Stages & Management

Speaking with your doctor or therapist about the stage of your lymphedema will help determine the most effective treatment option for managing it. It’s important that lymphedema is diagnosed and treated as early as possible to reduce swelling and limit its damaging effects.

We can fit you with the best, most effective product available for the current stage you are managing to help prevent progression of disease. The stages and their criteria according to the International Society of Lymphology are listed below.

Stages of Lymphedema

Stage 0 (Latent Stage)

No swelling or changes to the body can be seen, but you may feel a mild tingling, or slight tightness or heaviness to the skin. Stage 0 may last for months or even years before more obvious symptoms develop.

Ready to Wear Compression Garments

Stage 0 patients can sometimes prevent lymphedema secondary to cancer surgery with light or little compression. Ready to wear circular knit garments are those that are knitted on a round cylinder. These garments are seamless and more tubular shaped vs. custom flat knitted garments. Circular knitted garments have a bit more stretch and are best suited for patients with mild to moderate lymphedema with normally shaped limbs.

Stage 1 (Mild Stage)

The arm, leg, hand, foot, or other area looks slightly swollen as lymph fluid builds up. Pressing the skin will cause a temporary dent (or pit) to form. Elevating the affected limb can help to reduce the swelling, and wearing compression garments will help keep fluid from pooling. This stage is considered reversible with proper management and treatment.

Ready to Wear Compression Garments

Stage 1 can sometimes manage their lymphedema with ready to wear circular knitted compression garments if precautions are followed and the doctor or lymphedema therapist monitors the extremity closely.

Flat Knit Compression Garments

The advantage of custom made flat knitted garments is that they are made exactly to the patients body type making it possible to fit unique shapes. Flat knitted garments also make it easier to apply the garment, are more comfortable and more effective in the treatment of lymphedema. A flat-knitted garment should only be measured by an experienced garment specialist or lymphedema therapist. This is extremely important for a product that has to be worn every day, but not while sleeping.

Alternative (Wrap/Velcro)

Over the last few years, velcro wrap products have become more and more utilized in the world of lymphedema for therapy and maintanance. These garments attache with VELCRO Brand fasteners which makes them adjustable and easy to put on and take off. Product selection is extremely important when selecting an alternative garment as not all garments in this group are appropriate for the treatment of lymphedema. Patients should be evaluated and measured by an experienced garment specialist or lymphedema therapist to help with selecting the correct alternative garment.

Stage 2 (Moderate Stage)

Elevating the limb alone no longer helps to reduce the swelling, and it continues to worsen. Pressing on the skin doesn’t leave a pit, as the skin thickens and hardens. The swelling is managed with daily wearing of compression garments, both during the day and at night.

Flat Knit Compression Garments

Patients that are diagnosed with stage 2 lymphedema rarely achieve good results with Ready to Wear Circular Knit Compression Garments. Ready to Wear Circular Knit Garments are almost impossible to don on a stage 2 limb and cause significant pain in the creases (ankle, knee, elbow, etc.). Custom made flat knitted compression garments are the ideal choice for this group providing a perfect fit that are much easier to don, contain the patients swelling with great effectiveness, and feel great without the pinch. It is very important that you are measured for this garment by an experienced garment specialist or lymphedema therapists. Flat knitted compression garments are daytime only garments and should never be worn when sleeping.

Alternative (Wrap/Velcro)

Alternative (Wrap/Velcro) compression garments are a great option for the stage 2 patient. Ideal for patients with lymphedema swelling that fluctuates and for patients that still require limb reduction. They should be short-stretch in nature to assist with the muscel pumping like traditional bandages. These garments can be worn during the day and the night instead of bandaging. These products are great to help get your limb back to normal size to fit back into your custom made flat knit compression garments.

Nighttime Compression Garments

Nighttime compression garments aka: quilted chipped foam compression garments have become a necessity for every stage 2+ lymphedema patient to maintain their swelling during their sleeping hours. These garments come in ready to wear sizes and can also be made custom for more unique sizes. They are very comfortable and easy to put on and take off. These channelled chipped foam garments are highly successful in softening hardened fibrotic tissue. Patients experience great long term results when these nighttime compression garments are utilized with flat knit or alternative compression garments for daytime achieving 24 hours of continous compression treatment.

Pumps (Pneumatic Compression Therapy Devices)

Compression pumps are machines that have an inflatable sleeve or vest-like garment attached to it, with multiple chambers that inflate and deflate rapidly one after the other to stimulate the flow of lymph in the right directioin. Shown to be safe and effective these devices have been utilized during both the decongestion and maintenance phases of lymphedema.

Stage 3 (Severe Stage)

The affected limb becomes large and misshapen, and the hardened skin takes on a leathery, wrinkled appearance. Lymph fluid may leak from breaks or folds in the skin, and should be kept clean and dry to avoid infection. Special or customized compression garments and pumps can still help to manage symptoms.

Bandages

The short-stretch bandages provide a natural resistance to the pressure exerted on the tissue during movement of the muscles. This promotes the return flow of lymph and brings about reduction in the swelling. Patients that are diagnosed with stage 3 lymphedema should never be prescribed ready to wear circular knit stockings. They will leave deep indentations causing skin breakdown, open wounds, infections, and possible hospitalization. Custom flat knitted garments shouldn’t be utilized for this group either. Stage 3 patients require limb reduction that can be achieved through complex decongestive therapy provided by an experienced lymphedema therapist.

Alternative (Wrap/Velcro)

If for some reason a stage 3 patient is unable to participate in a complex decongestive therapy program a properly fit Alternative (Wrap/Velcro) garment may provide some relief. They attach with VELCRO brand fasteners which makes them adjustable and easy to put on and take off. As the patients swellind reduces the garment can be adjusted so proper compression can be achieved leading to continued limb reduction. Just like compression bandaging the advantage to having an adjustable alternative (Wrap/Velcro) compression garment is that it can be continuously adjusted as the swelling decreases.

Pumps (Pneumatic Compression Therapy Devices)

Compression pumps are machines that have an inflatable sleeve or vest-like garment attached to it, with multiple chambers that inflate and deflate rapidly one after the other to stimulate the flow of lymph in the right directioin. Shown to be safe and effective these devices have been utilized during both the decongestion and maintenance phases of lymphedema