How does the ReidSleeve work?

Surgery and radiation can damage the lymphatic system, causing increased lymphatic pressure. This increased pressure can eventually result in the accumulation of lymphatic fluid in the interstitial tissue. The ReidSleeve utilizes special convoluted foam that provides a gentle, gradient counter pressure to the tissue. This design provides areas of high and low pressure so that effective pressure can be applied without obstructing venous or lymphatic outflow. This tissue gradient technology (U.S. Patent 5,91 6,183) increases the effective pressure in the tissue so that lymphatic and venous outflow is favored.


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Why is convoluted foam used?

The venous and lymphatic systems operate at low pressure. If the pressure applied to the limb is too high, the veins and lymphatics can be blocked. Blocking venous and lymphatic flow raises the venous pressure and increases backflow. To avoid this problem we have incorporated convoluted foam that provides areas of high and low pressure. The low-pressure areas insure that venous and lymphatic obstruction is minimized when pressure is applied to the limb.


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What is the advantage of using the compression gauge?

One of the problems of compression wraps is that it is very difficult to apply an appropriate pressure. Some areas are too tight and can obstruct venous and lymphatic outflow. Other areas can be too loose so that an effective pressure is not obtained. The compression gauge operates on the same principle as a blood pressure cuff and it allows the physician to determine the best pressure for each patient. For most patients we recommend using the lowest pressure that provides reduction in edema.


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Do I have to use the compression gauge every time I use the ReidSleeve?

No. An advantage of the ReidSleeve is that once this pressure has been determined, the sleeve is then marked with removable tags. The appropriate pressure can be reproduced and reliably obtained by simply slipping into the sleeve and adjusting the straps to these predetermined marks. As the patient improves and the edema is less, the pressure can be adjusted to maintain the pressure in the effective range.


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Why is low pressure recommended for treatment with the ReidSleeve?

Edema occurs when there is obstruction of lymphatic or venous outflow. High pressure can block venous and lymphatic pressure, causing increased backflow and can even worsen edema. The goal is to reduce tissue edema without blocking venous and lymphatic outflow. We recommend using the lowest pressure that provides an effective reduction in edema and maximizing the amount of time this pressure is used.


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Why are follow-up visits recommended?

Many patients experience significant reduction in edema in the first few days or weeks of treatment and the sleeve will become loose. Therefore, it is important to assess the improvement and readjust the compression into the effective range.


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Is the lymphatic system completely obstructed?

In most cases the lymphatic system is only partially obstructed. Generally, only a portion of the lymph nodes are removed during a surgery such as mastectomy. This leads to an increase in lymphatic pressure. The remaining lymphatic channels and collaterals are able to accommodate the lymphatic flow for most patients. Infections and radiation can further scar the lymphatics leading to further increases in lymphatic pressure. Eventually, as the pressure rises, backflow into the tissue can occur. In these pat ients, the lymphatic flow is insufficient although not completely blocked and edema results.


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What is the best time of day to wear the ReidSleeve?

Most patients prefer to wear the sleeve at night, although any time of the day is fine. For most patients who suffer from lymphedema, it is important to maximize wearing time. Leakage of fluid into the tissue occurs whenever effective counter pressure is not applied; therefore the best results are obtained when effective counter pressure is applied during as much of the day as possible.


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Can wearing time be reduced?

Many patients experience a significant reduction in edema when treated with the ReidSleeve and have found, when the edema is adequately controlled, they can go without compression during the day and not have a significant recurrence of their edema. These patients often find they can reduce the amount of wearing time and still maintain adequate control of their edema. The amount of wearing time required for adequate control during this phase of treatment depends on the patient and is best determined by the patient and their doctor.


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Can the ReidSleeve be shared between patients?

We do not recommend sharing. Patients with lymphedema are susceptible to skin infections and it is advisable to reduce exposure to potential sources of infection. Additionally, the ReidSleeve is custom manufactured to the patient's measurements. Effectiveness can be reduced if the sleeve is not the appropriate fit.


