Without the beneficial support provided by both forms of compression (garments and bandages), lymphedema treatment would not be possible. It is helpful to understand precisely how these forms achieve the desired affect (limb reduction) and how they complement each other in the successful treatment of lymphedema.

Bandaging reduces the ultrafiltration rate.

Lymph originates as a clear, protein-rich fluid in tissue spaces throughout the body. This fluid (1-2 liters/day) is usually carried by lymph vessels, passes through regional lymph nodes and joins the venous blood shortly before this blood enters the heart. The circulation of lymph is important in maintaining normal tissue homeostasis throughout the body. Because of the reduced lymph transport in lymphedema, protein-rich fluid accumulates in the tissue spaces. By raising the tissue (interstitial) pressure by means of an external force (the compression bandage), less fluid accumulates and less fluid has to be removed from the tissue spaces. The lymphedema improves.

Bandaging improves the efficiency of the muscle and joint pumps.

Lymph is propelled through the various lymph vessels by muscular activity, by contraction of the lymph vessels themselves, by the movements of the diaphragm (breathing) and by negative pressures within the chest during the breathing cycle. In the extremities, the activity of the skeletal muscles is an important factor in lymph transport. During contraction of an arm or a leg muscle, the venous and lymphatic systems propel the fluids they contain towards the heart. This results in a more rapid flow and a decompression of both systems. In order to preserve this process, normal tissue (skin, muscle) and joints are essential. In lymphedema these conditions are damaged. The use of external compression bandages compensates for this diminished tissue pressure and thus improves the efficiency of the muscle and joint pumps.

Bandaging/Garments prevent the re-accumulation of evacuated lymph fluid.

Manual Lymph Drainage (MLD) involves specific manual motions that follow lymphatic pathways, emptying and decompressing obstructed lymph vessels in the swollen body part. Each MLD treatment decongests the limb and helps return it to a more normal size. The reduction of edema volume and the elastic insufficiency of the skin make refilling of the limb with edema fluid quite easy. Since the compression bandages makes up for the diminished tissue pressure of the skin, it prevents the re-accumulation of evacuated, stagnating lymph fluid .It thus maintains the result of the MLD treatment.

Bandaging helps break up deposits of accumulated scar and connective tissue.

First stage lymphedema is caused by an accumulation of protein-rich edema fluid. Lymphedema in a later stage is associated with thickening of the skin and hardening of the limb. This hardening is due to the proliferation of connective and scar tissue. In order to soften this connective tissue buildup, one must make use of special techniques during the MLD treatment. Additional softening and breakdown of this fibrotic tissue is obtained by including foam rubber padding materials within a moderately tight bandage. This achieves a localized pressure increase in this area. Muscular activity further acts upon these fibrotic areas, loosening and breaking up accumulated deposits of scar and connective tissue. In addition to the listed beneficial effects of compression bandages in lymphedema, they are also valuable in venous disorders.

Qualities of Compression: Working and Resting Pressure

When a short stretch compression bandage is applied to the lymphedematous limb it supports the tissues without "squeezing" because its fabric does not contain elastic materials. This means that the bandage is not capable of shortening around the limb after application and is therefore not exerting ever- increasing pressure during inactivity. This dynamic is called resting pressure and is considered safe and comfortable for long-term treatment. Conversely, the stability of the bandage creates a very high resistance to stretch when pressure is applied through internal muscle contraction and joint movement. This force is called working pressure. The multi-layering of these bandages creates a soft "cast-like" environment which fully resists these forces and further prevents refilling of evacuated lymph fluid. Additionally, the exercise regimen prescribed for each patient is maximized by this working pressure as these forces promote further lymph removal.