Lymphoedema Evidence Library › Topics › Compression
Compression
Compression: bandaging, garments, wraps and pneumatic devices
114 sources
Evidence in one minute
- Compression is the core of treatment. In early BCRL, garments alone were nearly as effective as intensive CDT in the one adequate trial (low); use the highest tolerated class (~20–60 mmHg). There are no trials to choose flat- v circular-knit. Executive Committee of the International Society of Lymphology 2023 · Dayes 2013
- Intensive phase: inelastic multilayer short-stretch bandaging with static stiffness index ≥10; arm bandages at 31–40 mmHg work as well as 41–50 and are better tolerated. Partsch 2007 · Karafa 2018
- Adjustable wraps are non-inferior to bandaging for lower-leg volume over 10 days and quicker to apply — low (wrap maker funded). Reisshauer 2025
- Night-time compression added to a day sleeve reduces excess volume, and self-bandaging works as well as a costly garment — moderate (revised 2026-10-09). McNeely 2022
- Prevention: a sleeve after axillary dissection cuts first-year swelling (moderate); stockings after groin or pelvic surgery do not clearly prevent leg lymphoedema (low). Paramanandam 2022 · Stuiver 2013
- Arterial safety (legs): ABPI <0.5 — no compression, refer to a vascular surgeon; 0.5–0.8 — reduced compression (≤25 mmHg) under specialist supervision; the SA statement uses <0.79. A quarter of lymphoedematous legs have a toe-brachial index <0.7. Lymphoedema Framework 2006 · Davey 2018 · Trihan 2024
- Pneumatic compression (IPC): a modest home adjunct; multi-chamber sequential pumps that clear the root of the limb or trunk; trials are small and conflicting — low to very low (revised 2026-10-08). O'Donnell TF Jr 2026 · Su 2025
- Industry: almost every compression guidance document held is manufacturer-sponsored (Sigvaris, BSN, Lohmann & Rauscher, medi, Essity, Activa, Haddenham, Juzo, Thuasne, Tactile, Koya).
Bandaging
- Inelastic bandages give high working and low resting pressure; static stiffness index ≥10 defines effective compression. European Wound Management Association ; senior editorial advisor Moffatt CJ; consultant editors Mortimer P 2005 · Charles 2013 · Partsch 2007
- Higher pressure is not shown to be better (arm RCT n=96; skin-thickness trial very low). Bandaging does most of the work in CDT; MLD adds a little. Karafa 2018 · Duygu-Yildiz 2023 · Johansson 1999
- Palliative bandaging methods for arm oedema. Crooks 2007
Garments and wraps
- Choice: circular-knit for regular shapes; flat-knit (custom, stiffer) for distorted limbs, skin folds and lipo-lymphoedema; wraps for self-management and adherence. Lymphoedema Framework ; senior editorial advisor Moffatt C 2006 · Fletcher 2024 · Keast 2025 · Scheer 2017
- Wraps: non-inferior to bandaging in the intensive phase (above); the All Wales review gives supportive evidence and a cost case. Thomas 2017
- Night compression: LYNC (120 women, independent) reduced excess volume by 11–15 percentage points over 12 weeks; self-bandaging matched a US$450 garment — moderate, sustained benefit low. LYMphoNIGHT (56 women, Thuasne-funded) reduced rebound after intensive therapy — low. McNeely 2022 · Borman 2026
- Early BCRL: garment-first is not shown inferior to intensive bandaging (very low); a class 1 sleeve at diagnosis of mild BCRL cut 6-month progression from 57% to 16% — low, at the cost of embarrassment and practical burden. Jeffs 2024 · Blom 2022
- During exercise: a sleeve is optional during resistance exercise (randomised crossover, moderate) and during HIIT for leg lymphoedema; sports compression garments have been studied. Singh 2015 · Wittenkamp 2025 · Sierakowski 2014
- Replacement: about every 6 months; two garments per 6 months is usual (useful for medical-aid motivation). Heat and humidity can worsen swelling and garment tolerance (observational, very low), although heat exposure has not been shown to cause lymphoedema. Wounds UK / BSN medical unknown · Davey 2014 · Witt 2024
Compression to prevent lymphoedema
- Arm: a first-year sleeve after axillary dissection — moderate for first-year swelling, low for lasting lymphoedema. PLACE (sleeve for 4–9% subclinical swelling) was inconclusive (low); CALGB 70305 used an activity-only sleeve, not prophylactic compression; BIS-triggered sleeves led to less tape-defined chronic BCRL than tape-triggered ones (PREVENT, low) (revised 2026-10-08). Paramanandam 2022 · Bundred 2023 · Paskett 2021 · Ridner 2022 · Ridner 2019
- Leg: class II stockings for 6 months after inguinal dissection 65% v 81% (RR 0.80, 0.60–1.07) — low; 6-week garments after gynaecological surgery 7.7% v 13.3%, not significant; after groin dissection for melanoma 11% v 45% at 3 months but 39% v 55% at 24 months, not significant — very low; light hosiery in a self-care package after radical hysterectomy 13.6% v 34.5% at 1 year — low. Compression delays swelling while worn. Stuiver 2013 · Hnin 2018 · Brown 2026 · Wang 2020
