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Lymphoedema effects approximately 200 000 people in UK. It is a chronic condition without a cure but there is much that can be done to ease and manage these complications. This article looks at the eight most common complications, providing advise on how to manage them, derived from the literature and the author's own experience. It also presents advise on how nurses can promote self-management of these complications, promoting patients' self-care.

The use of compression therapy to treat chronic oedema of the lower limbs can be a challenge, especially when this is undertaken by clinicians who have limited experience and knowledge of the theoretical principles which underpin its use in clinical practice. This articles aims to discuss the reasoning which underpins the use of compression hosiery in the management of lymphoedema and how this understanding can improve treatment outcomes and reduce the burden of disease on patients and clinical resources.

During the second wave of the COVID-19 pandemic, district nursing teams were overwhelmed with their caseload due to the palliative care needs of their patients. This led to patients with wet legs and chronic wounds deteriorating due to staffing levels. Therefore, the Swansea Bay University Health Board and Lymphoedema Network Wales teams redeployed two working time equivalents (WTE) into the community to take over the management of these patients with chronic wounds for 4 months. The clinicians came from a variety of different backgrounds, including nursing, physiotherapy, emergency medicine and occupational therapy. Between the teams, 866 visits were carried out over the 4-month period, where patients' compression therapy was altered to promote healing and reduce oedema. At the end of the 4-month period, 21% of the patients were discharged off the district nursing caseload completely, while of the 60% who were still active caseload patients, 35% were in increased compression and 20% had reduced need for visits.

Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome-percentage tissue water-measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.

Reticence to apply compression therapy has been widely observed in clinical practice, compounded by an absence of evidenced-based pathways for application of prompt compression prior to measuring ankle brachial pressure index (ABPI). Importantly, delaying compression therapy for patients with chronic oedema and lymphorrhoea causes many avoidable complications. In 2017, Lymphoedema Network Wales (LNW) developed an evidenced-based pathway to improve the management of chronic oedema and wet legs (lymphorrhoea) for community nurses. During the past 4 years, the Chronic Oedema Wet Leg Pathway has been presented, published and used internationally, as well as being translated into different languages. It is commonly used in community nursing Teams as an evidenced-based document. However, like all documents and guidelines, when more evidence becomes available, the pathway needs updating. Therefore, this clinical focus article will present the new and enhanced Chronic Oedema Wet Leg Pathway, introducing a new level four compression section, which increases the layers of compression bandaging for patients with venous insufficiency or who are morbidly obese.

During the COVID-19 pandemic it was initially not possible to see people with lymphoedema face-to-face at lymphoedema services, due to the potential risks of the virus, because they were shielding, because of redeployment of rooms or staff, and due to sporadic restrictions of movement. The pandemic therefore accelerated adjustments in lymphoedema service delivery, while ensuring effective and efficient care was paramount. This document presents a pragmatic guide for lymphoedema services. Although clinical and non-clinical staff need to comply with guidance from their own organisations/commissioners, this document aims to provide specific guidance and share good practice in relation to lymphoedema management. These guidelines are based on analysis of the national response of Lymphoedema Network Wales during the first few months of the COVID-19 pandemic and incorporate supporting contemporary advice. They have been used throughout NHS Wales, providing a standardised approach in supporting care for people with lymphoedema. In light of the enduring nature of COVID-19, it is imperative that lymphoedema services have a means to provide suitable care for patients. Although face-to-face appointments are sometimes deemed necessary, many patients can be suitably supported via telehealth consultations. These guidelines may help lymphoedema services restore and reset in a safe and acceptable manner.

