best practice for the management of lymphoedema ... - EWMA

BOX 26 Principles of MLLB
MLLB
■ Protect the affected area using tubular bandage and soft synthetic wool or foam underpadding
■ Start bandaging distally and move proximally
■ Guide bandages close to the limb using the entire hand to ensure good fit and to prevent creasing
■ Always apply additional padding to the popliteal fossa and the inside of the elbow
■ Apply inelastic bandages at full extension (lock-out point), except when applied to fingers and toes
■ If elastic bandages are used, they are usually applied at 50% extension and with 50% overlap
■ Use several layers of inelastic bandages to achieve the desired pressure
■ Minimise creases at joints by bandaging the limb in a slightly flexed position and using figure of eight turns at the joint
■ Extend partial limb bandaging beyond the area of swelling and ideally incorporate the knee or elbow joint to prevent proximal
displacement of fluid into the joint
■ Figure of eight bandaging increases the number of layers of bandage applied and results in higher sub-bandage pressures than spiral
bandaging. Its use over the whole limb may be appropriate to reduce slippage or for inverted champagne bottle shaped legs, when high
sub-bandage pressures are required
■ Assess security of bandages and fixation, range of movement, circulation, sensation and level of comfort after application. Ask the
patient to report bandage slippage and any change in digit sensation or colour
■ The patient should be encouraged to contribute to the development of an individualised bandage system that fulfils their needs
MLLB OF THE LEG
FIGURE 26 Application of
tubular bandage to lower leg
Apply a cotton tubular bandage
next to the skin. The tubular
bandage can be applied after toe
bandaging, if indicated. If applied
before toe bandaging, the tubular
bandage should be folded back
temporarily to allow access to
the toes.
FIGURE 27 Bandaging the toes
and foot
Toes should be bandaged if
swollen. If not bandaged, the
toes should be monitored and
bandaged if they become
swollen.
(a) Anchor the 4cm conforming
bandage with one complete
circle at the base of the toes.
(b) Take the bandage to the distal
end of the big toe.
(c) Bandaging should be distal to
proximal starting from the base
of each toenail with a turn
around the base of the toes
before starting the next toe.
(d) Keep slight tension on the
bandage. Avoid making creases
on the underside of the toes. The
little toe can be bandaged on its
own, with the adjacent toe, or left
unbandaged. On completion
check that the bandage does not
slip off, and check the toes for
cyanosis and sense of touch.
BOX 27 Recommended materials for MLLB of the leg
■ Cotton tubular bandage
■ Toe bandages (if indicated) – 4cm conforming bandage
■ Soft synthetic wool or soft foam roll (10cm or 20cm) or
sheet
■ Inelastic bandages – one 8cm, three to four 10cm for lower
leg, and four to six 12cm for thigh
(a) (b)
(c) (d)
BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA 35