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Can the ReidSleeve be used with other treatments such as MLD, pneumatic pumps and compression stockings?

Yes. Many patients need several types of treatment to receive the maximum reduction in their edema. The ReidSleeve is designed to compliment many types of current therapy and can be effectively used in conjunction with these treatments. Patients require individualized treatment and are most effectively treated by the consistent application of a sound management program developed by their doctor or therapist.


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Is the ReidSleeve covered by insurance?

Yes, most insurance companies cover the ReidSleeve, providing the policy has benefits for durable medical equipment and all the required provisions are met.


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What is the recommended code for insurance?

Product coding should be verified with each carrier, Peninsula BioMedical makes no specific recommendations. While SADMERC has assigned A4465 for billing, most companies will allow miscellaneous codes to be used for reimbursement purposes.


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Is it possible for patients who have recurrent breast cancer with chest wall involvement/ brachial plexopathy to use the ReidSleeve for symptomatic relief of lymphedema? Would the pressure cause spread of the disease already in the lymphatics? Would increased pressure on the arm risk the breakdown and oozing of scabbed-over l esions already treated with radiotherapy?

Recurrent breast cancer, with chest wall involvement is one of the situations where we commonly see lymphedema. In these cases, the patients usually have had surgery and extended field radiation. As a result, they have a much higher incidence of lymphedema. Many patients in this situation have benefited from use of the ReidSleeve. Effective control of the lymphedema can actually reduce the overall pressure in the affected limb, resulting in improved healing. One of the advantages of the ReidSleeve in this setting is that the pressure can be adjusted and calibrated to the lowest effective pressure. By using the ReidSleeve in conjunction with the pressure gauge you can reduce the risk of further tissue breakdown. Since patients are all different, the final decision about the applicability of the ReidSleeve or any compression treatment should be made with your physician and therapist.


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In the treatment protocol you describe that a pressure of 15mmHg should be applied to the patients arm by means of the bladder and the compression gauge. How do you know that this is also the pressure that is applied on the patient's skin. Did you do any research in this field. How did you perform the skin pressure measuremen t, what kind of sensors were used?

Thanks for your question, it is a very good one. The bladder of the Precise compression gauge does not exert pressure. The purpose of the compression gauge is to measure the pressure exerted by the sleeve upon the skin. The bladder of the compression gauge rests upon the skin. As the pressure exerted by the sleeve increases, it applies increasing pressure to the bladder which is then registered as increased pressure on the gauge. As a result, the Precise compression gauge system measures the pressure exert ed by the Reid Sleeve upon the skin.


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I have been diagnosed with Congestive Heart Failure and have swelling in my feet and ankles is this lymphedema?

This is discussed in Dr. Reid's Corner.


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Is there any special treatment for an incipient infection at the cuticle of the finger of a lymphedemous upper limb that could avoid a raging cellulitis of the arm?

Infections are a common problem in lymphedema. Early treatment is important to prevent further injury to the tissue. Most doctors favor use of penicillins or cephalosporins and often prescribe these to patients to start at the earliest signs of an infection. For a review of this see below.

Vasc Med 1998;3(2):145-56
Lymphedema: classification, diagnosis and therapy.
Szuba A, Rockson SG



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I have fairly mild lymphedema of my right arm, hand and fingers, which developed 2 years after a mastectomy, node removal and radiation. About 1 month after the lymphedema developed, I noticed bumps developing on my fingers, especially the lower part of my index finger , near my thumb. I also feel small bumps on all the finge rs on the affected limb. What would cause this to happen?

Thanks for the question. It is very hard to determine from your description what is happening. Some patients will develop increasing skin thickness in involved areas, often called brawny edema. You would have to have this evaluated by your doctor.


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I had a mastectomy with lymph node dissection of the left breast. I have slight swelling in my left arm but I have continuous pain in my arm and left shoulder. I am waiting on the delivery of a compression sleeve at the durable medical office. My question is, can the pain and discomfort be alleviated by use of the compression sleeve or should I be searching for some other reason for the pain?

