When should lymphedema wraps be used?

Optimal Timing for Lymphedema Wrap Usage

Lymphedema wraps should be used during the active treatment phase of lymphedema management and during maintenance phases when compression is needed, with nighttime compression providing superior outcomes compared to daytime compression alone. 1, 2

Types of Lymphedema Compression

There are two primary phases when lymphedema wraps are indicated:

1. Active Treatment Phase (Intensive/Decongestive Phase)

   • Short-stretch multilayer bandages or Velcro adjustable compression wraps are used during this phase 3
   • Typically applied after manual lymphatic drainage (MLD) sessions
   • Used daily during the intensive treatment period (typically 2-3 weeks)
   • Both conventional multilayer short-stretch bandaging and Velcro adjustable compression wraps show significant improvements in reducing lymphedema volume 3

2. Maintenance Phase

   • After initial volume reduction is achieved
   • Compression wraps are used in addition to daytime compression garments
   • Particularly beneficial during nighttime when regular compression garments may be uncomfortable 2

Specific Timing Recommendations

Daytime Use

• During active treatment: Apply wraps throughout the day, removing only for hygiene and MLD sessions 1
• During maintenance: Use compression garments during the day for regular activities 4

Nighttime Use

• Critical timing: Research shows that adding nighttime compression to daytime compression garments provides superior outcomes for lymphedema management 2
• Nighttime compression can be achieved through either compression bandaging or specialized nighttime compression system garments 2
• High adherence rates (95-96%) have been reported with nighttime compression systems 2

Patient-Specific Considerations

• Post-cancer treatment: Particularly important for breast cancer survivors and those who have undergone lymph node dissection 5, 1
• During exercise: Compression wraps or garments should be worn during physical activity, especially resistance training 1
• After periods of limb elevation: Apply compression immediately after elevation to maintain the benefits 1
• During symptom flare-ups: Increase usage during periods of increased swelling or discomfort 4

Effectiveness and Adherence

• Compression is considered the most important component of lymphedema treatment 4
• While lymphedema can improve with bandages alone, sustained improvement requires consistent compression 4
• Adjustable compression Velcro wraps may improve quality of life compared to conventional multilayer bandages while providing similar volume reduction 3

Common Pitfalls to Avoid

• Inconsistent use: Lymphedema wraps must be used consistently during the prescribed periods to maintain effectiveness
• Improper application: Incorrect pressure gradient can worsen symptoms or be ineffective
• Using wraps without proper training: Patients should receive instruction from a lymphedema specialist
• Neglecting skin care: Always perform proper skin care before applying compression wraps to prevent skin complications 1
• Delaying use after infection: Promptly resume compression therapy after treating any infections to prevent worsening of lymphedema 1

Lymphedema management requires a lifelong commitment to compression therapy, with wraps playing a crucial role in both active treatment and maintenance phases. The addition of nighttime compression to daytime compression garments represents the current best practice for optimal lymphedema management.