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Joachim Zuther, Lymphedema Specialist. Read more
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The Role of Short-Stretch Bandages in the Management of Lymphedema

 

Compression therapy, like manual lymph drainage (MLD), exercises and skin care, is a main element of Complete Decongestive Therapy (CDT).
In most cases of lymphedema, the elastic fibers in skin tissues affected by lymphedema are damaged and unable to provide adequate resistance against the musculature working underneath, and the blood and lymph vessels within these tissues. External compression compensates for the elastic insufficiency of the affected tissue, providing the resistance necessary to maintain the reduction of the swelling and to prevent re-accumulation of lymphedemateous fluid.

Compression bandages are used during the decongestive (intensive) phase of CDT. In this sequence of the treatment the volume of the affected limb changes almost on a daily basis, and it is necessary that external compression adapts to these changes. Bandages are much better suited for this task than compression garments (sleeves, stockings), which would have to be re-fitted constantly. Garments are used in the second phase of CDT, when the limb is decongested and volume changes are minimal.

Why short-stretch bandages?
Crucial in lymphedema management is to provide the skin tissues with a solid counterforce against the muscles working underneath, particularly while standing, sitting, walking, or performing therapeutic exercises. The subsequent increase in the tissue pressure during muscle activity promotes lymphatic and venous return, and prevents fluid from accumulating in the skin. It is equally important to prevent the bandages from exerting too much pressure on the tissues during rest, which could cause a tourniquet effect and effectively prevent adequate return of these fluids.

There are two distinct types of compression bandages – short-stretch and long-stretch bandages. The difference refers to the extent the bandages can be stretched from their original length. Short-stretch bandages are made from cotton fibers, which are interwoven in a way that allows for about 60% extensibility of its original length, whereas long-stretch bandages, commonly known as “Ace” bandages contain polyurethane, which allows for an extensibility of more than 140% of the bandages’ original length.

The extent of which a bandage can be stretched specifies the two main qualities of pressure in compression therapy – the working pressure and the resting pressure. The working pressure is determined by the resistance the bandage provides against the working musculature underneath, and is active only during muscle activity, and therefore temporary. The pressure the bandage exerts on the tissues at rest, i.e. without muscle contraction is known as the resting pressure, which is permanent. Relevant to these pressure qualities are the number of bandage layers, the tension with which these layers are applied, and most importantly the type of bandage used.

The high working pressure of short-stretch cotton bandages provide the necessary solid counterforce and make them the preferred compression bandage in the management of lymphedema. Due to the low resting pressure of short-stretch bandages, tourniquet effects are prevented – provided these bandages are applied correctly.

Long-stretch (“Ace”) bandages have the exact opposite effect and are not suitable for lymphedema management. The low working pressure these bandages provide does not offer adequate resistance, and fluid would inevitably accumulate. In addition, the high resting pressure of long-stretch bandages could constrict veins and lymph vessels during rest.

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27 comments to The Role of Short-Stretch Bandages in the Management of Lymphedema

  • dianne kerr

    I also wonder if the high stretch bandages don’t cause too much compression at rest on the skin, which could cause problems with stasis ulcers and other compromised skin comditions. I just was referred a patient from our local wound care clinic who has been in ace bandages for lymphedema and non healing skin lesions for several months (bandaged 3 times a week by a home health agency with no LED therapist. He is insulin dependent diabetic and a smoker, so I’m sure he has capillary disease, and his wound care physician is puzzled as to why his wounds haven’t healed in all this time. I think a lot of it is the bandages they are using, with the high resting pressures on the skin.

    • Joachim Zuther

      I agree with you. Ace bandages, or high-stretch bandages apply high resting pressure and low working pressure on the tissues. This situation is certainly not conducive to would healing.

  • Sharlane Adams

    For billing purposes, does Medicare consider the time given to application of short stretch bandaging included in the Manual (Lymphatic Drainage) Therapy code? My facility is currently reviewing this and there is conflict of opinions. Thank you.

    • Joachim Zuther

      Dear Sharlane: there is no specific code for the application of padded short-stretch bandages. However, you may try to use code
      97139 – Therapeutic procedure, one or more areas, each 15minutes, unlisted therapeutic procedure.
      This code may be used if the provider performs a therapeutic procedure to one or more body areas that is not listed under current codes.
      A narrative descriptor should be noted in the claim. This code may be billed in 15-minte units.

