The Lymphoedema Service is based in the Therapy Department, at the Royal Cornwall Hospital in Truro. We are currently unable to offer this service elsewhere in Cornwall. The service is provided by experienced Heathcare Professionals with specialist qualifications in lymphoedema management, with the support of a Lymphoedema Technician.We will see patients with oedema that has been present for more than three months or is related to cancer and its treatment. This includes:
Due to the underdevelopment or failure of the lymphatic system. It may develop without any obvious cause at different stages in life, but particularly in adolescence and during the menopause.
As the result of some problem outside of the lymphatic system that prevents it working properly such as cancer and treatment for cancer, surgery, injury or infection, reduced mobility / paralysis, obesity and problems with veins such as varicose veins.
An adipose tissue disorder that is characterised by abnormal fat deposition of the lower limbs and tenderness.
For more information on lymphoedema, you may find this short video useful.
Treatments may include:
You may be asked to get onto a couch to enable the therapist to assess you. If you have difficulty getting in and out of a chair or bed, or need special equipment to help you, please let the clinic know before you come to your appointment.
If you think you would like someone else to be present, you are welcome to bring a friend, family member or carer or ask us to provide a chaperone for you.
At the end of your initial assessment we will agree a treatment plan. We’ll rarely start treatment at this initial appointment and you’ll need to return to the clinic for further appointments.
If you have lymphoedema, the build-up of fluid in your tissues makes you more vulnerable to infection and your lymphatic system, in the affected area, does not function adequately to fight infection. Cellulitis is a bacterial infection of the deep layer of skin (dermis) that often affects people with lymphoedema. Cellulitis can also sometimes cause lymphoedema.
Symptoms of cellulitis can include:
If you feel your lymphoedema is worse or your compression garment no longer fits, following the resolution of the infection, then please contact the lymphoedema clinic for advice.
Following discharge from The Lymphoedema Clinic the patient will need to request their compression garments prescribed by their GP annually. A prescription letter will be sent to the Patient’s GP and a copy to the patient. This letter will give full details of the patient’s hosiery prescription and when the repeat date is due. Each year the patient can request a repeat prescription from their GP which will be fulfilled by their Pharmacy or an online prescription service. If the Pharmacy has a query or any problems getting the correct garment they should contact the supplier who will be able to assist.
If the prescription is for a ’Made to Measure garment’, a size or measurements are not required. Please quote the Order Reference number as shown in the discharge letter and the company will make the repeat garment, to the same size as previously ordered. The Order Reference number is unique to the patient. Prescriptions for made to measure hosiery can be fulfilled by the pharmacy in the usual way or using an on-line prescription service as shown below.
Sigvaris Group have changed the names of some of their products. Therefore from 1st January 2020 they have set up a support line for any Sigvaris issues with products and ordering. Please contact 01264 326666 Option 0.
From 1st May 2020 JOBST Bellavar will be replaced and re-named as JOBST Classic on drug tariff. If you have any patients currently in JOBST Bellavar you will need to switch their next order to JOBST Classic. Please contact the supplier on 0845 1223600 who will be able to supply you with the code changes and offer advice for prescription requests.
Online pharmacy services offer a free compression garment, prescription delivery service for patients, this service is free of charge but prescription charges will apply. Prepaid envelopes can be obtained from the companies. Examples of these services are:
www.daylong.co.uk Tel 0800 195 0160
www.patientchoice.net/ Tel 0800 862 0686
www.bsnmedical.co.uk Tel 0845 1223600
email@example.com Tel 01432 373500
Occasionally due to complex clinical need patients are discharged with items that are not available on FP10 prescription. The prescriber will need to request the item from the RCHT Appliance Office annually, quoting the Order reference shown in the prescription letter. The Appliance Office will then order the items and send to the patient directly.
Prescribers should email the request to rch-tr.ApplianceOrder@nhs.net
Unless you are exempt from prescription charges or have a pre-paid prescription certificate you will need to pay a prescription charge for your compression garment.
Your pharmacy will advise how much this is and whether a pre-paid certificate is more cost effective.
As a general rule you should be charged one prescription charge for each type of item i.e. if you have four pairs of identical stockings then this would be one prescription charge, however if you have two pairs of black and two pairs of beige then this would be two prescription charges.
Patients discharged with a hosiery prescription will have been stable for some time. We would therefore not expect them to need to be re-measured for compression hosiery as they should remain within the tolerance of the hosiery. If the patient is not reporting any problems with their compression hosiery then a repeat prescription can be made. However if the patient’s weight or lymphoedema has changed significantly or they report issues with their hosiery it would be prudent to check that they still fit within the hosiery prescribed. If the patient reports weight loss or gain then they should just require a different size. If the patient feels their condition has become worse than they should be re-referred back to the lymphoedema clinic
As a rule, the following circumferences should be checked:
As a rule, the following circumferences should be checked:
The sizing charts for the hosiery are all available online and can be found on the links below.
Essity (formerly BSN)
L&R (formerly Activa)
The patient will be discharged with a well-fitting garment that they have been stable in for some time. The measurements should therefore not need to be changed. However if the patient’s weight or lymphoedema has changed significantly or they report issues with their hosiery it would be prudent to check that they still fit within the hosiery prescribed. If the patient reports weight loss or gain then they should just require a different size. If the patient feels their condition has deteriorated, please submit a new referral to the Lymphoedema Clinic.
To obtain the measurements for the patient you will need to contact the company and ask for the measurement form. There is a 2cm tolerance in the hosiery up or down (i.e. the patient can be 2 cm smaller or larger and the garment will still fit).
Compression wraps are commonly used to treat leg lymphoedema. They are adjustable and can accommodate a wide range of measurements. Most can also be trimmed to reduce the size of the garment as the oedema reduces therefore prolonging the use of the garment. They should be used over a liner or yellow line and dressings should be used to control exudate where needed. There are a number of compression wraps on the market the most commonly used in Cornwall are the Juzo ACS, the Juzo 6000 and the Medi Juxta-fit. They are all available on FP10. Instructions on how to measure for them, fit them (including videos) and care for them are on the links below:
Additional Velcro can be ordered for Juzo wraps should the Velcro become damaged or worn out.
Medi Juxta-Fit wrap
Toecaps can be used with compression bandaging to reduce toe and base of toe oedema. The following toecaps are trim to fit so the toes can be reduced in length. They can be washed by the patient and reused. They are both available on FP10.
Haddenham Healthcare Microfine toecap
Available in 20-36 mmHg
Juzo Classic Seamless Toecap
Available in Class 1 and Class 2
We recommend that patients with lymphoedema, who are wearing compression garments, should have, as a minimum, an annual vascular assessment. We do not recommend Ankle Brachial Pressure Indices (ABPI) in the presence of oedema, obesity and hyperkeratosis, as the results can be falsely elevated.
A full clinical assessment of risk factors and presenting symptoms is needed; pedal pulses may also be needed depending on the age and health of the patient.
For further information about vascular assessment in lymphoedema please see the following documents:
The British Lymphology Society
Position paper for Ankle Brachial Pressure Index (ABPI)
Informing decision making prior to the application of compression therapy
The British Lymphology Society
Vascular Assessment Tool