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

Addressing specific problems
FIGURE 31 Padding skin folds
Deep skin folds can occur on the toes.
Forefoot swelling may also be present. Skin
folds must be padded. Bevel edged foam
strips can be used. This is an area of
treatment that is initiated and monitored by
practitioners with training at specialist level.
MLLB OF THE ARM
BOX 28 Recommended materials for MLLB of the arm
■ Cotton tubular bandage
■ Finger bandages – 4cm conforming bandage
■ Soft synthetic wool or soft foam roll (10cm)
■ Inelastic bandages – one 6cm, one 8cm, and two to three 10cm
FIGURE 35 Finger and hand
bandaging
(a) Begin with the palm of the
hand facing down. Make one
loose complete turn with the 4cm
conforming bandage around the
wrist to anchor it.
(b) Ask the patient to spread their
fingers and thumb. Then begin to
bandage the hand. Wrap each
finger individually.
(c) Bring the bandage over the
back of the hand to the fingertips
without tension. Bandaging
should be distal to proximal,
leaving the fingertips uncovered.
Make circular turns around each
finger. Maintain light tension on
the bandage.
(d) On completion check that the
bandage does not slip off, and
check digits for cyanosis and
sense of touch.
FIGURE 32 Forefoot swelling
Foam padding can be applied to the forefoot
and fastened with a toe bandage to increase
local pressure. This care is initiated and
monitored by practitioners with training at
specialist level, as it requires accurate use of
appropriately cut foam.
FIGURE 34 Application of
tubular bandage
Apply a cotton tubular bandage,
first cutting a hole for the thumb.
(a) (b)
(c) (d)
MLLB
FIGURE 33 Padding for retromalleolar
oedema
Foam padding can aid oedema reduction
around the malleoli.
BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA 37