Damstra, R.J., & Partsch, H. (2009). Compression therapy in breast cancer-related lymphedema: A randomized, controlled comparative study of relation between volume and interface pressure changes. Journal of Vascular Surgery: Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter, 49(5), 1256–1263.

To determine whether there is a difference between low- and high-pressure bandaging in intended volume reduction

Bilateral arm volume was measured before, two hours post-bandage placement, and after 24 hours. The amount of edema was calculated. Sub-bandage pressure was measured after bandage application and two hours later. Bandages were re-applied and pressure measurements were repeated. After 24 hours, pressure measurement was recorded and bandages were removed for final volumetry. Primary outcome measures were reduction of arm volume and edema in both study groups. Secondary outcomes were changes in sub-bandage pressure and patient comfort later. Patients were randomized into two groups: group A received low pressure bandages (20–30 mm Hg) and group B received high pressure bandages (44–58 mm Hg). 

• The sample (N = 36) was comprised of female patients aged 45–84 years.
• All patients had unilateral breast cancer-related lymphedema (moderate-to-severe edema [volume difference 20%–40% and greater than 40%, respectively).
• Patients were included in the study if they were at least 18 years of age, a minimum of 12 months post-treatment for breast cancer without signs of recurrence, and hospitalized because outpatient treatment was not successful.
• Patients with allergies to any of the materials, severe systemic diseases, acute superficial or deep vein thrombosis arterial occlusive disease, or confirmed thrombophilia were excluded.

The study took place at Nij Smellinghe Hospital in Drachten, Netherlands.

The study used a randomized, controlled comparative design.

• Bilateral arm volume was measured by inverse water volumetry.
• Sub-bandage pressure was measured after bandage application and two hours.
• The main outcome measures were reduction of arm volume and edema volume in the affected arm in both study groups.
• Secondary outcome parameters were changes in sub-bandage pressure and patient comfort.
• Air-filled pressure transducer with a large probe was used to measure sub-bandage pressure.
• Accuracy and variability of this method was referenced.

Median arm volume reduction after two and 24 hours was 104.5 ml (95% confidence interval [CI], 51.2–184.2) (–2.5%) (p < 0.0001) and 217 ml (95% CI, 143.9–280.2) (–5.2%) (p < 0.01) for group A and 56.5 ml (95% CI, 2.7–123.1) (not significant) and 167.5 ml (95% CI, 105.2–316.1) (–4.2%) (p < 0.01) for group B, respectively. There was no statistically significant difference between the volume changes in group A and group B. Bandages in group A were better tolerated. The sub-bandage pressure drop in the first two hours was between 41% and 48% in both treatment groups at both measuring sites. After 24 hours, the pressure drop was between 55% and 63%. No proximal swelling above the bandage was observed.

Inelastic, multi-layer, multi-component compression bandages with lower pressure (20–30 mm Hg) were better tolerated and achieved the same amount of arm volume reduction as bandages applied with higher pressure (44–58mm Hg) in the first 24 hours.

The sample size was small (N < 100).

More studies are needed to evaluate efficacy of lower pressure to better understand optimal treatment and tolerability, which will impact compliance.