Background: During the COVID-19 pandemic, lymphoedema staff adapted services, providing care remotely, and worked in other NHS sectors. The impact on services and staff must be understood in order to safeguard patient care and foster workforce resilience., Aims: To evaluate the experiences of clinical and non-clinical lymphoedema staff in Wales during the COVID-19 pandemic., Methods: An anonymous online survey, based on scoping work, was sent out via the Welsh lymphoedema services mailing list., Findings: 71% (68/96) of eligible lymphoedema staff completed the survey. More than half supported lymphoedema services (40/68) with the remaining staff deployed elsewhere. Overall, staff and services felt prepared for new ways of working. Concerns about others and the future burden on services when life returned to normal were reported. Opportunities identified included education initiatives and virtual services., Conclusion: Lymphoedema services were well prepared to deliver virtually, enable effective care and share knowledge. Co-ordinated efforts to uphold patient advocacy will support virtual services to meet their needs.

The COVID-19 pandemic of 2020 has led to considerable changes in how healthcare is delivered, as it has pushed people to think outside the box technologically. Mobile working is becoming more widespread, useful and valuable in this innovative period in the NHS. Point-of-care (POC) technology encompasses mobile devices and systems that support health professionals in their daily activities of patient care. It allows the user to safely assess and diagnose individuals at the point of care, providing actionable information to allow rapid clinical decision-making. POC technology also has the ability to support and educate patients with health needs, encouraging patients and their carers to assume greater more control of and responsibility over their health. Providing patients individual care plans to maintain their health will help realise the future of self-care. This article describe the development of a mobile app-Juzo Care-designed to enhance the management of chronic oedema and lymphoedema in mobile working settings.

To investigate the effect of evidence-based nursing (EBN) intervention on upper limb function in postoperative breast cancer patients undergoing radiotherapy.A total of 126 breast cancer patients who had received postoperative radiotherapy in the Union Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology from September 2017 to September 2018 were randomly divided into 2 groups, namely, experimental and control groups, with 63 cases in each group. Both the control and experimental groups received routine postoperative radiotherapy followed by traditional and EBN interventions, respectively. All patients were followed up for 6 months and differences in the upper limb function after nursing intervention were compared between the 2 groups.The scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS), and short form-36 survey (SF-36) in the 2 groups had no statistical significance before intervention. After the EBN intervention, the SAS and self-rating depression scale scores of patients in the experimental group were lower than that of those in the control group. In the experimental group, 90.67% of the patients had an excellent score for the University of California, Los Angeles shoulder score, which was higher than that of the control group (73.92%). The Mayo Elbow Performance Score of the experimental group (95.01) was higher than that of the control group (91.33). The total length of the sum of arm circumference in the experimental group was (128.39 cm) lower than that of the control group (143.66 cm). The scores of SF-36 in the overall health, physical pain, mental health, and physiological functions of the patients in the experimental group were higher than those of the control group. All of these parameters' differences between the 2 groups were of statistical significance (P < .05).EBN can positively influence the negative emotional state of breast cancer patients after radiotherapy. At the same time, it is helpful in reducing the degree of lymph node edema on the affected side of the upper limb, thereby improving the function of the shoulder joint, which has a positive effect on the upper limb function.

Background: Patients with lymphoedema referred to a lymphoedema service from care homes in one health board area in Wales were often complex cases, with repeated cellulitis, a history of falls and other complications. A pilot project was initiated to develop education and raise awareness of lymphoedema among care home staff., Aims: To enable care staff to identify residents with lymphoedema, promote prompt referrals, raise the importance of skin care and exercise in the management of lymphoedema and estimate the likely costs from complications associated with lymphoedema., Methods: An education tool was developed and 47 care homes were asked to participate. A lymphoedema therapist carried out a scoping review of the residents., Results: Forty-four care homes agreed to participate in the project with 1216 education packs being issued to care home staff. Initial findings suggest that of the 960 residents reviewed, 262 had lymphoedema (27%); 4% suffered with frequent falls, 1% had wounds and 3% had recurrent cellulitis. Only 13% (35/262) of residents with lymphoedema were known to the local lymphoedema service. Of the 31 residents reporting cellulitis, 81% had lymphoedema; of the 11 residents identified with a wound, 100% had lymphoedema and of the 40 residents reporting falls, 70% had lymphoedema., Conclusion: This educational project has identified the value of raising awareness of lymphoedema within care homes.

