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Compression Hosiery in Upper Body Lymphoedema

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Compression Hosiery in Upper Body Lymphoedema ��������������������� �������������������� �������������� ����������� ��������������������������������������� �������������������� �������������������������������������������������� ������������������������������������������� ����������������������������������������������� ������������������������������������� ������������������������������������������������ ������������������������� INTERNATIONAL LYMPHOEDEMA FRAMEWORK Template Upper body Cover.indd 3 28/9/09 19:26:09 SUPPORTED BY AN EDUCATIONAL GRANT FROM BSN MEDICAL The views expressed in this MANAGING EDITOR publication are those of the authors Nicola Rusling and do not necessarily reflect those of the publishers or BSN medical. SENIOR EDITORIAL ADVISOR THIS DOCUMENT IS ENDORSED BY: Christine Moffatt Honorary Professor, Glasgow University Medical School Australasian Lymphology Association (ALA, Australia) DEPUTY EDITOR British Lymphology Society (BLS, UK) Binkie Mais Lymphoedema Association of Australia (LAA, Australia) EDITORIAL ADVISORS Lymphoedema Support Network Jane Armer (LSN, UK) Professor, Sinclair School of Nursing, Director, Nursing Research, Ellis Fischel Cancer Center, Lymphology Association of Director, American Lymphedema Framework Project, University of Missouri, Columbia North America (LANA) MLD UK Augusta Balzarini National Lymphedema Network MD, Oncological Rehabilitation, Palliative care and Rehabilitation, National Cancer Institute, Milan (NLN, USA) Håkan Brorson Nederlands Lympfoedeem Netwerk Consultant Plastic Surgeon, Department of Clinical Sciences, Lymphoedema Unit, Plastic and Reconstructive (NLN, Netherlands) Surgery, Malmö University Hospital, Malmö, Sweden Norsk Lymfødemforening (NLF Michael Clark Norsk, Norway) Senior Research Fellow, Department of Wound Healing, School of Medicine, Cardiff University, Cardiff, UK Israel Lymphoedema Association (ILA, Israel) Robert Damstra Svensk Förening för Lymfologi Dermatologist, Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten, (SFL, Sweden) The Netherlands STATEMENT OF RECOGNITION: Sarah Davies The International Society of Lymphology Physiotherapist, Peter MacCallum Cancer Centre, Victoria, Australia (ISL) recommends the new Template Etelka Földi for Practice: Compression hosiery in upper body lymphoedema as a valuable, useful Physician-in-Chief, Földi Clinic, special clinic for lymphology, Hinterzarten, Germany and illustrative educational resource for Nicole Stout Gergich general practitioners and the public as Physical Therapist and Lymphedema Specialist, National Naval Medical Center, Breast Care Center, Bethesda, a thoughtful, detailed compendium of established practices within the MD, USA United Kingdom Kaoru Kitamura Vice Director (Department of Breast Surgery), Kyushu Central Hospital, Fukuoka, Japan ©HealthComm UK Ltd, a division of Schofield Isabelle Querry Healthcare Media Ltd, 2009 Professor of Vascular Medicine, Head of the vascular medicine department, Saint Eloi University Hospital of Montpellier, Montpellier University, France Saskia Thiadens All rights reserved. No reproduction, Founder and Executive Director, National Lymphedema Network, Inc, Oakland, California copy or transmission of this publication may be made without written Anna Towers permission, with the exception of Director, Palliative Care Division, McGill University, Montreal, Canada BSN medical. No paragraph of this publication may be reproduced, copied Horst Weissleder or transmitted save with written Professor of Radiology, Freiburg University, Germany; Honorary President German Society of Lymphology permission or in accordance with the provisions of the Copyright, Designs & Patents Act 1988 or under the terms of any licence permitting limited copying Copies of this document are available from: issued by the Copyright Licensing Agency, 90 Tottenham Court Road, www.wounds-uk.com London W1P 0LP. www.lymphormation.org www.woundsinternational.com TO REFERENCE THIS DOCUMENT CITE THE FOLLOWING: PUBLISHED BY Template for Practice: Compression HealthComm UK Ltd, Suite 3.1, 36 Upperkirkgate, Aberdeen AB10 1BA hosiery in upper body lymphoedema. 