A Study of the Efficacy of Multi-Layer Bandaging and Elastic Hosiery in the Treatment of Lymphoedema, and their Effects on the Swollen Limb
Three factors were identified as having a potentially adverse effect on the outcome of treatment when elastic hosiery was used as the main means of containing lymphoedema:
1. the size of the swollen limb;
2. the effective distribution of interface pressures - determined by the shape of the swollen limb.
3. the composition of the subcutaneous tissues;
Clinical experience suggested that the negative impact of these three factors could be overcome by introducing a course of multi-layer bandaging before fitting elastic hosiery.
A series of studies was carried out to determine methods of measurement. A non-invasive method of measuring the impact of treatment on the subcutaneous tissues of swollen limbs was investigated using Computed Tomography. Various methods of measuring the volume of limbs were studied and compared and a suitable method selected for the purposes of this study. An objective method of measuring differences in the shapes of normal and contralateral swollen limbs was established and the impact of changes in shape on the profile of interface pressures under bandages and hosiery was also assessed.
A randomised, controlled treatment trial was then conducted to investigate the relative impact of two different regimes of treatment on the size and shape of unilaterally swollen limbs over a period of six months. The two treatment regimes were: a course of multi-layer bandaging followed by the application of elastic hosiery elastic hosiery used on its own. Two main outcomes were assessed at prescribed intervals over the six months: limb volume and limb shape.
The results revealed that the reduction in limb volume in the bandage plus hosiery group was significantly greater at each assessment than that achieved in the hosiery alone group. By the end of the trial, significantly greater numbers of patients had their distorted limbs returned to a more normal shape by bandaging plus hosiery than by hosiery alone.