT). To select the correct garment (ready-made or custom made), compression level, and, if necessary, fastening systems, the patients age, physical abilities [...]

  • molly

    I am wondering if night time custome made garments stick to bed linens ? I am in thearapy right now & using coban 2 for the maintancene phase until custom garments arrive. So far it’s not going well as i am sticking to the bed sheets & I like to roll around in bed . thanks

  • I would like to know the manufacturer of the stocking and toe cap that is photographed in this article. I have two pieces for my leg and foot, but Mediven includes seams in both the foot cap and the end of the stocking around my foot that cause discomfort and areas of constriction. I like the lack of seams in the garments that are pictured.

  • Amy

    I have Klippel Trenaunay Syndrome associated with portwine stain of the left arm and hand. It has arterial-venous lymphatic malformaions. I have lymphedema in it and wear a juzo sleeve and glove occasionally but not as often as I should. I have had it for a few years but since I havent worn it much it pretty much fits like it did when I bought it. I dont like how it makes my arm and fingers have a very cold sensation? is that normal? i will sometimes put a jacket on because i get cold.

    • Joachim Zuther

      Dear Amy: It is not normal to have a cold sensation when wearing your compression glove. However, this symptom may be due the KTS associated with your swelling.

  • janis

    Iam still having problems with my Juxta and fit circaid velcro wrap for my left leg. I have a large pouch on the side but need help stuffing part of the pouch under my leg and then wrap. However, it still don’t seem to stay and I will not always have someone to help me. Circaid manufacture has saw a picture of the pouch and thought the velcro wrap was best. i diagree

  • DIVESH

    my mom[46] is having lyphedema on her left leg[II stage]
    What materials/fabric is best for the lymphedema garments.??
    Which is the best Sequential gradient pump ??
    I specially want to know about fabrics.I have been searching about it online but I always get answers on what is lymphedema and about its garments. So pls help us out.
    Thank you

    • Joachim Zuther

      All garment manufacturers basically use the same materials to produce compression garments and the quality of all leading manufacturers (JUZO, MEDI, Jobst) is very comparable.
      Advanced and newer compression pumps consist of multi-chambered inflatable sleeves that include trunk garments containing inflatable chambers designed to prepare drainage areas on the trunk prior to moving fluid from the extremities.

      Pneumatic compression pumps should not be used as an initial treatment approach to lymphedema, since there are certain risks involved that could lead to worsen the symptoms. I would suggest to consult with a trained lymphedema therapist in your area before looking into any kind of pneumatic compression pump.

  • DIVESH

    Thank you for your reply , but I still want to know the name of the fabric and the name of materials use for it.The reason is that the lymphedema is grown bigger and the stocking of her size is not available in market, because of which we have to customize the stocking.We found one person who can make it but we have to provide him with the materials used for making the stocking.

    So we need the name of fabric to begin inquiry in the market.As soon as we get the name we can start making our required stocking.

    And also if can elaborate about the Pneumatic compression pump.
    Pls help us out.
    Thank you.

  • Heather

    I have symmetrical lipo-lymphedema and I am considering purchasing the readywrap by Solaris to replace my nighttime bandaging, it is much more cost effective than the other custom made nighttime compression garments. We moved to a small town where the closest known facility that performs decongestive therapy is a 2-3 hour drive. I currently just wear Mediven ready made compression stockings, but I had much less swelling when I was able to attend the clinic for bandaging. Do you have any experience with the readywrap? If so, Is it as effective as the more costly custom nighttime compression garments?

  • Suzanne

    I have lymphedema in both legs one leg weighs approx 75 lbs

    and the other weighs 50 lbs the right leg is a little smaller then the left someone told me i could get bandages custom made because of the size of my legs and and hopefully they would be easy to get on and off this person
    is very happy with her bandages hopefully I can finally get some help for this condition as my life has become very limited. hard for me to drive and walk can anybody get back to me I live near Boston Massachusetts

  • Carole

    Hi Joachim ~ You answered Devish’s question about pumps by saying:
    Pneumatic compression pumps should not be used as an initial treatment approach to lymphedema, since there are certain risks involved that could lead to worsen the symptoms.
    Would you please explain the risks?
    Many thanks

    • Joachim Zuther

      Dear Carole: The 2011 Position Statement of the National Lymphedema Network states that intermittent pneumatic compression is not a “stand-alone” treatment for lymphedema and should not be used without adjunct complete decongestive therapy (CDT).
      Pumps are effective in removing water from the interstitial spaces, but do not remove proteins. By reducing the water content in the lymphedematous limb, the extremity will initially become smaller with the application of pneumatic compression. However, if the interstitial water content is reduced, but the accumulated protein molecules remain in the tissue, the interstitial fluid colloid osmotic pressure (COPIP) increases. This will result in more water leaving the blood capillaries, exacerbating the swelling. The remaining proteins in the tissue continue to generate new connective tissue.