Lymphedema-the accumulation of fluid in tissues, usually in the upper and lower extremities-often results from lymph node dissection or radiation and can cause painful and debilitating swelling that may interfere with a patient's daily living activities and quality of life. The goal of treatment for lymphedema is to reduce the volume of fluid in the affected area. Lymphedema is staged according to presenting characteristics, and interventions may be surgical or nonsurgical, such as complex decongestive therapy. Lymphovenous bypass is a surgical procedure performed for the management of lymphedema and involves rerouting microvascular channels to allow for the drainage of fluid that has accumulated in the lymphatic tissue of the upper or lower extremities. It requires supermicrosurgery techniques because of the small size of the vessels being anastomosed. Perioperative nursing implications for lymphovenous bypass include OR preparation and providing emotional support for patients living with lymphedema., (© AORN, Inc, 2020.)

Interface pressures with compression depend on many factors relating to the science of measurement and intrinsic, patient-related factors, including limb size and tissue texture. While it is important for manufacturers of compression devices to measure pressures, it may not always be relevant to clinical practice where application methods and oedematous limbs may affect final pressures. Accurate performance of any compression system relies on the use of the right technology for the right condition and patient lifestyle. Correct application following training and in accordance with instructions for use may be adapted according to individual patient comfort and needs, including mobility, tissue texture and the stage of management. In order to provide treatment regimens that are safe, effective and well tolerated by patients, as well as being easy to apply and demonstrate sound economic practice, science needs to meet clinical practice. Patient reporting is an important for successful treatment, matching clinical effectiveness with patient acceptance during reassessment and monitoring.

Lymphoedema is a long-term chronic condition that results from lymphatic insufficiency and may cause skin changes, which can cause discomfort and impact patient' quality of life. The four cornerstones of lymphoedema management are exercise, lymphatic massage, compression and skin care. This article critically examines self-management in lymphoedema focusing on skin care. Patients may initially demonstrate enthusiasm to undertake the required skin care independently. However, psychosocial factors, such as financial burden and physical restraints, can affect motivation and behaviours over time. A patient's knowledge of the importance of skin care self-management should not be limited to the initial assessment, but should be continually assessed throughout their lymphoedema journey. The ongoing provision of patient-centred care may have psychological and behavioural benefits and help optimise skin care self-management.

Lymphoedema of the upper limb can be an unwelcome side effect of treatment for breast cancer, some skin cancers, as well as having non-cancer-related causes. Treatment focuses on patient self-management, and involves skin care, exercise, lymphatic drainage massage and compression. Lymphoedema is a chronic, life-long condition, and the correct choice of garment will influence treatment outcomes, enhancing concordance and improving quality of life. This article examines how, following recent improvements to the comfort and overall fit of the Haddenham Venex lymphoedema sleeve, patient feedback informed the implementation of further modifications, and how gaining feedback from patients has empowered them to manage and monitor their own condition. By taking ownership for their own care, long-term control of the condition is improved and self-management is enhanced.

Men, women or children can suffer from oedema (swelling) of the genitalia. When differential diagnosis has excluded acute trauma or pathology and swelling remains, the condition may be diagnosed as genital lymphoedema, a chronic condition that increases the relative risk of cellulitis. Diagnosis of genital oedema is often delayed due to problems with patient and health professional behaviour, in terms of embarrassment, lack of confidence or lack of knowledge. Awareness of this condition and knowledge on how to manage it will go a long way in helping both patients and clinicians overcome the challenges of addressing genital oedema. This article describes the authors' experiences in managing genital oedema. It also briefly discusses a new international project that seeks to identify the knowledge and training that health professionals need to manage this condition more confidently.

