Lymphedema Care: Lower Extremity Wrapping

Transcription

1 Lymphedema Care: Lower Extremity Wrapping Reviewed September 2014 Author: Sarah Zera Editor: Rehabilitation Institute of Chicago - Occupational Therapy Practice Council Wrapping the leg at home is often recommended for people with lower limb lymphedema. Your therapist will provide instructions from the options described below. Always follow the therapist s directions and call if you have any questions. Supplies Patients are given necessary materials as listed below. Consult the Rehabilitation Institute of Chicago LIFE Center or your therapist for additional sources of supplies. Tubular gauze stockinette Toe bandages (2-3 rolls) 6 cm short stretch bandage 8 cm short stretch bandage cm short stretch bandages cm short stretch bandages 2 rolls of synthetic cotton underpadding (Artiflex/Cellona) 2 15 cm elastic bandage roll (Isoband/Idealbinde) Pre-cut foam pads Tape Prior to bandaging, roll all bandages and underpadding. Compressive toe bandage

2 1. Apply stockinette to calf and foot. 2. Apply a pre-folded toe bandage by lightly anchoring over base of toes. 3. Guide bandage toward outside of the foot. 4. Spiral bandage toward the nailbed of the big toe, then back to the base with even overlaps and tension. 5. When exiting the to eat the base proceed in the opposite direction. This creates an X over the knuckle of each toe. 6. Continue with this pattern around each toe. 7. Therapist will instruct whether or not to wrap your small toe. Synthetic cotton 1. Keep foot flexed and apply synthetic cotton to the foot and ankle. 2. Use cotton to affix the pre-cut foam pad to the top of the foot and ankle. Affixing foam to calf 1. Use Isoband/Idealbinde to affix foam pads into 2. place. Anchor the front piece and then fix the 3. posterior piece in place. 4. Apply slight tension to keep the bandage smooth 5. and neat and to avoid cutting into unprotected 6. areas. 7. Affix with tape. Use paper tape to affix anatomically crafted foam pieces into place. Option 3:

3 Wrap synthetic cotton up the leg to the knee. Roman sandal If you have not yet placed the pre-cut foam foot pad over the end of the foot, you will do so when anchoring this bandage. Be sure not to cover the toes. If you have not yet placed the pre-cut foam ankle pads into place, you will do so by keeping the bandage low along your foot. 1. Keep your foot flexed upward and anchor a 6cm short stretch bandage to the end of the foot. Do not cover toes. Wrap bandage around two times. 2. Bring bandage to the back of the ankle, around the ankle and then to the front of the foot towards the great toe, pulling towards the little toe to make a triangle. 3. Go over the toes to cover the triangle two times. 4. Repeat until you run out of bandage. Your heel should be exposed when 5. completed correctly. 5. Affix with paper tape. Heel, ankle, sole Anchor an 8 cm short stretch bandage around the ankle. 1. Sole Direct the bandage on a steep angle towards the sole to cover the arch. 2. Heel From the sole proceed directly to the heel. Cover the heel. 3. Ankle Proceed directly to the ankle. 4. Repeat sole, heel, ankle pattern until sufficient 5. pressure and structure is achieved. Tape. Heel Cover the heel. Ankle Proceed directly to the ankle. Sole Wrap bandage on a steep angle toward the sole to cover the arch. After doing pattern once, continue wrapping bandage

4 up your leg. Tape. Calf wrap spiral pattern 1. Anchor a 10 cm short stretch bandage to the ankle and wrap around twice. 2. Spiral bandage up to top of calf using half spacing. Tape. 1. Anchor a 10 cm short stretch bandage where softness occurs. 2. Spiral bandage up to top of calf using half spacing. Tape. Herringbone pattern 1. Anchor a 10 cm short stretch bandage at the ankle. 2. Produce a herringbone pattern by alternating the angle of the bandage. The pattern will intersect in a line. Spiral pattern 1. Anchor a 10 cm short stretch bandage at the ankle. 2. Spiral with half spacing up the calf. Tape. 1. Anchor a 10 cm short stretch bandage where 2. softness occurs. 3. Spiral with half spacing up the calf. Tape.

5 Stockinette 1. If you have no tye ta pplied stockinette to thigh, do so now. 2. Allow extra length for coverage of the knee to fold over the completed 3. bandage. Synthetic cotton Apply synthetic cotton at knee, folding the material double behind the knee. Foam 1. Keep your leg straight while wrapping. 2. Affix foam padding into position on front of the thigh and encircle the knee with a 15 cm 3. Isoband/Idealbinde. 4. Position the pad for the back of the thigh and encircle the thigh again. 5. Cover all of the padding with the Isoband/Idealbinde with tension. First layer spiral pattern 1. Anchor a 12cm short stretch bandage below the knee. 2. Angle bandage upward behind the knee, encircle the thigh and then complete the X behind the knee. 3. Continue in a spiral back up the leg. Tape.

6 1. Anchor a 12 cm short stretch bandage where softness occurs in your bandage. 2. Angle the bandage upward behind the knee, encircle the thigh then complete the X behind the knee. 3. Continue in a spiral back up the leg. Tape. Second layer spiral pattern 1. Anchor a 12 cm short stretch bandage over the knee. 2. Spiral toward the top of the leg using half spacing. Tape. 1. Anchor a 12 cm short stretch bandage where softness occurs in your bandage. 2. Spiral toward the top of the leg using half spacing. Tape. Third layer herringbone pattern Anchor a 12 cm short stretch bandage just above the knee and create a herringbone pattern. Tape. Fourth layer spiral pattern

7 1. Anchor a 12 cm short stretch bandage at the bottom of your calf and spiral toward the top of the leg with larger spacing. 2. Finish the bandage at the top of the leg. 3. Fold over extra stockinette when finished. Tape. References Norton School of Lymphatic Therapy, Course manual: manual lymph drainage/ complete decongestive therapy certification training Guenter Klose, Compression Dressings for Lymphedema Treatment The content of this handout is for informational purposes only. It does not replace the advice of a physician or other health care professionals. Copyright 2014 Rehabilitation Institute of Chicago LIFE Center LIFE (5433) Fax