  • Marie

    Hi,

    Is there a specific sewing machine for lymphedema compression arm sleeve? Will an ordinary sewing machine enough for stitching these sleeves and do we have an evidence-based article for this?
    I would really appreciate your reply about this matter because we need the info in our department.
    Thank you!

    • Joachim Zuther

      Dear Marie: The manufacturing of compressiongarments requires specific machines. I am familiar with the process, which is high-tech and explaines the relatively high cost for these garments. If your intention is to stitch a defect on your garment using your own machine, I would recommend contacting JUZO, they are always very helpful.

  • Joy

    I am 58 yrs. old and have been wearing a class II cotton compression sleeve and glove on my right side for 10 years due to breast cancer in 1997. The garments are so expensive and with wearing them all day everday they do not last long. My insurance does not pick up much of the cost. I have contemplated making my own if I could find suitable heavy stretch fabric, a silicon band to add, and then design them from the measurements taken for my last garments. I am trying to find a cheaper route but I do not want to cause any further damage to my arm. Do you think it is viable to experiment making my own garments?

    • Joachim Zuther

      Dear Joy: i am aware of the necessary processes and machinery involved in manufacturing compression garments and I can tell you that it is not possible to construct a garment on your own. The National Lymphedema Network (NLN) offers assistance for garments through the Marilyn Westbrook Garment Fund http://lymphnet.org/mwgf/

  • amy

    How productive and what is your opinion on the flexitouch compression device associated with Klippel Trenaunay syndrome?
    thanks,

  • Richard Putz

    I have Lymphedema in both legs, developed Cellulitis from it and was in therapy and now pump two hours a day and wear compression socks and sometimes wrap over the socks and often wrap just at night…but wrapping over the compression socks just over the calf has been very beneficial with the compression socks.

  • Deekay

    J.Zuther I have Lymphedema on the lower right leg after radiotherapy for cancer. I am currentlt expiriencing this condition and unfortunately there is no one with special skills about the condition in this part of the region. I have learnt a lot just reading from the internet and I will be pleased if you can provide more information on treatment and garmets.

  • Marie

    how do I go about ordering a custom size stocking? I have been wearing it now for the past 3 years. The one I am currently wearing is up for a change and I no longer near the clinic I us to go.

    • Joachim Zuther

      Dear Marie: You would need to be seen by a certified fitter. Most trained lymphedema therapists are also certified fitters. Please click on the “Find a Therapist” tab in the menu bar on top to locate a therapist in your area.

  • sandy

    hi im in remission from stage 4 breast cancer ,i thought when I lived by the grace of Gods will that I could move on with my life but it hasnt happen all I want is my life back ((tears)) its been 10 years and ive had nothing but problems since my breast removal ,my gall bladder out sist in and out of the hospital pain blocks you name it ive been threw it but i havent given up my faith or hope ,i just turned 60years old this past dec.27th and finally decided that I wanted to have reconstruction surgery .once again my heart got crushed ive been told ive got lymphedema and have to start wearing a sleeve and that my operation would be at high risk and my odds of making it was 50/50 because I was told im so burned still from the radiation that it actually burned all my skin tissues to the point it was to damaged for reg. reconstruction and it was very high rick because they would have to cut part of my back out in order to do it it would be called flap something but ive decided not to do it ,its not worth after all this for me to die on the table so guess im going to just go one breasted .does it ever end.sick and tired in always being in pain which its chronic and no pain blocks dont work and now this new darn thing with the lymphedema which hurts and ive got little lumps under my skin can you help me or give me some advice on anything ive told you or can anyone ((tears))) please anyone ):

  • I came to know about your blog. All the information are tremendous thanks for sharing such a great post.

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