by: Judith R. Casley-Smith & J.R. Casley-Smith (L.A.A., University of Adelaide)

This document was last amended on April 2002.

Obviously, if the therapist, patient, or supplying agent measures incorrectly, the garment cannot work properly. The time of day of measurements and the temperature also make a difference. However, even when the therapist is experienced, inaccuracies may occur when the measurements are transferred to the computer at the manufacturing end. If a garment is almost satisfactory but is either slightly too loose or slightly too tight at one point, a good seamstress can alter it - but the guarantee is voided. If you do have problems with the fit or the garment needs repairs, and you have bought it from a local manufacturer, then it is obviously easier to overcome the problems on the spot.

If a patient can be correctly fitted with a standard garment, this is preferable and alleviates the risk of the garment arriving made to incorrect measurements.

The measurements of the garment MUST correlate very closely with those of the patient. Otherwise, the garment may cause a tourniquet effect in one or more places - thereby limiting lymph flow. It can cause quite severe damage. Alternatively, it may be far too lax in some parts and allow bulges to form.

If there is a serious discrepancy in even one parameter, another make must be used, or a custom-made garment. With lighter grades, two garments (one over the other) are needed to maintain reductions after C.P.T.

Manufacturer: Jobst (Beiersdorf) GmbH, Emmerich, 46446 Germany; 49+(282) 260 70; fax: 49+(282) 260 199

Australia: Smith & Nephew, Customer service no. 1800 772 577, 211 Wellington Rd, Clayton, Vic, 3168, PO Box 100, Clayton, Vic 3168 (Can be measured-for at: Cosmac Surgical or O.P.C – see above)

The range includes 3 different arm styles, 2 leg styles and 2 styles of gloves. Fabric: cotton covered, flat knitted with a seam. Compression: sleeves, Class 2 (30 mm Hg); stockings Class 3 (40 mm Hg)

There is not a large ranges of sizes or styles; the sleeve will only fit a fairly bulky shoulder, not a finely built person. They are very comfortable to wear. However there have been some problems with obtaining the garment which was ordered. Garment life is excellent. They also supply glue, moisturiser and stocking washing liquid (Jolastic - Jobst).

Manufacturer: Jobst, 5825 Carnegie Blvd, Charlotte, NC 2809-4533, USA; 704 554 9933; fax: (419) 691 4511 www.jobst-usa.com

Australia:Smith & Nephew Australia, 1800 772 577, 211 Wellington Rd, Clayton, Vic, 3168, PO Box 100, Clayton, Vic 3168

Synthetic material, seamed, shaped, legs only, open toes. Pressures 30-40 or 40-50 mm Hg. We believe the German Elvarex (above) are superior.

Jobst Pre-sized Gloves.

Manufacturer: Jobst, 5825 Carnegie Blvd, Charlotte, NC 2809-4533, USA; 704 554 9933; fax: (419) 691 4511 www.jobst-usa.com

Australia: Smith & Nephew Australia,1800 772 577, 211 Wellington Rd, Clayton, Vic, 3168, PO Box 100, Clayton, Vic 3168. Two styles (standard or adjustable with velcro) and 6 sizes are available.

Manufacturer: Julius Zorn, Juliusplatz, D-86543, Aichach, Germany; 49+(8251) 901 111;
fax 49+(8251) 901 121

Australia: Appliance & Limb Centre, 16 Cope St., Redfern NSW 2016; (02) 9319 1955;
fax (02) 9698 1281

Sleeves compression: Class 1 (20-30 mm Hg), Class 2 (30-40 mm Hg). Fabric: synthetic (including silk inside making them good for sensitive skins). Varin Soft-in or Varin Soft-in Silk (particularly comfortable). Good shoulder fit for most people. Max sleeve: standard wrist measurements but larger upper arm section, there is also an extra small sleeve (in Varin Soft-in Class 2). Separate hands (with thumb stub – Class 1, or finger and thumb stubs – Class 2) are available in Helastic.

Stockings, compression: Class 1 (25 mm Hg), Class 2 (35 mm Hg), Class 3 (45 mm Hg). Wide range of styles, including for maternity, fair range of colours. Fabric: good variety, synthetic, cotton or silk covered fibre. Wide colour range in Hostess (sheer - synthetic and very fine, Class 1 & 2). Varying ranges are very comfortable and easy to don. Good for patients with sensitive skins. A measuring service in a number of areas – contact the Supplier.

