Short-Stretch Bandaging vs. Adjustable Compression Wraps for Reducing Lymphedema: What Does the Research Show?
Compression is one of the most important components of lymphedema treatment, particularly during the intensive or reduction phase of Complete Decongestive Therapy (CDT). I wanted to share my clinical experience using adjustable compression wraps and examine how that compares with the current evidence.
When I completed my Certified Lymphedema Therapist (CLT) training in 2016, I was taught to use multilayer short-stretch bandaging to reduce limb volume during the intensive phase of treatment. In clinical practice, however, maintaining this approach could be challenging—particularly for patients with bilateral lower-extremity lymphedema. Bandaging was time-intensive, and some patients had difficulty tolerating the compression. This was especially true for some patients with lipolymphedema, who could experience pain or tenderness even with relatively light pressure. I began incorporating adjustable compression wraps—sometimes called reduction kits—as another option during the reduction phase. Here is what I observed in clinical practice:
Pros:
Supported patient and caregiver self-management, which was particularly helpful when insurance limited the frequency or duration of therapy visits.
Made certain daily activities easier to manage, such as showering, handwashing and other tasks that required temporarily removing compression.
Could be removed for skin care and the self-MLD sequence I taught, then reapplied by the patient or caregiver.
Immediately adjustable when an area felt uncomfortable and could be resized/trimmed as limb volume decreased.
Much faster to apply, leaving more treatment time for skin assessment, MLD, exercise, education and self-management training.
Could serve as temporary compression while patients waited for their long-term compression garments.
Allowed easy access for skin checks.
Many patients found them more comfortable and easier to tolerate.
The wrap system I used provided tools to help patients reproduce the prescribed compression more consistently.
Cons:
Patient/ caregiver application errors.
Can be difficult for some patients apply independently.
Separate hand or foot compression may be necessary to prevent or address distal swelling.
Higher upfront costs for the patient.
Can migrate, creating pressure points.
May provide less precise contouring in patients with unusual limb shape, deep skin folds, lobules or complex areas of swelling.
Less clinician control over adherence and application, since I could not verify how consistently or accurately the wraps were being used outside the clinic.d when not in clinic.
Did I Think They Worked?
In my clinical experience, most patients achieved measurable reductions in limb circumference when they used the wraps consistently and applied them correctly. I regularly monitored circumference measurements, and although the degree of reduction varied, most adherent patients demonstrated improvement.
Compliance mattered. Some patients returned with straps applied too loosely and experienced little reduction. Others discontinued treatment because they could not tolerate the pressure even when it was reduced. Those experiences reinforced something that remains important regardless of the compression system being used: a compression device only works if the patient can apply it correctly and tolerate it consistently.
What Does The Evidence Say? Can adjustable compression wraps reduce lymphedema as effectively as traditional short-stretch bandaging?
2021: Lower-Extremity Lymphedema
Borman and colleagues compared traditional multilayer short-stretch bandaging with an adjustable compression wrap during the active treatment phase of CDT. The study included 36 patients with lower-extremity lymphedema. Treatment lasted three weeks, for a total of 15 sessions. Both groups also received skin-care education, manual lymphatic drainage and supervised lymphedema exercises. One group received multilayer short-stretch bandaging using Rosidal-K®, while the other used the Circaid Reduction Kit (The same one I used in clinic).
Both groups experienced significant reductions in limb volume and subcutaneous tissue thickness, and the improvements were maintained at the one-month follow-up.
Some measures of quality of life—including appearance, symptoms and overall quality of life—improved only in the adjustable-wrap group.
2025: Randomized Noninferiority Trial in Lower-Extremity Lymphedema
A 2025 study by Reisshauer and colleagues provides particularly useful evidence because it was designed specifically as a randomized noninferiority trial. The study included 24 patients with Stage II–III bilateral lower-leg lymphedema undergoing 10 days of intensive CDT.
Each patient received an adjustable compression wrap on one leg and traditional inelastic multilayer bandaging on the other. This design allowed each patient to essentially serve as their own comparison.
The adjustable wraps were found to be noninferior to multilayer bandaging for short-term lower-leg volume reduction and approximately 83% of participants indicated that they would continue using the adjustable wraps.
