Lymphoedema Evidence Library › Topics › Compression
Compression
Compression: bandaging, garments, wraps and pneumatic devices
29 sources
Evidence in one minute
- Garments alone have strong trial support in early BCRL; highest tolerated class (~20–60 mmHg); no trials to choose flat- vs circular-knit. Executive Committee of the International Society of Lymphology 2023
- Intensive phase: inelastic multilayer short-stretch bandaging (high working, low resting pressure); bandages with static stiffness index ≥10 give effective compression. European Wound Management Association ; senior editorial advisor Moffatt CJ; consultant editors Mortimer P 2005 · Charles 2013
- Garment choice: circular-knit for regular shapes; flat-knit (custom, stiffer) for distorted limbs, skin folds and lipo-lymphoedema; wraps for self-management and adherence. Lymphoedema Framework ; senior editorial advisor Moffatt C 2006 · Fletcher 2024 · Keast 2025
- Arterial safety (legs): ABPI <0.5 — no compression, refer vascular; 0.5–0.8 — reduced compression (≤25 mmHg) under specialist supervision; SA statement uses <0.79. UK: ≤20 mmHg may start before ABPI if no red flags. Lymphoedema Framework 2006 · Davey 2014 · Davey 2018 · Wounds 2015
- Heart failure: not a contraindication once compensated; start 20 mmHg both legs and step up one leg at a time over ~2 weeks. Wounds 2023
- Pneumatic compression (IPC): multi-chamber sequential with root-of-limb/trunk coverage; avoid single-chamber pumps and a fibrotic ring at the limb root. An advanced device beat a simple pump at home in BCRL (very low certainty, revised 2026-10-08). Fife 2012 · National Lymphedema Network Medical Advisory Committee 2011
- Garment replacement: every ~6 months; two garments per 6 months is usual (useful for medical-aid motivation). Wounds UK / BSN medical unknown · Davey 2014
- SA reality: garments often made by occupational therapists with unmeasured pressures; long custom lead times; neoprene wraps may give only ~20 mmHg. Davey 2018 · Vivian 2019
Industry note: almost every compression guidance document held is manufacturer-sponsored (Sigvaris, BSN, Lohmann & Rauscher, medi, Essity, Activa, Haddenham, Juzo).
Update 2026-10-08 — downloaded evidence
- Prevention (revised 2026-10-08): a sleeve for 4–9% subclinical swelling was not shown to prevent BCRL (PLACE, inconclusive, low certainty); CALGB 70305 did not test prophylactic compression (activity-only sleeve). BIS-triggered sleeves led to less tape-defined chronic BCRL than tape-triggered sleeves (PREVENT, low certainty). Ridner 2022 Paskett 2021 · Bundred 2023 · Ridner 2019
- IPC: meta-analysis of 14 RCTs (many Chinese) — RR 0.36 for developing BCRL with early low-pressure IPC; little effect in established lymphoedema. Very low certainty (revised 2026-10-08: 5 small prevention trials, contradictory search dates, a subgroup estimate outside its own CI). Su 2025
Appraisal update 2026-10-09
- Manufacturer-linked material (BSN/JOBST leaflet, Wounds UK quick guides, Charles 2013 SSI article) is accurate on principles but brand-led; cite the ILF/ISL documents for recommendations. The LIPLEG critique arguing that compression was “underrepresented” was translated with compression-industry funding. Wounds UK / BSN medical unknown · Charles 2013 · Bertsch 2025
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 0 | 0 | 1 | 2 | 0 |
| Null or negative | 0 | 0 | 2 | 0 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.
All 29 sources
Loading 29 sources…