Manufacturer: Medi Bayreuth, Waldsteinring 6, D-95448 Bayreuth, Germany; fax 49+921 91 257

Australia: Reis Orthopaedic Services, 25 John St., Lidcombe, NSW 2141; (02) 9643 1444,
fax (02) 9643 1264

Compression: Class I = 20-30 mm Hg; Class II = 30-40, Class III = 40-50 (Class IV,= 50-60, is made-to-measure only). Fabric: synthetic; Range: a number of styles available. They also make a combined arm with mitten sleeve in Classes I & II.

Manufacturer: Ganzoni, Groblistrasse 8, CH-9014, St. Gallen, Switzerland; fax 41+712 74 29 29

Australia: Morris Surgical, GPO Box 9, Brisbane, Q 4001; (07) 3357 5944; fax (07) 3857 0031.

Fabric: synthetic with natural rubber. Compression: Class 1 (801)= 20-30; Class 2 (503) = 30-40, Class 3 (504) = 40-50, Class 4 (505) = 50-60.

This is a very good, graded compression-garment. They have the widest range of styles and sizes, with good wearing capabilities. We usually find them very satisfactory. They also supply good gloves for donning the garments and glue for sticking them to the skin if necessary. There is sometimes a problem with 'banding' at the wrist and toes. This should not occur if measurements are really correct. N.B. the length of the longest stocking has been reduced, so do check it is adequate.

They now make an arm sleeve with a mitten (hand plus thumb piece) attached. This is the only one, that we are aware of, in standard garments.

The 902 sleeve is ideal for prophylactive use for a patient without lymphœdema, but at risk, when flying.

Manufacturer: Viso Med., 2072 St. Blaise, Switzerland; 41+(32) 753 22 12; fax 41+(32) 753 43 94

Australia: Bar Med, 408 High St., Northcote, VIC 3070; (03) 9486 7770, (1800) 803 662;
fax (03) 9486 7771

Varisma come in compression classes 1-3 (class 3 = 36-45 mm Hg). Fabric: cotton next to skin; good colour range in Varisma Class 2 only.

These are cool since only cotton is in contact with the skin, so they are very comfortable to wear. A wide range of styles is available. They have good graded compression and wearing capabilities. A program (in Lotus Version 2.1) to aid in choosing is available.

Viso have released a new range of stockings made from Lycra cotton and Microfibres. Compression class 1,2,3 and 4 (49 + mm Hg) These are lighter and finer than Varisma.

Manufacturer: Salzmann, Unterstrassse 52, St. Gallen, CH-9001 Switzerland, 41+(71) 228 43 13; fax 41+(71) 228 43 10

Australia: Biomet, P.O.Box 348, North Ryde, NSW 2113; 1800 251 201, (02) 9878 6100, fax (02) 9878 6473

Venosan 2000 cotton blend, 100% cotton on skin breathes well, cool to wear. Extra sizes for big calf and large thigh measurements. All styles available off the shelf. Compression up to 49mmHg. Arm-sleeves standard sizes available up to 50mmHg with strap, wrist and hand extension. Travel arm-sleeves very reasonably priced 25-32mmHg. New (4000) range/high tech micro fiber, very soft, very cool, easy don up to 36mmHg+. All styles, comfortable on skin under heavier garments, as self wicking, helps to keep swelling down during the night. All colours in stock.

Manufacturer: Vikora, PO Box 44, Wahroonga, NSW 2076, Australia; ph (02) 9487 6730, fax (02) 9487 6740, email vikora@geko.net.au, http://www.geko.net.au/~vikora

Fabric: synthetic, very soft and durable. Sizes: children 4-7, 8-12 yrs plus ranges of sizes in women’s and men’s. Extra-large fingers can be accommodated. Choice of glove lengths. The fingertips can be cut off without the fabric "running" or preferably with a glove worn inside out over another for extra pressure. These are extremely reasonably priced.

(Check how measuring should be done; it varies with the supplier!) When ordering Elvarex custom-made stockings and perhaps other custom-made ones, the "H" (heel) measurement should be taken with the foot flexed to make a 90° angle with the front of the leg. The tape runs from just under the heel just below the malleolus. If a great deal of reduction has been achieved just above the ankle and extending up the lower leg, the fit and compression gradient of the garment will be much better if the "B" measurement is taken up to 10 cm proximally.

