A 24-hour interval compression plan for managing chronic oedema: part 1—the science and theory behind the concept

Compression, skin care, manual lymph drainage, exercise and education form the components of treatment for upper or lower extremity chronic oedema. Individuals with chronic oedema manage chronic swelling from a range of disease processes of the venous, lymphatic and other systems.¹ All five treatment components are complementary and facilitate the implementation of a total treatment regimen.

International expert consensus on compression for management in the intensive phase recommends multilayer lymphoedema compression bandaging (MLLB), transitioning to maintenance with a combination of bandaging and garments that could be applied by patients themselves as part of their long-term care.² Patient adherence with long-term care remains variable, with venous leg ulcer (VLU) reoccurrence, cellulitis and progression of fibrosis still a concern for patients and providers.³

More recent developments in practice have further highlighted the benefits of self-care with compression for individuals with chronic oedema.^4–6 Studies have indicated that prescription of garment stiffness and pressure based on the aetiological origin of oedema do not predict the effectiveness which is due to the maintenance of moderate to strong compression over time.^4–7 Therefore, a focus on self-care and the individual patient’s specific oedema, pressure needed and the specific body site is beginning to drive guidelines for compression selection.^8,9 The increasing use of adjustable compression wraps (ACW) has allowed more patients the opportunity to reapply and sustain the garment’s pressure.⁶ While guidelines for the management of patients with no or low risk of swelling post-VLU healing recommend compression hosiery to be removed at night, patients with persistent chronic oedema need 24-hour compression to prevent rebound swelling.¹⁰