A custom compression garment is designed to hold a reduced limb in place, not to reduce it. If the patient is measured while the limb is still swollen, the garment is built for a limb that won't exist a few weeks later. That's why we ask therapists to measure at the end of the reduction phase, once limb volume has stopped going down.
Two phases of lymphedema treatment
Complete decongestive therapy (CDT) is the standard treatment for lymphedema, and it has two phases:
Phase 1: Reduction. Intensive treatment with manual lymphatic drainage, multilayer compression bandaging, exercise and skin care. The goal is to reduce limb volume as much as possible. This phase usually lasts a few weeks, depending on the patient.
Phase 2: Maintenance. The patient moves into daytime compression garments, often with nighttime garments, a home pump, self-massage and exercise. The goal is to keep the volume reduction achieved in phase 1.
Custom garments belong in phase 2. They're the main tool for maintaining the result.
What goes wrong when garments are ordered too early
The garment gets loose. As the limb keeps shrinking, a garment measured for a larger limb no longer applies the prescribed pressure. Swelling can return.
Uneven pressure. A loose garment can slide, bunch and fold, creating tight bands that restrict flow and irritate the skin.
Wasted coverage. Insurance limits how many garments a patient can get in a set period. Medicare, for example, allows three daytime garments per body area every six months. A garment that no longer fits can leave the patient waiting for the next allowance or paying out of pocket.
Lost time and frustration. Remeasuring and reordering delays care, and patients may lose confidence in compression therapy.
When and how to measure
Wait for the plateau. Measure when limb circumference has stopped decreasing between sessions, typically near the end of phase 1.
Measure right after bandages come off, before swelling has time to return. Early in the day is best.
Take complete measurements. Flat-knit custom garments need circumferences and lengths at many points along the limb. Include the hand or foot if a glove, gauntlet or toe cap is needed.
Note shape details such as skin folds, fibrotic areas or a deep ankle crease, so the garment can be adjusted for them.
Send measurements with the order, along with the diagnosis code and recent therapy notes.
Bridging the gap
Patients still need compression between bandaging and the arrival of their custom garment, which can take a few weeks. Good options include:
Adjustable wraps, such as CircAid or ReadyWrap, which can be tightened as the limb continues to change
Ready-to-wear garments as a short-term option
Continued bandaging until the custom garment arrives
Adjustable wraps are also a good choice for patients who struggle with bandaging at home or whose limb size changes often.
How Midwest Compression can help
We work with therapists to time custom orders around the reduction phase. We can supply adjustable wraps during the transition, review measurements before ordering, and handle insurance for both. We carry custom flat-knit garments from Juzo, Medi, Sigvaris, Jobst and L&R. Email us at customersupport@midwestcompression.com or call 800-883-1549.
Need forms? Find every measurement form, sizing guide and order form on our Measurement & Sizing Forms page, and manufacturer charts on our Size Charts page.
This article is general information for healthcare professionals and is not a substitute for clinical judgment.
