Since the initial lymphatic vessels are just below the skin, healthy skin tissue provides a good counterpressure for the muscles to pump the fluid effectively. In the case of lymphedema, the tissue pressure is low because the tissues are overstretched. To maintain the reduced limb size for long term, compression garments are usually necessary. In an edematous limb, the intercellular spaces are over stretched and the elastic component of the tissue is damaged. Even after using a technique which empties fluid out of the limb the tissue spaces remain overstretched for several months and will continue to attract protein rich fluid.
Garments vary significantly in fabric, style, color, compression, and price.
Once garments are delivered, patients should be instructed in proper donning techniques, wearing schedules and care of the garment. Body adhesive and shoulder or hip straps are available to help prevent garments from sliding down. Many clinics utilize compression pumps to increase the uptake of fluid from the tissues into lymphatic vessels and pump fluid out of the limb. Significant progress has been made since the original single cell pumps. Multicell sequential gradient pumps are more effective because they are designed to segmentally move fluid from the distal to the proximal portion of the limb.