Lymph Drainage

Several beneficial mechanisms of compression therapy on the swollen extremity may be explained by its effects on the lymphatic system:24

• Reduction of capillary filtration

• Increase of capillary reabsorption

• Shift of fluid into noncompressed parts of the body

• Increase of lymphatic reabsorption and lymphatic transport

• Breakdown of fibrosclerotic tissue

• Down-regulation of pro-inflammatory cytokines and receptors for growth factors.

External compression increases the interstitial pressure and prevents fluid from filtering out of the capillary network. The amount of the lymphatic load thereby is decreased.

Compression removes more water than protein from the tissue, thereby increasing oncotic tissue pressure and reinforcing the need for sustained compression. Therefore in chronic edema, success is dependent on continued compression.

Compression together with movement enhances the contraction of the lymphangion.

TABLE 10.4 RCTs and Systematic Reviews on Compression Therapy

First column: Indications, following the CEAP classification; second column: number of RCTs identified; columns 3-7: levels of recommendation A, B, C (see later) for bandages (column 3) or different stockings with their pressure ranges (columns 4-7)

Indication Ref # Bandage Stocking 10-14 Stocking 15-21 Stocking 23-32 Stocking 34-46

TABLE 10.4 RCTs and Systematic Reviews on Compression Therapy

First column: Indications, following the CEAP classification; second column: number of RCTs identified; columns 3-7: levels of recommendation A, B, C (see later) for bandages (column 3) or different stockings with their pressure ranges (columns 4-7)

Indication Ref # Bandage Stocking 10-14 Stocking 15-21 Stocking 23-32 Stocking 34-46

C0S, C1S

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