2017: Early Evidence for Upper-Extremity Wraps
A small 2017 pilot study by Campanholi and colleagues followed nine women with breast-cancer-related upper-extremity lymphedema who had previously undergone conventional compression-bandaging treatment. They wore compression wraps daily for one month without receiving manual lymphatic drainage during the study period. The median volume difference between the affected and unaffected arms decreased from approximately 564 mL to 391 mL, a statistically significant reduction (p=.008).
Participants also reported high satisfaction and described the adjustable device as practical and comfortable compared with conventional bandaging.
2023: Mixed Results During Intensive Upper-Extremity Treatment
Ochalek and colleagues studied 36 women with advanced breast-cancer-related arm lymphedema. Participants were randomly assigned to either adjustable compression wraps or traditional compression bandaging for two weeks. Both groups were treated and educated by experienced PTs. During the second week, patients continued their respective compression methods themselves at home.
Both groups experienced reductions in limb volume during the first week. During the second week, however, an additional statistically significant reduction occurred only within the traditional bandaging group. Patients using adjustable wraps also reported compression-related complications more frequently.
The authors therefore concluded that although adjustable wraps reduced lymphedema and related symptoms, their findings were not sufficient to recommend wraps as an alternative to conventional bandaging during the acute treatment phase for women with advanced arm lymphedema.
2024: More Encouraging Evidence for Ongoing Volume Control
A larger randomized controlled trial published in 2024 examined adjustable compression wraps during the control phase rather than the initial intensive reduction phase.
Da Silva and colleagues studied 71 women with breast-cancer-related lymphedema, comparing adjustable compression wraps with a conventional compressive garment/mesh. Participants were evaluated after 30 days and again at six months.
At 30 days, the adjustable-wrap group demonstrated a 37.6 mL reduction in excess limb volume (p=.041) as well as improvement in upper-extremity function (p=.013). However, when the two treatments were compared directly, there were no statistically significant between-group differences in excess limb volume, adverse events, adherence, grip strength, quality of life or function at either follow-up.
Both compression approaches demonstrated satisfactory adherence and were considered safe and effective for controlling upper-extremity lymphedema.
The Bottom Line
Taken together, current evidence supports adjustable compression wraps as a viable option for lymphedema management, although results vary by limb and phase of treatment.
For lower-extremity lymphedema, studies suggest wraps can provide volume reduction comparable to traditional multilayer bandaging during intensive treatment. For upper-extremity lymphedema, evidence is more limited and mixed, particularly during the intensive reduction phase.
Ultimately, I think compression should be individualized and take into account what the patient or caregiver can realistically manage. Treatment decisions also have to consider real-world factors, including insurance coverage and access to frequent clinic visits. The best option is one that provides appropriate compression while being safe, tolerable and practical enough to use consistently.
References
Campanholi LL, Lopes GC, Mansani FP, Bergmann A, Baiocchi JMT. The validity of an adjustable compression Velcro wrap for the treatment of patients with upper limb lymphedema secondary to breast cancer: a pilot study. Mastology. 2017;27(3):206–212. doi:10.5327/Z2594539420170000203.
Borman P, Koyuncu EG, Yaman A, Calp E, Koç F, Sargut R, Karahan S. The comparative efficacy of conventional short-stretch multilayer bandages and Velcro adjustable compression wraps in active treatment phase of patients with lower limb lymphedema. Lymphatic Research and Biology. 2021;19(3):286–294. doi:10.1089/lrb.2020.0088.
Ochalek K, Kurpiewska J, Gradalski T. Adjustable compression wraps (ACW) vs. compression bandaging (CB) in the acute phase of breast cancer-related arm lymphedema management—a prospective randomized study. Biology. 2023;12(4):534. doi:10.3390/biology12040534.
da Silva JMP, Araújo RDD, de Aguiar SS, Fabro EAN, Pinto MVM, Thuler LCS, Bergmann A. Efficacy, safety of and adherence to adjustable compression wraps in the control phase of breast cancer-related lymphedema: a randomized controlled trial. Clinical Rehabilitation. 2024;38(11):1481–1494. doi:10.1177/02692155241270921.
Reisshauer A, Tsatrafilis E, Kornappel S, Huscher D, Liebl ME. A randomized, controlled noninferiority study of adjustable compression wraps compared with inelastic multilayer bandaging used in the intensive complex decongestive therapy of lower leg lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2025;13(4):102214. doi:10.1016/j.jvsv.2025.102214.