Problem: Patients in Queensland have had difficulty in accessing lymphoedema services, particularly in rural and remote locations., Design: The aim was to trial and evaluate a compression garment service model, to provide care for patients with lymphoedema closer to their homes. The service model trialled compression garment, selection, fitting and monitoring services for stabilised malignancy-related lymphoedema undertaken by generalist therapists., Setting: Ten Hospital and Health Services in the Queensland public sector., Key Measures for Improvements: The patients would have access to safe, quality services closer to their homes., Strategies for Change: The generalists were supported by telehealth coaching and supervision by lymphoedema therapists, an education program, resources and governance processes., Effects of Change: Compression garment selection, fitting and monitoring by generalists (physiotherapists and occupational therapists without Level 1 Lymphoedema training), as defined in the service model, was safe, effective and evaluated positively by patients and health professionals. There was increased access to compression garment services provided by generalist therapists in rural and remote locations., Lessons Learned: The service model implemented has the capacity to address workforce and service provision issues. It provides resources, education and training for clinicians to improve access to the provision of compression garment services., (© 2019 National Rural Health Alliance Ltd.)

Prompt application of appropriate compression therapy is essential for effective treatment of lymphoedema. However, it is accepted that prior to the application of compression to the lower limbs, either with bandaging or compression garments, patients should demonstrate a satisfactory vascular status, as assessed via axillary brachial pressure index (ABPI). Unfortunately, the presence of peripheral oedema may render a reading impossible or grossly inaccurate. Relying solely on ABPI assessment is potentially harmful to patients, who may be denied appropriate treatment or experience complications and deterioration of their condition due to delayed treatment. The British Lymphology Society recognises a need to focus more on clinical assessment skills to determine vascular status, rather than relying on ABPI alone. Thus, the Society has developed guidance and a practical tool to support clinical decision-making and enhance practitioner confidence in the safe application of compression therapy in the absence of ABPI.

This prospective, single-centre, observational study set out to evaluate the clinical performance and safety of JOBST Relax®, a custom-made compression garment, when worn by a series of patients with lymphoedema during resting hours and at night. Patients were recruited after undergoing complete decongestive therapy (CDT) and wore the night-time compression garment for 21 days as part of their compression therapy regimen. Questionnaires were used to capture their views on parameters such as the garment's comfort, ease of use, fit, ability to avoid excessive heat and perspiration, its effect on their quality of life and their overall satisfaction with it. Occurrences of erythema, skin rash, skin dryness and pain were also evaluated. Ninety-one patients completed the study. Most perceived the night-time compression garment to be 'very good' or 'good' in terms of its ease of use and comfort, its ability to control their oedema and its effect on their quality of sleep. The prevalence of erythema, skin rash, skin dryness and pain was reduced when compared with baseline. Patients also reported that the night-time garment reduced their dependence on others and improved their quality of life. Overall, most rated their satisfaction with the garment as 'very good' or 'good'. Patients reported a high level of satisfaction with both the garment and the comfort associated with it when wearing it frequently.

There are a number factors that need to be considered when managing frail older people with multiple health problems. Inappropriate polypharmacy and poor adherence, particularly in older adults, is associated with negative health outcomes. In addition to assessing the patient's current symptoms and health status, it is therefore important to consider which medications patients are prescribed, whether they are appropriate and whether they are being taken as prescribed. This case study aims to increase awareness of poor adherence to medication in the older adult population.

