Compression therapy is the single most important long-term self-management tool in lymphoedema. During the intensive phase of treatment, multi-layer bandaging provides the mechanical force that drives initial volume reduction. In the maintenance phase, a correctly fitted compression garment maintains the limb volume achieved and prevents re-accumulation. Understanding the difference between garment types, how to assess correct fit, and how to wear them effectively is essential knowledge for anyone with lymphoedema.
Flat-Knit Versus Round-Knit
Round-knit garments are the familiar graduated compression hosiery available in pharmacies and medical supply shops. They are manufactured by knitting in a continuous spiral, producing a smooth, stretchy fabric. They are appropriate for mild venous insufficiency and deep vein thrombosis prophylaxis. They are not recommended as the primary garment for lymphoedema because their elasticity means they tend to collapse over prominent areas, such as the ankle, creating a tourniquet effect rather than graduated compression. Flat-knit garments are constructed from flat panels sewn together, producing a stiffer, inelastic fabric. They can be shaped to accommodate irregular limb contours, provide the high working pressure and low resting pressure appropriate for lymphoedema, and resist the rolling and slipping that afflicts round-knit garments on oedematous limbs.
Compression Classes
European Standard compression classes for hosiery range from class I at 18 to 21 mmHg through to class IV above 49 mmHg. In lymphoedema, class II at 23 to 32 mmHg is commonly used for maintenance of mild to moderate limb lymphoedema, with class III at 34 to 46 mmHg for more significant disease. The appropriate class should be prescribed by a qualified lymphoedema practitioner based on individual limb volume, skin condition, and patient tolerance. Too low a compression class will fail to control the oedema; too high risks impeding arterial perfusion, particularly in patients with concurrent peripheral arterial disease.
Upper Limb Garments
Arm sleeves for upper limb lymphoedema following breast cancer treatment are typically flat-knit and extend from the wrist to just below or above the axilla depending on the distribution of lymphoedema. A gauntlet covering the hand is often required when lymphoedema involves the hand and fingers. The sleeve must provide graduated compression, highest distally and reducing proximally. Seams should be minimal and flat to avoid creating pressure ridges on fragile post-treatment skin.
Donning and Daily Wear
Compression garments should be applied first thing in the morning before oedema accumulates from gravitational drainage during the day. Rubber gloves or commercial donning devices make application easier, particularly for women with reduced grip strength after breast cancer surgery. Garments should be worn throughout the waking day and removed at night unless a healthcare professional has specified otherwise. They should be washed daily: sweat degrades the elastomeric fibres and reduces compression efficacy. Most garments have a clinical lifespan of approximately six months with daily washing before their compression properties become inadequate.
Replacement and Access
In the United Kingdom, compression hosiery for lymphoedema is available on prescription via the Drug Tariff, allowing NHS patients to obtain garments without personal cost. Flat-knit custom garments are typically accessed through specialist lymphoedema services. Patients should be re-measured every six months or when they notice changes in limb volume, skin condition, or garment fit, as changes in the limb or in garment condition both necessitate reassessment.