2009. HealthComm UK Ltd, PRINTED BY Aberdeen WACE Corporate Print Limited, Swindon, Wiltshire, SN3 4FH, UK TEMPLATE FOR PRACTICE 1 Compression garments in upper body lymphoedema CJ Moffatt Compression hosiery is at the Lymphoedema is a major, international compression garments to treat oedema of the centre of long-term healthcare problem in both developed and upper body by Johansson shows the paucity of management of developing countries. Although the true size of good quality studies in this area over the last 30 lymphoedema and is one of the problem remains obscure, research across years. All of the existing evidence relates to the the most important aspects the globe is beginning to show the true extent of use of garments on the upper limb, however, it is of care that helps patients to the problem. Millions of people are affected at frequently flawed by poor design, problems of take greater control of their huge personal cost to patients and their families. definition and difficulties of standardising condition. Much of the Professional knowledge and practice is often assessment methods that would allow emphasis in the field of poor and this level of ignorance leads to incorrect comparability between studies. This is an area compression has been on the treatment or no treatment being offered, and that requires considerable research investment. lower limb. This Template for contributes to the lack of reimbursement of The final paper by Doherty and Williams Practice is unique in treatment in many parts of the world. provides in-depth practical advice on how to use attempting to provide an This template follows on from the first compression garments in practice. The international resource that document, Compression hosiery in lymphoedema recommendations are largely drawn from the provides guidance on the (Lymphoedema Framework, 2006a) that International Best Practice Document in appropriate use of recognises the central role that compression Lymphoedema (Lymphoedema Framework, compression garments for garments play in the treatment of lower limb 2006b) that was developed and endorsed by the upper body. lymphoedema. Together they provide a renowned international experts in the field. This comprehensive, yet practical guide for practitioners paper highlights the need for careful and who are managing patients with lymphoedema. continuous assessment of garment efficacy and In the first paper, Krimmel describes the basic also gives an overview of the different construction of compression garments and how presentations of lymphoedema in the upper body. the different types of knitting and use of yarn Despite the lack of empirical evidence there affect the type of garment that is produced. This is a wealth of expert clinical opinion that is a critically important issue as it directly supports the central role that compression influences the choice of compression garment garments play in lymphoedema management. Of that is given to patients with different clinical particular importance is the emerging presentations. Unlike lower limb hosiery where recognition that early treatment and prevention different national hosiery standards exist, there is of lymphoedema are critical if the long-term only one recently introduced standard, the RAL, complications resulting from poor management that underpins the pressures and production are to be avoided. criteria for upper limb garments. By elucidating the rationale for and use of The paper by Carati, Gammon and Piller compression garments in the treatment of provides an in-depth review of the anatomy and lymphoedema of the upper body, this document physiology of the upper body, and outlines how aims to enhance practitioners’ and patients’ use an understanding of arterial, venous and of compression garments and improve the lymphatic flow in the upper body in normal experience of patients with lymphoedema. limbs and those at risk of, or with, CJ Moffatt, CBE, REFERENCES lymphoedema will greatly improve patient Lymphoedema Framework (2006a) Template for practice: Honorary Professor, Glasgow outcomes. The authors highlight the difficulties compression hosiery in lymphoedema. MEP Ltd, London University Medical School, Lymphoedema Framework (2006b) Best Practice for the Director, International of measurement beneath compression. Management of Lymphoedema. International Consensus. Lymphoedema Framework The literature review of the evidence for using London: MEP Ltd 2 TEMPLATE FOR PRACTICE The construction and classifi cation of compression garments G Krimmel Flat- and circular-knitting are In patients with lymphoedema of the upper interaction of the physical properties and the two main methods body, compression garments are usually construction of the compression garment, the employed in the construction prescribed for the long-term management of size and shape of limb to which it is applied, of compression garments for lymphoedema following a period of intensive and the activity of the wearer. As a broad patients with lymphoedema. therapy, but they can also be used for principle, the level of compression is directly Both techniques infl uence the prophylaxis or as part of initial treatment in proportional to the tension with which the properties of the fi nished patients with mild lymphoedema. In some compression device is applied and is inversely garment in terms of the level patients, compression garments may be the related to the size
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