Australia: Vikora Medical Distributors

PO Box 44, Wahroonga, NSW 2076, ph (02) 9487 6730, fax (02) 9487 6740, email vikora@geko.net.au, http://www.geko.net.au/~vikora

There is a complete range of styles and colours. Fabric: Spandex (nylon) which should be cooler to wear than heavier garments. Compression: up to 50 mm Hg. They have a simplified measuring technique. They are posted (Federal Express) two working days after receipt of order. They are amongst the most reasonably priced on the market.

Manufacturer: Jobst (Beiersdorf) GmbH, Emmerich, 46446 Germany; 49+(282) 260 70; fax: 49+(282) 260 199

Australia: Smith & Nephew Australia, 1800 772 577, 211 Wellington Rd, Clayton, Vic, 3168, PO Box 100, Clayton, Vic 3168 (Can be measured at: Cosmac Surgical or O.P.C – see above)

U.S.A.: Order directly from Jobst, Germany (above).

Compression: up to 60-70 mm Hg. These are a seamed, but shaped, garment. Allow 10 days from ordering before delivery. They have a good life-span - patients say about 6 months at least and that they are very comfortable to wear. They 'breathe' well. They are similar to the standard range, but made to order. They will try to accommodate special requests and will make (e.g.) one leg of a higher compression than the other.

Australia: Smith & Nephew Australia, 1800 772 577, 211 Wellington Rd, Clayton, Vic, 3168, PO Box 100, Clayton, Vic 3168

Synthetic material, seamed, but shaped. Many design modifications possible; special requests catered-for (e.g. lining around certain areas). Pressures: 20 - 50+ mm Hg. Delivery 5-10 days. We believe the Elvarex ones (above) are superior.

U.K.: BSN-Jobst Helathcare House, Goulton St Hull, HU3 4DJ, Ph 44 (0) 1482 222200, fax 44 (0) 1482 673081

Manufacturer: Julius Zorn, Juliusplatz, D-86543, Aichach, Germany; 49+(8251) 901 111;
fax 49+(8251) 901 121

Australia: Appliance & Limb Centre, 16 Cope St., Redfern NSW 2016; (02) 9319 1955;
fax (02) 9698 1281

Compression, Sleeves: Class 1 (20-30 mm Hg), Class 2 (30-40 mm Hg), Class 3 (40-50 mm Hg); Stockings: Class 1 (35 mm Hg), Class 2 (45 mm Hg), Class 3 (60 mm Hg). Fabric: synthetic, silk or cotton covered. Wide range of styles, including for maternity, fair range of colours. Varin Soft-in or Varin Soft-in Silk, Hostess (sheer - synthetic and very fine, Class 1 & 2) plus special models in silk or cotton (Class 1 & 2). Varin ranges are very comfortable and easy to don. They are recommended for patients with sensitive skins. Helastic/cotton gloves or gauntlets (finger lengths as required).

Manufacturer: Medi Bayreuth, Waldsteinring 6, D-95448 Bayreuth, Germany; fax 49+921 91 257

Australia: Reis Orthopaedic Services, 25 John St., Lidcombe, NSW 2141; (02) 9643 1444,
fax (02) 9643 1264

U.S.A.: Medi USA, 78 W. Seegers Rd., Arlington Heights, IL 60005; (1800) 633 6334;
(847) 640 8400; fax (847) 640 0209.

Compression: Class I = 20-30 mm Hg; Class II = 30-40, Class III = 40-50; Class IV,= 50-60. Fabric: synthetic. A number of styles available

Manufacturer: Ganzoni, Groblistrasse 8, CH-9014, St. Gallen, Switzerland; fax 41+712 74 29 29

Australia: Morris Surgical, GPO Box 9, Brisbane, Q 4001; (07) 3357 5944; fax (07) 3857 0031.

U.S.A.: Sigvaris, Box 570, 32 Park Drive East, Branford, CT 06405; tel (800) 322 7744,
fax (203) 481 5488

In Australia, at present these are only available direct from Morris Surgical. Supply takes 10-14 days and the cost is about a 80% surcharge on the standard range. They are of a similar quality to the standard range. So far the garments have proved to be very satisfactory. They are knitted, with no seam. Their sizes will cover from about 12-35 cm at the ankle , with the thigh going up to 96 cm. The range covers all styles in the 503, 504 and 505 series, from just calf to full pantyhose. Full-body garments are not available. The arms are in the 504 range, in the standard styles, with or without gauntlet.