Aim: Currently, there is no provision for continuous care to monitor lymphedema risk-reduction behavior for survivors of cancer. The aim was to explore the possibility of community-based lymphedema education programs by investigating the knowledge, training needs, and intention to organize such programs and barriers among government-employed public health nurses., Methods: A cross-sectional Internet survey was conducted among government-employed public health nurses in Japan. The participants were recruited from 2841 health center and community health centers., Results: The final sample included 641 government-employed public health nurses. The participants' knowledge about lymphedema risk-reduction strategies was relatively good, especially on the importance of observation, detection of early signs, and referral to lymphedema clinics. A small proportion of participants indicated an intention to organize community-based lymphedema education programs. Three determinants for this intention were identified: a general interest in lymphedema education, past experience of undertaking training in lymphedema risk-reduction strategies, and the perceived difficulty in organizing community-based lymphedema education programs. The participants' perceptions of difficulty included not knowing the needs for lymphedema education in their community with survivors of cancer., Conclusions: The results suggest that working collaboratively with government-employed public health nurses to organize community-based lymphedema education programs is possible. Achieving this requires further investigation of the needs of survivors of cancer in the community, communicating these needs to governmental agencies, and organizing and delivering comprehensive training programs about lymphedema risk-reduction strategies for government-employed public health nurses., (© 2018 Japan Academy of Nursing Science.)

Compression therapy is the main method used within the treatment and management of lymphoedema and chronic oedema. The increasing prevalence of the condition, which has multiple causes, such as genetic factors, age and external factors, require the effective management of the condition, and to enhance the management methods used to contain the condition. The use of exercise alongside the mainstay method of treatment (compression therapy) has been an underutilised area. The application of a structured exercise programme in conjunction with multi-layer lymphoedema bandaging combined with an adjustable velcro wrap based systems led to a decrease in limb volume in one case study. The results of the programme indicate that the approach is beneficial and requires embedding further within Walsall lymphoedema service, due to improved patient outcomes, and cost effectiveness in terms of resources.

Marie Todd, Lymphoedema Clinical Nurse Specialist, Specialist Lymphoedema Service, Glasgow, discusses the difficulties of caring for people with compounding conditions.

This case study demonstrates the benefits of early intervention and a proactive approach for a patient with chronic oedema living in the community. These benefited the patient and also supported value-based healthcare in the NHS. The patient's health and wellbeing significantly improved with an assessment of his chronic oedema and a management plan consisting of skincare, an exercise and movement programme and the introduction of a class 1 British standard compression garment.

Background: After total knee arthroplasty (TKA) efficient control and reduction of postoperative edema is of great importance. Aim: The aim of this pilot study (EKNZ 2014 – 225 DRKS00006271) was to investigate the effectiveness of multi-layer compression therapy (MLCT) to reduce edema in the early period after surgery compared to the standard treatment with Cool Pack. Methods: In this randomized controlled pilot trial, sixteen patients after TKA were randomized into an intervention group (IG) or a control group (CG). Circumferential measurements were used to assess edema. Secondary outcomes were range of motion (ROM), pain (numeric rating scale, NRS) and function as measured with the fast Self Paced Walking Test (fSPWT). Results: Clinically relevant differences in edema reduction between the two groups were found in the early postoperative period and at the six weeks follow up. Six days postoperatively the group time interaction (IE) in favor of the IG were −3.8 cm (95 % CI: −5.1; −2.4) when measured 10 cm proximal to the joint space and −2.7 cm (CI: −4.1; −1.3) when measured 5 cm proximally. We further observed differences in secondary outcomes in favor of the CG. Six days postoperatively the IE for knee flexion was –8.3 ° (CI: −22.0; 5.4) and for the fSPWT it was 12.8 seconds (CI: −16.4; 41.3). Six weeks postoperatively these differences diminished. Conclusions: The findings suggest that MLCT could be an alternative treatment to reduce postoperative edema in patients after total knee arthroplasty. Eventually possible negative effects on early knee flexion and function must be considered.

