Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca© 2015 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only.

Author: Stephanie Phan, Sylvia Crowhurst, Pam HammondCreated: 02/2015Form: D-8519

For patients with lower body lymphedema who have had treatment for gynecologic cancer, including:• Removaloflymphnodesinthepelvis,• Removaloflymphnodesinthegroin,or• Radiationtothepelvis

Read this resource to learn:• Whoneedsself-bandaging• Whyself-bandagingisimportant• Howtodoself-bandaging

Disclaimer:Thispamphletisforpatientswithlymphedema.Itisaguidetohelppatientsmanagelegswellingwithbandages.ItisonlytobeusedafterthepatienthasbeentaughtbandagingbyaclinicianattheLymphedemaClinicatthePrincessMargaretCancerCentre.

Howtoself-bandageyourleg(s)andfeettoreducelymphedema(swelling)

PrincessMargaret

2

Do not self-bandage if you have an infection in your abdomen, leg(s) or feet.

Signsofaninfectionmayinclude:• Swellingintheseareasandrednessoftheskin(thisrednesscanquicklyspread)

• Paininyourleg(s)orfeet• Tendernessand/orwarmthinyourleg(s)orfeet• Fever,chillsorfeelingunwell

If you have an infection or think you have an infection, go to:• YourFamilyDoctor• Walk-inClinic• UrgentCareClinic

Ifnowalk-inclinicisopen,gototheclosesthospitalEmergencyDepartment.

3

What is the lymphatic system? Yourlymphaticsystemremovesextrafluidandwastefromyourbody.Itplaysanimportantroleinhowyourimmunesystemworks.Yourlymphaticsystemismadeupoflymphnodesthatarelinkedbylymphvessels.

Yourlymphnodesarebean-shapedorgansthatarefoundalloveryourbody.Largegroupsorchainsoflymphnodescanbefoundinyourneck,underyourarmsandinyourgroin(seepicturetotheright).

Havingsurgerytoremovelymphnodes,orradiationtreatmenttoareasinyourbodywhereyouhavelymphnodes,canpreventfluidfromflowingproperly.Thiscancauseswellingcalledlymphedema.

The Lymphatic SystemCirclesshowwhereclusters(groups)oflymphnodesareinyourbody.Itisnormalforlymphnodestoberemovedduringcancertreatment.

How does self-bandaging help with lymphedema?Ifyouhadsurgeryand/orradiationtreatmentforgynecologiccancer,theareasthatmayhaveswellingincludeyourfeetandleg(s).Wrappingyourbodywithbandages(compression),helpsmovethelymphfluidinthedirectionoftheheart.

Thegoalofbandagingisto:• Helpreduce yourswelling• Helppreventtheswellingfromgettingworse

Theshortstretchbandagesthatyoushouldusearedesignedforpatientswithlymphedema.AsktheLymphedemaClinicstaffforalistofplaceswhereyoucanbuythesebandages.

4

When should you wear the bandages?• Tobemostuseful,bandagesshouldbewornduringthedayandwhenyouexercise.

• Itiscommonforthebandagestoslipdownwithmovement.Thebandagescanalsoslipifyourlegbecomeslessswollenasyouwearthem.Youmayneedtowrapthebandagesagainifthishappens.

• Youmayalsobandageatnight,onceyouarecomfortablewearingthem.

What should you do before you start? • Cleanyourskinwithsoapandwaterandpatitdry.Makesuretodrybetweenyourtoes.

• Checkyourskinforanybreaks(cuts)orredness.Ifneeded:

• Cleanthecutandapplyabandage.Donotwrapwithcompressionbandagesuntiltheskinhashealed

• Ifthereisredness,followtheinstructionsabove.Itmaybeaninfection.Donotwrapwithcompressionbandagesuntiltheinfectionhasgone.

• Applymoisturizer(lotion)toyourskin.Thiswillhelpyoutoavoiditchiness,irritationandskinbreakdown.

