Lymphedema: Are Open Wounds a Contraindication for Compression Bandaging?

Amy H. Pannullo, PT, DPT, WCS, CLT, Kirsten I. Wightman, PT, DPT, CLT

December 11, 2013

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Question

Is compression bandaging contraindicated for clients with open wounds or weeping?

Answer

If someone has open wounds without a great amount of depth, we can use bandages or dressings to absorb some of the drainage, and then, we can use compression bandaging over those areas.  The compression will actually push the fluid out of the area which will help the healing.  The only concern is that if these compression bandages get wet or soiled, they will lose their effectiveness, and we cannot use them again. 

Many times we see patients who are also being seen at a wound clinic.  In those cases, we use dressings as best we can to absorb the moisture and help with the healing.  Sometimes these patients will do really well with Manual Lymphatic Drainage either in clinic or with us.  We teach caretakers the technique as well to heal their wounds much more quickly.  Then, we are able to move forward with compression bandaging. 

Some wounds may also need pressure point relief.  We can use foam padding or various materials to alleviate some pressure.  We also use wet to dry garments to heal a wound.  This garment offers a low level compression so that we are able to move forward with the compression bandaging after that.  Make sure that there are no signs of infection when you are bandaging.  Also keep in mind that you want to create an environment for healing to decrease the risk for cellulitis or other types of skin infections. 

It is really important that you teach caretakers or even teach the client themselves things that you think they may already know.  Many of them are not going to be able to see the wounds very clearly.  Teach them to use mirrors to visually assess the wound.  Put mirrors under their feet to look between toes.  Teach them that meticulous skin and nail care is one of the most important ways to prevent wounds.  It is really important that clients are aware of the fact that someone may see something before they feel it.  If someone comes into the clinic with a suspicious area, trace the area with a pen so that it can be monitored.  Note that standard protocol for an infection is that a client needs to be on antibiotics for 72 hours before we can do treatment.  From that point, we are Ok to continue as long as the client’s doctor is aware.  


amy h pannullo

Amy H. Pannullo, PT, DPT, WCS, CLT

Amy Pannullo graduated from Stony Brook University with her Doctorate of Physical Therapy in May 2007.  She then went on to specialize in the field of women’s/men’s health, earning her board certification as a Women’s Health Certified Specialist, and credentials as a Certified Lymphedema Therapist.  She actively serves as a mentor for Duke University’s Women’s Health Residency program, a teaching assistant for the DPT program and a Certified Clinical Instructor for student internships.

 


kirsten i wightman

Kirsten I. Wightman, PT, DPT, CLT

Kirsten Wightman graduated with her doctorate of physical therapy in May of 2012. She then went on to pursue a yearlong residency in the field of Women’s Health physical therapy at Duke University under the direct mentorship of some of the best women’s health clinical specialists in the country. She received her lymphedema certification in the fall of 2012 through the Norton School of Lymphatic therapy. With a true passion for treating pelvic health and the lymphedema/oncology population, she will start a new position at Palo Alto Medical Foundation in Sunnyvale, CA in the fall of 2013 working in women’s health and cancer care.

 


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