Chronic oedema and leaking lymphorrhoea can be distressing and challenging for patients to live with. This article introduces the Chronic Oedema 'Wet Leg' Pathway, which became an output from the Lymphoedema Network Wales 'On the Ground Education Project' ( Thomas et al, 2017 ). The evidence-based pathway provides nurses and therapists with clear guidelines to support prompt, efficient and effective management of all patients with chronic oedema and wet legs. This article presents the evidence and demonstrates the benefits of timely active treatment for all patients with leaking lymphorrhoea, which includes decreasing pain and improving mobility and daily activities. Other benefits include reducing the risk of cellulitis and the development of chronic wounds. The pathway also demonstrates opportunities for the NHS by decreasing both the number of community nursing visits and the number of wound dressings used. By actively treating symptoms-rather than simply mopping up the leaking lymphorrhoea-this pathway demonstrates value-based health care by reducing waste, harm and variation within the NHS.

Compression, in the form of either a compression bandage or a compression stocking, has been touted as the gold standard for treatment of swelling and venous leg ulcers (VLUs). Adjustable Velcro wraps have been marketed as compression alternative. Although there is a growing body of evidence to support use of these products, there has not been a critical evaluation of the functionality of the devices to best matching product to patient presentation and ability to use the device effectively. Unlike compression garments, which are classified by compression category (class I/II or flat knit/circular), there is not an algorithm to direct health professionals to best match a specific adjustable Velcro wrap to an individual patient presentation. This small case series demonstrates that although each product performed as marketed in vitro, performance in clinical setting varied greatly dependent on patient presentation and functional skill level.

Lymphoedema Network Wales has focused on maximising the impact of its service through the effective use of available resources to ensure high-quality and consistent care for people with lymphoedema across Wales. The aim of this evaluation was to estimate the economic impact of a national lymphoedema service on the NHS Wales budget. Work was undertaken to determine the care pathway within Lymphoedema Network Wales and develop a hypothetical 'world without' the service as a comparator. The four groups of patients that made up the pathways were group 0: 'at risk', group 1-2: 'uncomplicated lymphoedema', group 3: 'complicated/complex' and group 4: 'palliative care'. Overall resource utilisation between 6 months pre- and 6 months post-entry indicated that there were significant cost reductions to be seen after lymphoedema service entry for all patients in each group. This evaluation provides estimates that suggest that the service is likely to be cost saving when people with lymphoedema are managed within Lymphoedema Network Wales rather than in a 'world without' the service.

Lymphoedema, primary and secondary after cancer treatment, is a chronic condition which has a significant impact on patients' quality of life. Therapeutic education plays an important role in the initial care and in the follow-up of these conditions., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Lymphoedema management has evolved over many decades, but the core components of treatment remain largely unaltered, such as skin care, compression and self-lymphatic drainage. Near-infrared fluorescence lymphatic imaging (NIRFLI) offers an opportunity to enhance patient outcomes by evaluating and increasing the effectiveness of these treatment options. This is relevant when we consider the impact of this chronic condition and its endemic proportions ( Mortimer, 2014 ), while Moffatt et al (2017) suggests it is one of the biggest health risks in the Western world, due to the multiple causes, such as cancer, obesity and as a complication of an ageing population. The impact of the condition can be reduced through early identification and the risk-reduction strategies that NIRFLI can offer through greater understanding of its chronicity. The use of NIRFLI has also led to the development of a new manual lymphatic drainage technique to assist in the management of lymphoedema ( Belgrado et al, 2016 ). The aim of this article is to introduce and describe NIRFLI and its use within lymphoedema management. It will discuss use with early detection of lymphoedema and expand further, focusing on its use within the management of lymphoedema.

Compression therapy is used in the treatment of venous disorders, lymphoedema and burns. Adherence to compression therapy is reported to be poor, due to a number of factors, including difficulty in applying and removing the compression garments. A literature review was conducted to identify aids, equipment and other approaches to ease the application and removal of compression therapy garments. Some 12 studies were identified. Most studies focused on chronic venous insufficiency and venous ulcers. Four methods of easing compression garment application and removal were identified: (1) devices to assist in application and removal; (2) altered compression stocking design; (3) adjustable compression wrap devices; and (4) education. Patients prescribed compression therapy should be educated on how to apply and remove the compression garments, and have application devices made available to them.

