Published 14 April 2009 Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.06.2008.0050] Copyright © 2009 by the BMJ Publishing Group Ltd. Novel treatment (new drug/intervention; established drug/procedure in new situation) Use of an inelastic bandage as an adaptation of the lymphatic drainage technique in lower limbs Guilherme Fregonezi 1,2 , Vanessa Resqueti 1 , Socorro Ferreira 1 and Ana Paula Lima 1 1 Universidade Federal do Rio Grande do Norte, Physical Therapy Department, Caixa Postal 1524 - Campus Universitário Lagoa Nova, Natal, 1524, Brazil 2 Master Program in Physical Therapy, Universidade Federal do Rio Grande do Norte Correspondence to: Guilherme Fregonezi, fregonezi@ufrnet.br SUMMARY The inelastic bandage is an adaptation of the manual lymphatic drainage, which substitutes the circular movements of the fingers. A patient with lymphoedema underwent 20 sessions using the modified lymphatic drainage technique. Perimetric measurements were taken before and after each session, and volumetric measurements at the first, 10th, and 20th sessions. Limb circumference was significantly reduced at three points on the perimeter (10, 15 and 25 cm): 2.5 cm (7.3%), 2.5 cm (6.5%) and 1.5 cm (5%), respectively. Volumetry decrease of 26.4% from initial limb volume was observed. The use of the inelastic bandage proved to be an effective adaptation when compared with the results using other techniques described. BACKGROUND Manual lymphatic drainage (MLD) is part of the complex decongestive therapy used in the treatment of lymphodema. 1 Despite its proven effectiveness in draining lymphoedemas, MLD has some limitations, related mainly to the treatment of large lymphoedemas, in which the circular movements of the fingers is difficult to use for drainage. In modified lymphatic drainage (LD modif ) the circular movements of the fingers are substituted by the inelastic bandage. The aim of this case report is to describe the use of LD modif , substituting the circular movements of the fingers with an inelastic bandage, in draining an infectious secondary lymphoedema. CASE PRESENTATION A 53-year-old woman with a 6 year history of stage III secondary lymphoedema of the right lower limb was referred for physical therapy treatment after resolution of her infectious erysipelas. TREATMENT Twenty treatment sessions were carried out using the LD modif technique with a frequency of three sessions a week. LD modif was applied using the inelastic bandage technique (fig 1). The inelastic bandage substituted for the circular movements of the fingers. The physical therapist wraps the polyester anelastic bandage around the limb to be treated, applying moderate pressure. The LD modif follows the same procedures described by Leduc, substituting the circular movements of the fingers with the inelastic bandage. 2 OUTCOME AND FOLLOW-UP Perimetric and volumetric measurements of the patient’s lower limbs were assessed using techniques widely described in the literature. 2,3 Perimetric measurements were taken with a common measuring tape, and each limb was measured at 5 cm intervals, at 9 points below the View this figure (121K): in this window | in a new window | PowerPoint for Teaching Figure 1 Applying the inelastic bandage technique. Página 1 de 2 Use of an inelastic bandage as an adaptation of the lymphatic drainage technique in ... 08/06/2009 http://casereports.bmj.com/cgi/content/full/2009/apr07_2/bcr0620080050