Damstra, R.J., Brouwer, E.R., & Partsch, H. (2008). Controlled, comparative study of relation between volume changes and interface pressure under short-stretch bandages in leg lymphedema patients. Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [Et Al.], 34(6), 773–779.

To demonstrate that therapeutically intended volume reduction of the compressed leg is the most important cause for the loss of bandage pressure

All patients and control group volunteers were treated with the same bandages by trained staff. The bandages started at the base of the toes and covered the leg up to the capitulum fibulae in all cases. The bandages were removed after two hours, and new bandages were applied for the next 24 hours. On the first day, all patients were encouraged to walk and treated exclusively with compression therapy of the whole leg. No other therapeutic interventions were performed.

• The sample size (N = 29) was comprised of 20 patients (75% female and 25% male) for the study group and 9 healthy volunteers for the control group. 
• Mean age of the study group only was 51.1 years with a range of 20–78 years. Mean age for the control group was not available. 
• The study group consisted of patients who had been hospitalized for extensive lymphedema of the lower extremities.

• Single site
• Inpatient unit
• Netherlands

The study used an experimental, controlled comparative design.

• Sub-bandage pressure was measured by an air-filled pressure transducer.
• A water displacement device was used to measure leg volumetry.

A significant reduction of leg volume was achieved two hours after bandage application in both groups. A further volume decrease of the lymphedematous legs was observed in the following 24 hours after application of a new bandage. The volume reduction was associated with a significant loss of bandage pressure.

Volume reduction is the most important cause of loss of pressure and effectiveness, supporting the need for proper materials, technique, and compliance.

• The sample size was small (N < 30). 
• The study was conducted at a single site.

More frequent bandage changes, in the initial phase of edema reduction in patients with venous diseases, with compression treatment using short-stretch bandages appears to be necessary.