Pneumatic and active compression devices
- Device design: multi-chamber sequential with root-of-limb or trunk coverage; avoid single-chamber pumps and a fibrotic ring at the limb root. IPC pushes fluid to the groin, so clear the root first; it lowers volume without speeding tracer transport. National Lymphedema Network Medical Advisory Committee 2011 · Olszewski 2011 · Miranda F Jr 2001
- Effect: an advanced trunk-and-arm device beat a simple pump in BCRL (very low; revised 2026-10-08). Early low-pressure IPC RR 0.36 for developing BCRL in 14 RCTs, little effect in established lymphoedema — very low (5 small prevention trials, a subgroup estimate outside its own CI). For leg lymphoedema only one sequentially allocated trial showed a volume difference v no IPC — low (the review says moderate). Fife 2012 · Su 2025 · O'Donnell TF Jr 2026
- Small and conflicting trials: MLD plus IPC beat MLD alone; IPC settings matter little; IPC can replace MLD within CDT (n=46); IPC added nothing in lipoedema; 1 hour daily is enough (pilot, very low); text reminders did not improve adherence (Tactile-funded, 29 women). Szolnoky 2009 · Pilch 2009 · Sanal-Toprak 2019 · Szolnoky 2008 · Keeley 2023 · Maingi 2023
- Reviews: a 49-study scoping review found no major harms and modest adjunct benefit; ALFP 2012 calls IPC a useful home adjunct with unknown best parameters; advanced-pump reviews rest on manufacturer-funded before–after and claims data — very low. Pandey 2024 · Feldman 2012 · Panchik 2025
- Non-pneumatic active devices (Dayspring, Koya): sponsor-run, unblinded crossover trials report large benefits over pumps (arm 64.6% v 27.7%; leg 370 v 83 mL, completer analysis) — very low; the AVF/AVLS position statement relies on these trials only. Rockson 2022 · Barfield 2025 · Jacobowitz 2026
- Origin of the sequential pump (Lympha-Press developer report). Zelikovski 1980
Safety
- Arterial disease: ABPI thresholds above; in the UK, ≤20 mmHg may start before ABPI if there are no red flags. Wounds 2015 · Davey 2014
- Heart failure: not a contraindication once compensated; start at 20 mmHg on both legs and step up one leg at a time over about 2 weeks. MLD is haemodynamically safe in compensated failure; screen older patients with bilateral oedema with BNP. Wounds 2023 · Leduc 2011 · Todd 2011
- Harms: genital oedema in 43% of patients with leg lymphoedema after pump use v 3% without; an unremoved garment led to amputation in an isolated patient. Boris 1998 · Hilder 2024
Gaps and warnings
- Manufacturer-linked material (BSN/JOBST leaflet, Wounds UK quick guides, the 2013 SSI article) is accurate on principles but brand-led; cite the ILF or ISL documents for recommendations. Wounds UK / BSN medical unknown · Charles 2013
- Manufacturer-authored practice articles and product notes are flagged: Juzo wraps, negative-pressure massage, Fast'n Go (co-written by its distributor); Farrow Wrap, Juzo and Coban 2 case reports are case-level only. Close 2018 · Gott 2018 · Mangion 2024
- The LIPLEG critique arguing that compression was "underrepresented" was translated with compression-industry funding. Bertsch 2025
- No trial compares flat- and circular-knit garments.
For the therapist
- Do: make compression the core of every programme; use inelastic bandages (static stiffness index ≥10) for reduction, then the highest class the patient tolerates and can don; offer night-time compression or self-bandaging after intensive treatment (moderate). Check ABPI or toe pressure before leg compression.
- Stop: prolonged twice-daily therapist bandaging where garments or wraps achieve the same (low); bandage pressures above 40 mmHg on the arm (no added benefit, n=96).
- Measure: where possible, check interface pressure under bandages and locally made garments with a pressure monitor, and record the garment class; this closes the "unknown pressure" gap.
- Certainty: night compression moderate; garments-first in early BCRL low; IPC low to very low.
For a vascular surgeon in South Africa
- Many garments are made by occupational therapists, often without a measured pressure; recording the class and checking interface pressure with a pressure monitor would close this gap and support medical-aid motivation; custom garments have long lead times; neoprene wraps may give only ~20 mmHg. Davey 2018 · Vivian 2019
- Locally made zinc-paste bandages (~US$2 per leg per week) did not improve Kaposi sarcoma leg lymphoedema in a 30-patient Kenyan pilot — very low. Chang 2022
- Check ABPI or toe pressures before leg compression; self-bandaging at night is a low-cost option with trial support.
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 0 | 3 | 9 | 7 | 0 |
| Null or negative | 0 | 2 | 10 | 6 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.
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