• applyaskinlotiontoyourlegandfoot

• rubitintoyourskin

• pullonthetubularcottonsock(stockinette).Itwillpreventthelotiononyourskinfrombeingrubbedoffbythebandage.

• Makesureyouareinacomfortablepositionwhilebandagingtoavoidanybackdiscomfort.

Please follow instructions given by the clinic staff at the Lymphedema Clinic.

5

Have all your supplies ready before you begin

Bandagingsuppliesmayinclude:

1.Stockinette(tubularcotton)toprotectthelegandfoot

2.Padding(softwhiteartiflex/castorpaddingorfoam)tohelpwithpressureofthebandages

3.Gauze(white,4cmand/or6xcm)bandageforyourtoes

4.Short stretch bandagesforyourfeetandlegs(beige,8cm,10cmand/or12cm)

5.Kidney-shapedhard foamforswellingbehindyourankles

Bandagingsuppliesmaydifferbasedonyourspecificneeds.Youwillonlybegiventhesuppliesyouneed.Askadoctor,nurseortherapistattheLymphedemaClinicforthepamphletcalled“HowtoCareforYourBandages”.

Foot and ankle padding

Toe gauze

Short stretchbandagesTape

Stockinette

Leg padding

Foam for ankles

6

Step 1. Bandaging the toes

• Putthestockinette(tubularcotton)onyourleg• Pullitbacktobandageyourtoes.

• Beginwiththe4cmtoegauzeandwrapitoncearoundthebaseofallyourtoes.Wrapthebigtoefirst.

• Startfromthebottomofthetoenailandwraparoundthetoetwotothreetimestowardsthebaseofthetoe.

• Do not stretch gauze as you bandage the toes.

• Wrapthegauzearoundthebaseofallthetoesagain.

• Wrapthe2ndtoe(theonenexttoyourbigtoe)thesamewayasthebigtoe.

• Continuewrappingeachtoethesameway.• The4thand5thtoecanbewrappedtogetheroryoucanleavethe5thtoeunwrapped.

7

Option: ToeWrapwithAdhesive(sticky,glue-based)GauzeYoucanuseadhesive(stickyorglue-based)gauzetobandageyourtoesseparately.• Wraparoundeachtoewithoutpullingthegauze.• Youcanleavethe5thtoeunwrappedifyouchoose.

Whenyoufinishbandagingyourtoes,checkyourbloodflowbydoingthefollowingtest:• Pressonthebigtoenail.Itshouldlosesomecolourorturnpale.

• Thecolourwillreturnafterafewsecondswhenyoureleasethetoe.

• Ifthisdoesnothappenyoumayhavebandagedtootightly.Youwillneedtoremovethebandageandwrapitmoreloosely.

The toe bandages should feel comfortable. You should have no pain or discomfort.

8

Step 2. Foam for ankles

Iftheskinaroundyouranklebonesisthickandspongy,youmayhavebeengiventwopiecesofthickfoam(kidney-shaped)tohelpwiththeswelling.

• Placethefoambehindtheanklebones.

• Wrapthe6cmlargergauzearoundthefoamsothatitdoesnotslip.

• Pullthestockinettebackovertheankleandfoot.

9

Step 3. Applying padding to the foot and leg

• Withthe10cmpadding:Wraparoundyourfootbeginningatthebaseofthetoes.

• Wraparoundthefootagainmovingclosertotheankle.Coverthewholefoot.

• Overlapthepaddingbyhalfwitheachwrap.

• Continuewiththispaddinguptheleginthesameway.

• Makesurethebackofthekneeiswellpaddedandprotected.Youmayhavebeengivenanextrapieceofpaddingforthisarea.

• Continuethepaddingtojustunderthegroin(abouttwofingerwidthsbelowgroin).

• Trytosmoothoutthewrinklesinthepaddingasbestasyoucan.Donotusetapeasitmaytearthepadding

10

Step 4. Bandaging the foot and ankleBandage #1

• Trytokeepyourfootata90-degreeanglewhenyouwrapthefoot.

