How we treat lymphoedema

Limb volume is recorded before anything is treated, using a method that can be repeated identically at the end. Skin condition, fibrosis, range of movement and any history of cellulitis are recorded alongside it.

Without a baseline there is no way to tell a good block from a pleasant one, and the patient has no way to hold anyone to account.

Multi-layer compression bandaging is applied daily through the intensive phase and worn between sessions. This is uncomfortable, unglamorous and responsible for most of the reduction.

Manual lymphatic drainage precedes the bandaging. Exercise is done in the bandages, because muscle working against compression is what moves fluid.

Skin is inspected and treated daily, and you are taught what to look for. This is not cosmetic: cellulitis is the main route by which lymphoedema gets permanently worse, and it starts at a break in the skin.

The compression garment is measured once the volume has come down, in the last days of the block. A garment fitted to a swollen limb is the wrong garment.

You leave able to put it on unaided, knowing how to tell when it has lost compression, and with a written maintenance routine that takes minutes rather than hours.