4^th. Floor, 251 Adelaide Tce., Perth, WA 6000; (09) 325 7055; fax (09) 325 7066.

Fabric: synthetic. Compression: unknown - possibly about Class 2 of Sigvaris. Not suitable for use for other than the lowest pressures. Any style, including full body suits can be made. Much effort is put into making the garments comfortable and æsthetically pleasing. These seem only suitable for mild lymph-œdemas of the arm, or in a child after C.P.T., or for helping to control the size of the limb without C.P.T.

Manufacturer: Viso Medical, 2072 Saint Blaise, Switzerland; 41+(32) 753 22 12; fax 41+(32) 753 43 94

Australia: Bar Med, 408 High St., Northcote, VIC 3070; Tel (03) 9459 0322, outside Vic: 1800 803 662; Fax (03) 9459 0499. Agents in all states.

Will make custom-made up to Class 3 (36-45 mm Hg) - see Standard Range. Delivery to Australia is 3 weeks. Cost is twice the standard.

Manufacturer: Salzmann, Unterstrassse 52, St. Gallen, CH-9001 Switzerland, 41+(71) 228 43 13; fax 41+(71) 228 43 10

Australia: Biomet, P.O.Box 348, North Ryde, NSW 2113; 1800 251 201, (02) 9878 6100, fax (02) 9878 6473

U.S.A.: Venosan North America, 718 Industrial Pk Ave, PO Box 4068, Asheboro, N.C. 27204/4068; (910) 672 6062; fax (910) 672 3969.

Venosan 2000 cotton blend available in all styles for legs and arms. Arm-sleeves with hand extension and thumb, heavy duty, durable, ointment resistant. Compression up to 49+mmHg. Full knit to groin, pantyhose special request for individual compression on each leg. Excellent quality very reasonably priced. 1000/4000 range class 1 and 2 (18-22mmHg and 25-32mmHg) available in all styles for legs only. Maximum 10 days on all made to measure. Venosan garments carry a 6 month warranty on compression and manufacturing faults.

Norma D.N.D. Products, Norma Complex, D.D.A. Market, J-Block, Vikas Puri, New Delhi - 110 018 Ph 91 11 562 4506, 07, 08, 554 6708 Fax: 091 11-552 1239. email: normadnd@vsnl.com
This company makes a full range of sleeves, stockings and body garments in elasticised pure cotton. Their garments are very cheap by western standards and of good quality. Compression ranges from 20-40 mg. Hg Classes 1,2 and 3.

Sr. Marie Doolan is an excellent Compression Therapy Consultant and Educator (310 Nicholson St., Fitzroy, VIC, Australia; Ph (03) 9486 9738, fax 9486 9850, email srmdln@aol.com). She has trained the following people in garment design , change and manufacture.

Janet Milne, PO Box 677 Traralgon Vic 3844 Ph (03) 5174 6863,

email stephen42m@netspace.net.au

Jenny Jensz, 5 Victoria St, Hamilton Vic 3300, Ph (03) 5571 0390,

email jnjensz@ansonic.com.au

Rachel Friebel, 43 Tyne Street, Box Hill North, Vic 3129, tel: (03) 8800 4429 mob: 0425 70 8490 email rachelfriebel@yahoo.com

Janice Pekin, 64 Oberon Drive, Belmont, Geelong Vic 3216, Ph (03) 5244 2871

Kay Porter, Compression Garment Alterations 144 Fairy St. Warrnambool 3280, Ph (03) 5562 7607 email porter@dansonie.com.au

While these are expensive, $(US) 250-400 (Standard) to over $(US) 1000 (Custom-made), because they last much longer than bandages or other garments (and can be adjusted as a limb reduces further), they are cheaper in the long-term. This, plus their ease and speed of application make them a very attractive alternative, particularly for night use. They will also give extra pressure if needed over an existing garment. Both only obtained from the USA.

Both sleeves and full-leg garments. These adjust circumferentially every few cms with adhering tapes. An undergarment of some kind, e.g. a Tricofix sleeve, is essential since they must not be worn next to the skin. Foam pads can be used in difficult areas, e.g. ankles or elbows, and for protection.

A very comfortable adjustable garment. Particularly suitable for use at night, since it is a little bulky because of padding. Sleeves and stockings available.