• Beginwiththe8cmbandage(beige).Wraparoundthefootatthebaseofthetoes without pulling.Thiswillsecurethebandage.

• Nowwraptwotothreemoretimes,pullingthebandageacrossthetopandacrossthebottomofthefoot.

• Giveagentlepullonthebandageateachhalfturntokeepevenpressure.

• Continuewiththesamebandageacrossthetopofthefoottowardthe back of the ankle.

11

• Wrapthebandagearoundthebackoftheankleandacrossthetopofthefoot.

• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.

• Bringthebandagearoundtothebottomofthefoot.Thenacrossthetopofthefootagain,movingthebandageclosertotheheel.Thispatternofwrappingiscalleda“figure8”.

• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.

• Repeatthisfigure8patternaroundthefootandankleuntilthearchofthefootiscovered.

• Continuewiththeremainingbandagearoundyourankleandupyourlowerleg.

• Overlapthebandagebyhalfwitheachwrap.• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.

• Tapetheendofthebandagetopreventitfromloosening.

12

Step 5. Bandaging the legBandage #2

• Takea10cmbandage:Wraparoundjustabovetheanklewithout pulling.Thiswillsecurethebandage.

• Wrapagainandgentlypullacrossthefrontandthenthebackoftheleg.

• Overlapthebandagebyhalfwitheachwrap.• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.

• Continuewiththesamebandage.Bendthekneeslightlyifpossible.

• Wrapthebandageover the knee.Thenwrapbelow the kneeandfinallyabove the kneeinafigure8pattern.

• Continuewrappingtheupperlegandtapetheendofthebandagetopreventitfromloosening.

• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.

13

Bandage #3

• Takeanother10cmbandage.Feelyourankleandlowerlegandstartthebandagewhereitfeelssoft.

• Wrap in the opposite direction to the previous bandage.

• Wraparoundthelowerlegwithout pulling.Thiswillsecurethebandage.

• Wrapagainandgentlypullacrossthefrontandthenthebackoftheleg.Overlapthebandagebyhalfwitheachwrap.

• Dothefigure8wrapovertheknee(asdescribedbefore).Thiswillhelpwithkneemovement.

• Alwaysgiveagentlepullonthebandageateachhalfturntokeepevenpressure.

• Placeyourweightonthelegthatyouarebandaging,ifpossible.

• Continuewrappingtothetopofthelegandtapetheendofthebandagetopreventitfromloosening.

14

Option: AddedBandage• Youmayhavebeentoldtoaddanotherbandage.• Ifso,wraptheaddedbandageinthesamewaystartingbelowtheknee.• Continuebandagingtowardtheupperlegandtapetheendofthebandagetopreventitfromloosening.

Whenyoufinishbandagingyourleg,checkyourbloodflowbydoingthefollowingtest:• Pressonyourbigtoenail.Itshouldlosesomecolourorturnpale.

• Thecolourwillreturnafterafewsecondswhenyoureleasethetoe.

Ifthisdoesnothappenyoumayhavebandagedtootightly.Youwillneedtoremovethebandageandwrapitmoreloosely.

The leg wrap should feel comfortable. You should have no pain or discomfort.

What should you avoid?• Donotstrainyourshoulders,neck,armorhand.• Donotwrapthebandageinawaythatcausesyoupain.• Donotcontinueself-bandagingifitiscausingyoupain.Ifpaincontinues,follow-upwithyourdoctororheathcareteam.

• Donotdoself-bandagingifyouhaveaninfectioninthatarea.

15

Contact informationIfyouhavequestionsaboutself-bandaging,pleasecontacttheSurvivorshipClinicat416-946-4501,extension2363,andasktospeakwithoneoftheclinicstaffmembers.

Notes/Comments

ThedevelopmentofpatienteducationresourcesissupportedbythePrincessMargaretCancerFoundation.