When a pneumatic compression pump is part of the plan, the custom garment order becomes a timing question. Order too early and the garment is made for a limb that is still reducing; within weeks it is loose and no longer holding the result. Order too late and the patient spends weeks in compression that doesn't fit. Here is how we suggest timing, measuring and bridging the gap. For the background, see Why the Limb Should Be Reduced Before Ordering Custom Garments.
1. Bridge with adjustable compression while the limb reduces
During the reduction period, use compression that can follow the limb down:
Adjustable wraps: Juzo Compression Wraps (30–60 mmHg, modular for the whole leg), Sigvaris Compreflex (20–50 with the Accutab guide), L&R ReadyWrap (color-coded, liners included), JOBST FarrowWrap Classic or Strong (Classic for stubborn edema and skin folds).
Multilayer bandaging if the patient is in an intensive phase with you.
Night compression if there is overnight rebound: JOBST JoViPak, CircAid Profile, Sigvaris Chipsleeve, L&R Tribute Wrap (not for ABI under 0.8) or a custom TributeNight.
Avoid placing a new custom order during this window unless the patient has nothing that fits and you've agreed to remeasure later.
2. Know when the limb has plateaued
Manufacturers are consistent on this: measure for flat knit once the best achievable decongestion has been reached. In practice we look for:
Stable girths. Measurements at the same landmarks, at the same time of day, show little or no change across two consecutive weekly checks.
Softer tissue. Pitting has resolved or eased and fibrotic areas are as soft as they're likely to get.
Consistent pump use. The patient has been using the pump as prescribed long enough that the reduction has levelled off, not just slowed for a week.
Wrap adjustments slowing. Patients in adjustable wraps who stop needing to tighten them are often close.
3. Measure at the limb's smallest point
Schedule a morning measuring, ideally right after a pump session or a treatment session.
Have the patient arrive in their wraps or bandages, removed only at measuring.
Use the manufacturer's own measurement form and tension guidance. Firm-hold fabrics are measured differently from softer ones.
Note fit problems from previous garments: ankle bands, knee creases, toe or finger swelling, distal edema below a sleeve.
4. Choose the flat knit by tissue and hand function
Lymphedema with fibrosis, skin folds or high rebound: a firmer-hold flat knit such as JOBST Elvarex, mediven 550, Sigvaris OPTIFORM HOLD or Juzo made-to-measure Dynamic.
Stage 1–2 lymphedema, sensitive skin, or limited grip: a softer, easier-to-don flat knit such as JOBST Elvarex Soft, mediven cosy 450, Sigvaris OPTIFORM FLEX or Juzo made-to-measure Soft.
Toe or finger swelling: add toe caps or gauntlets to the order (mediven 550 offers toe caps).
Can't don any garment: stay with an adjustable wrap for day as well as night.
Fast turnaround needed: Juzo made-to-measure Express ships in about 72 hours.
If a ready-to-wear garment is a reasonable bridge or long-term fit, L&R ExoStrong (ready-to-wear flat knit, 20–30) and firm circular knits such as Juzo Dynamic, Sigvaris Secure 550 and mediven plus are worth considering.
5. After delivery
The patient keeps using the pump as prescribed. The garment maintains the reduction; it doesn't replace the pump.
Check fit at two to four weeks. Early looseness usually means the limb was still reducing at measuring.
Remeasure at replacement, typically about every six months, or sooner after any meaningful size change.
6. What to send us
Send the measurement sheet with the order, plus a note that documents the reduction phase, the plateau and why custom is needed over ready-to-wear. See our custom garment documentation guide and measuring tips for custom flat knit. Fax 800-886-4201 or use our secure referral portal. If you'd like us to coordinate the measuring date with the patient's pump schedule, call 800-883-1549.
Product lines and levels reflect our current manufacturer catalogs. Timing and garment selection are the treating clinician's decision.