The purpose of this article is to present an evidence-based rationale for lymphoedema compression bandaging, one aspect of treatment for a patient with complex lower limb lymphoedema. The current health care climate requires treatment decisions to be transparent, based on the best available evidence. The challenge faced by community nurses is to formulate treatment plans which incorporate patients' preferences and best use limited resources provided by clinical environments. The article appraises research in order to formulate a suitable treatment plan and provides discussion and reflection regarding the challenges faced by the nursing profession in achieving evidence-based practice. Evidence-based practice is beneficial in formulating patient-centred and cost-effective treatment plans. Developing competence is not straightforward; however, clinical guidelines can provide much needed guidance.

Lymphoedema is a chronic disease affecting the patients' quality of life (QoL) especially with regard to mobility and daily activities. Lymphoedema cannot be cured but symptoms can effectively be improved by a comprehensive approach and the continuous use of compression therapy. An appropriate fitted compression garment is essential for compliance and thus a prerequisite for successful lymphoedema management. Compression garments with bulky seams are not only uncomfortable they also can lead to severe pressure marks or even reduce the mobility and function of the affected limb, which may negatively impact the already reduced QoL of lymphoedema patients. A prospective multicentre observational study was conducted to compare compression garments without and with a seam for hands and toes in 143 patients with lymphoedema. Product performance, lymphoedema symptoms, functionality of hands/toes, QoL and patient satisfaction were documented for the previously worn compression garment as well as for the 3D flat knitted JOBST® Elvarex Plus compression garment without a seam. The JOBST Elvarex Plus glove was perceived very positively by patients, who rated the mobility of the fingers, the adaptability to the shape of the hand/fingers, the fit of cuffs/welts, and the tactile sense of the fingers to be significantly better compared to the previous glove. Also pressure marks between fingers/toes and pressure marks due to cuffs/welts were significantly less frequent when wearing JOBST Elvarex Plus. Also pain, sensation of heaviness, swelling, tightness and dryness of skin were significantly improved when wearing JOBST Elvarex Plus gloves. Furthermore, 80% of the patients rated the wearing comfort of JOBST Elvarex Plus to be better than their previous garments with a seam. Regarding functionality, patients were significantly less limited in their daily activities when wearing JOBST Elvarex Plus garments. Finally, when wearing JOBST Elvarex Plus gloves and toe caps, patients rated the negative effect of their lymphoedema on their QoL to be significantly lower. In conclusion, the application of anatomically adapted compression garments without a seam led to improving patient's reported lymphoedema symptoms, increased patient's satisfaction with the compression garment and supported a better QoL.

Lymphoedema results from a failure of the lymphatic system. The consequences are swelling, skin and tissue changes and predisposition to infection. Lipoedema, however, results from the predisposition of an excessive number of fat cells in the lower limbs, typically from the ankle to the waist. Management for lymphoedema consists of volume reduction, reduction in shape distortion and improvement of skin condition. Treatment consists of a two-phase approach including an intensive and maintenance phase. The maintenance stage of treatment or self-care consists of skin care, exercise and compression garments. Case studies are presented featuring lower limb lymphoedema and upper limb lymphoedema and a patient affected by lipoedema. The case studies demonstrate how JOBST Elvarex custom-fit, flat-knit compression garments with knee and elbow functional zones enhances patient choice, garment suitability and potential for improved quality of life.

Self-management and the use of adjustable velcro compression wraps are not new concepts and quite often both can form part of the maintenance phase of treatment in those with lymphoedema or lipoedema, as well as those diseases in which compression therapy is advised as long-term management. The aim of this article is to identify some aspects that contribute to effective self-management and how the use of easywrap adjustable velcro compression wraps have improved quality of life for those with lymphoedema, chronic oedema and lipoedema. Case studies are given from patients to demonstrate the individual experience of living with lymphoedema or lipoedema, how this has impacted on daily life, and how using easywrap has helped as part of self-management.