  • Kat he

    I would like to know how other facilities handle short stretch bandaging. Do you provide them or have your patients purchase them? Has anyone had any luck with getting insurance purchasing them since medicare won’t?

  • Valerie Mills

    I have lipedema with type II going into type III lymphedema. I am 44 years old going on 45. I am single and living alone, no family or friends to assist. My fluid levels and swelling jump and the worse has been 32+ pounds in one day. I am currently at 561 pounds, a fourth is fluid in the lower half of my body (some rear, hips and thighs really bad, little in the lower legs and feet). I have tried to get help with the short bandage wrappings, but it is hard to do them myself. PT only would do two to three days a week at their location. Medicare did not feel the MLD was doing enough and that was stopped. Tried getting into a location like Siskins, but was told I am not bad enough off and the fluid could come off in two to three weeks with the wrappings. Tried Mayo Clinic in Florida and they tell me to loose weight first and then compression on the lower part of the legs. Do you have any suggestions of a place or location that can offer me assistance to get this fluid off? I am in the state of Georgia in the USA. Thank you so much for your assistance.

    Valerie

  • Kelly

    How would one bill for compression bandages only when it is performed alone and not with MLD? SOme of our patients need repeated bandaging by the therapist because they cannot do it/do not have assist at home. The self-care charge, which includes bandaging but only to self-manage, it not for these long-term bandaging patients. Our facility is looking into this and we are have trouble finding information.

  • Reita Dougan

    Skin lesions can be caused by other disorders that can be serious. ^

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  • i would like to know what is the different between using long starch compression bandage along with short starch bandage

  • Evelynne Rifkind Goldman

    I’m 66 and was diagnosed with primary LE in my legs over 30 years ago. I have seen Prof Mortimer in the UK twice and now living in Israel I recently had a 7 hour lymphapress treatment with Prof Zelikovsky in Israel. Prof Zelikovsky also tells me that I now have Lipodema too. After the Lymphapress treatment he bandaged my legs but told me to buy stockings. I am now wearing Jobst stockings and find that this is satisfactory. My LE has decreased in my legs and I can walk a lot better than without the stockings. My one fear is that is I get another cellulitis or eresypelas attack should I continue wearing them. Prof Zelikovsky told me that stockings are far better than MLD and hopes that I won’t need another Lymphapress treatment. Prof Zelikovsky is the only LE consultant in Israel although there are many vascular consultants. Your comments would be appreciated.

  • David Dickert

    Hello, I’m going to be caring someone who is on SSI disability via Medicaid-does medicaid cover the cost of CDT-we live far western N.C.

    • Joachim Zuther

      Generally Medicaid does not cover CDT. However, you may try to have it covered with a letter of medical necessity from the physician.

  • Melissa

    How long can short stretch bandages be used before they lose their stretch and need to be replaced?

    • Joachim Zuther

      Obviously, it depends on how much they are used. Generally, if used on a daily basis, they should be replaced every 4-6 months

  • Tina DiNardo

    Can you provide a list of name brands of short stretch bandages? Also please note the number of layers and which bandage is for which layer. Thank you.

    • Joachim Zuther

      Rosidal (Lohmann and Rauscher) and Comprilan (Beiersdorf-Jobst) are the most used products. I am unable to answer the second part of your question since this depends on each individual case, however, the narrowest bandage is applied to the distal end of the extremity and the widest to the proximal end.

  • natasha

    what if we used a bandage made from microfibres?

  • Carol Gundersen

    Hello,
    I had a TRAM flap reconstruction 12 years ago (4 nodes removed), then a lumpectomy on the same breast 2 years ago (11 nodes removed). I have lymphedema in the referenced breast that occurred, along with cellulitis, about 1 month after the second surgery. I am receiving weekly massage from a certified lymphedema massage therapist, and have a garment to wear. The swelling had not been reduced significantly. Is there the possibility that a surgery to remove some of the scar tissue, that is suspected to be damming the fluid, would significantly reduce the swelling? Note: The lumpectomy was done by a general surgeon. I don’t know what he had with relation to TRAM flaps reconstruction, thus negatively affecting the original TRAM.
    Thank you.

  • Anthony Gianpetro

    Any evidence that short stretch layered compression helps patients s/p TKA and THA?

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