Effects of Bandaging as One Component of Intensive Care

Lymphoedema specialists have long recognized that inelastic bandages with low extensibility produce high working pressures and lower resting pressures creating peak pressures that produce a massaging effect to stimulate lymph flow (Lymphoedema Framework, 2006).

Different mechanisms may explain the efficacy of compression therapy:
 

• Reduction in capillary filtration
• Shift of fluid into non-compressed parts of the body
• Increase in lymphatic reabsorption and stimulation of lymphatic transport
• Improvement in the venous pump in patients with veno-lymphatic dysfunction
• Breakdown of fibrosclerotic tissue

These beneficial effects have been further supported by Partsch, 2007 who identified that compression is the most critical aspect of treatment and is most effective when inelastic materials are used. Mayrovitz, 2009, further describes the effects of short stretch bandaging to provide the required resistance to support and distribute the dynamic working pressures created by functional, muscle activities to move interstitial fluids, soften fibrotic tissues and stimulate lymphatic contractility.

Breakthrough research (Schuren, 2010) has shown that the dynamics of effective compression therapy are better explained by Pascal’s Law, which states that when pressure is applied (functional activity) on a fluid (a muscle or muscle group) in a closed container (fascia muscularis and compression layer), there is an equal increase at every other point in the bandage.

In compression, dynamics refers to the difference between high and low working pressures reflecting intermittent changes in pressure caused by the patient’s own muscle movement within the bandage. Inelastic or rigid compression systems generate larger dynamics, or amplitudes, and therefore, more effective compression. Mayrovitz, 2009, showed that an inelastic external covering facilitates the lymph movement by the dynamic peak pressures generated through muscle contractions.

Maintaining function and activity will promote reduction of oedema and lymphatic return.