Lymphedema Care

Compression Bandaging for Lymphedema:
How It Works and Why It Matters

Compression bandaging—especially short-stretch multilayer wraps—is considered the gold standard for reducing swelling in the early phase of lymphedema treatment (International Society of Lymphology [ISL], 2023; International Lymphoedema Framework [ILF], 2012). This proven approach helps move fluid, protect skin, and prepare the limb for long-term maintenance with compression garments.

Understanding how and why bandaging works can give you confidence and a clearer roadmap in your treatment journey.

What is Compression Bandaging?:

Compression bandaging is a core part of Complete Decongestive Therapy (CDT), the gold standard treatment for lymphedema (ISL, 2023).

CDT has two phases:

Intensive phase: Daily treatment with manual lymphatic drainage (MLD), exercise, skin care, and multilayer compression bandaging.
Maintenance phase: Long-term self-care with compression garments, exercise, and skin care.

In the intensive phase, special short-stretch (inelastic) bandages are applied in layers over padding. These wraps gently squeeze the limb, helping to push fluid out of the tissues and reduce swelling (Partsch, 2005).

When the bandages are working, they gradually feel looser—this is a good sign that the limb is shrinking (Damstra & Partsch, 2013).

Once maximum reduction is achieved, patients transition to compression garments, which are designed to maintain—not reduce—the smaller size (ILF, 2012; Dzupina et al., 2025).

Why Short-Stretch Bandages and Not ACE Bandages?:

Short-stretch bandages are cotton-based, low-elasticity materials (10–100% extensibility). They provide:
- Low resting pressure (comfortable at rest).
- High working pressure (muscle contractions against the bandage help push fluid) (Partsch, 2005; Keller et al., 2009).

ACE-type long-stretch bandages (polyester, elastic fibers, >140% extensibility) provide:
- High resting pressure (uncomfortable, risk of impaired circulation).
- Low working pressure (less effective during activity) (Damstra et al., 2009).

Bottom line: Short-stretch bandages are safe and effective for lymphedema. ACE bandages are not recommended (ISL, 2023).

Alternatives Sometimes Used by Certified Lymphedema Therapist:

While short-stretch multilayer bandaging remains the gold standard, in practice therapists may also use:

Velcro-based adjustable wraps (e.g., FarrowWrap, Circaid): easier to apply, can be self-managed. Studies show they can achieve comparable short-term results in some cases (Damstra & Partsch, 2013).
Two-layer systems (e.g., Coban 2): thinner, easier to wear under clothing, and sometimes preferred for comfort (Yaman et al., 2021).
Special foam systems or quilted compression devices: used in selected cases, especially when bandaging daily isn’t practical.

These alternatives are often chosen for patient convenience, tolerance, or insurance coverage considerations, especially if daily re-bandaging is not feasible (ISL, 2023).

Pressure Gradient: Why Layering Matters

A well-applied bandage creates a pressure gradient:

Snugger at the bottom (hand/foot)
Looser at the top (shoulder/groin)

This directs fluid upward, back toward central circulation. If the gradient is reversed (too tight at the top), swelling can worsen (Partsch, 2005).

Padding, foam, and multiple layers help distribute pressure evenly and prevent skin injury (ILF, 2012).

How Often Are Bandages Applied?:

Ideal frequency (per guidelines):

Daily (5–7 times per week) for 2–4 weeks during the intensive CDT phase (ISL, 2023).

Real-world compromise:

In clinical practice, many patients receive treatment three times per week due to various real-life factors, such as:
- Personal schedules and family responsibilities
- Insurance plan coverage limitations
- Clinic availability and therapist caseload

Lymphedema therapists work with each patient to create a safe, effective, and sustainable treatment schedule that fits their lifestyle and care goals (Cancer Research UK, 2023).

Effectiveness: What the Research Shows:

Significant limb volume reduction: Multilayer short-stretch bandaging consistently reduces swelling (Partsch, 2005; ISL, 2023).
Loosening = progress: Bandages that loosen after application indicate fluid loss and successful decongestion (Damstra & Partsch, 2013).
Comfort & safety matter: Extremely high pressures do not improve results and may harm tolerance. Moderate, properly layered pressure is best (Damstra et al., 2009).
Alternatives: Newer two-layer compression systems (e.g., Coban 2) can be as effective as multilayer bandages (Yaman et al., 2021). Adjustable wraps may also provide non-inferior results in selected cases (Damstra & Partsch, 2013).
Transition to garments: Compression garments should be measured after reduction because their role is to maintain—not create—volume loss (ILF, 2012; Dzupina et al., 2025).

Materials Used：

Stockinette: Cotton sleeve placed first to protect skin.
Padding/foam: Distributes pressure, fills creases, protects bony areas.
Short-stretch bandages: Applied in multiple layers to build pressure gradient (Keller et al., 2009).

Safety Notes:

How to Check for Proper Circulation

Compression should never cut off blood flow. Use the following safety checks after applying bandages:

Color: Fingers or toes should stay pink—not white, blue, or purple.
Sensation: There should be no numbness, tingling, or pain.
Movement: You should be able to move your fingers or toes freely.
Capillary refill: Press a nail for 1–2 seconds, then release. Color should return within 2 seconds.

If any of these checks fail, remove the bandage and consult your therapist. Always report symptoms like coldness, burning, or loss of feeling (ILF, 2012).

Key Takeaways for Patients:

Bandaging is temporary but powerful—it reduces swelling before garments.
Short-stretch bandages only—ACE wraps are not safe or effective.
Daily bandaging is ideal, but 3x/week is commonly used in practice and still effective when well-managed.
Looser bandages = success—it means swelling is going down.
Other options exist—Velcro wraps or Coban may be used if daily bandaging isn’t possible.
Pressure gradient is the goal—snug at the bottom, looser at the top.
Garments maintain, not reduce—so they should be measured after the swelling is down.
Check circulation—look at color, movement, sensation, and capillary refill regularly.

Scientific References:

Cancer Research UK. (2023). Compression treatment for lymphoedema.
Damstra, R. J., & Partsch, H. (2013). Prospective, randomized controlled trial comparing adjustable compression wrap with inelastic multilayer bandages in the treatment of leg lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 1(1), 13–19.
Damstra, R. J., Mortimer, P. S., & Partsch, H. (2009). Compression therapy in breast cancer-related lymphedema: Pressure, comfort, and patient outcomes. Journal of Vascular Surgery, 49(5), 1256–1263.
Dzupina, A., et al. (2025). Timing of compression garment fitting and its impact on long-term outcomes in lymphedema management. Phlebology, 40(2), 112–119.
International Lymphoedema Framework (ILF). (2012). Compression Bandaging: Position Document. Wounds International.
International Society of Lymphology (ISL). (2023). The diagnosis and treatment of peripheral lymphedema: 2023 Consensus Document. Lymphology, 56(1), 1–37.
Keller, A., et al. (2009). Bandage pressure measurement and training in compression therapy. International Wound Journal, 6(4), 335–343.
Partsch, H. (2005). The use of pressure change on standing as a surrogate marker for the stiffness of a compression device. Dermatologic Surgery, 31(6), 625–630.
Yaman, A., et al. (2021). Efficacy of Coban 2-layer vs conventional multilayer bandaging in lymphedema treatment. Turkish Journal of Physical Medicine & Rehabilitation, 67(3), 261–268.