There have been a number of patients asking about the cause of pain in a limb affected with lymphedema. There are many causes of pain, so the answer is not simple. These causes include stress on the tissues, infection, thrombosis, phlebitis, pressure on connective tissue and muscle and other causes. The only person that can adequately diagnose your condition is your doctor. In cases where the cause of the pain is stress and pressure due to the edema, compression can be helpful. Especially, gentle pressure applied accurately as with the ReidSleeve. Pressure that exceeds the venous and lymphatic pressure of your limb can worsen the pain and can potentially cause additional damage to the lymphatic system.


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I have recently had a mastectomy. Is there any information with regard to air travel and Lymphedema? I might need to travel on very long flights, for example, 36 hrs to Europe from Australia. Any information would be greatly appreciated.

Please review the links provided on our Risk Reduction page. Flying is addressed. Risk Reduction.


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My son sprained his ankle and developed ankle edema, the doctor recommended ice therapy, should I consider using ice-packs for treatment of lymphedema.

Doctors commonly recommend ice-packs to treat edema due to acute injuries. So, I can see where you might think of it as a treatment for lymphedema. However, lymphedema is completely different from edema due to an ankle injury. In my opinion, the use of ice-packs has no role in the treatment of lymphedema. In fact, the use of ice-packs for the treatment of lymphedema maybe very dangerous because of the risk of tissue damage and frost-bite. When doctors use ice-packs to treat swollen ankles, the use of ice-p acks is limited to 15 minutes at a time and for no more than 1 to 2 days. The use of ice-packs for longer periods of time can cause tissue damage and frost-bite. The risk of tissue damage and frost-bite is likely to be much higher when patients with lymphedema are treated with ice-packs than when normal people are treated with ice packs. In lymphedema, the tissue is stretched and damaged and very susceptible to injury and infection. Treatment with ice causes vasoconstriction which deprives the tissue of mu ch needed oxygen and may worsen lymphedema in patients who already suffer from diminished and obstructed flow. In addition, the time it takes to restore normal blood flow and to re-warm the tissue will be much longer in patients with lymphedema, further increasing the risk of damaging the remaining normal tissue and making the lymphedema worse. The use of ice-packs for the treatment of lymphedema is not an accepted medical practice and I would not subject my patients to this risk without extensive, control led research to demonstrate safety.

For a review, see Ankle Injuries in Athletes by Leonard Wilkerson. PrimaryCare, 19:377.


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Is it possible to have lymphedema and not have visible swelling? Following a mastectomy and lymph node dissection my arm and side have been in pain for a 14-months. Doctor said he saw no swelling so no lymphedema. It FEELS like everything inside the arm pit and upper arm is swollen even if it doesn't look like it! Could the R eidSleeve help?

To have lymphedema, you would have to have some excess fluid. However, many patients do have discomfort in the affected arm that is often difficult to diagnose. Some patients benefit from compression, in fact, many have reported reduced pain with compression. So, I don't know if the ReidSleeve would help you. You could try one of the new OptiFlow CSs which are light and provide a moderate amount of compression. Alternatively, you could try one of the sleeve made by Juzo or Jobst.


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I have edema in my legs and feet, but I generally retain a lot of water anyway. Yesterday, I sprung a leak. Above the knee, inside my thigh, water started dripping out of my leg. It started yesterday morning and is still doing it. I had to put a cloth over it to keep it from getting all over the place. Is this normal? I'm wor ried because it's still doing it. I spent the day with my feet up, hoping that would help. Could you please tell me what this is all about? The hole is very tiny and can hardly be seen.

As the edema builds up, the pressure in the tissue causes stretching and weakening. I see this in my patients and suggest that you see your doctor about this change. Effective compression can help keep this from getting worse leading to skin breakdown and possibly infections. The Reid Sleeve has provided good results in this situation.


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In 1991, I underwent surgery in my left lower arm near elbow. Whenever I pressed the affected area, it was painful and it was like a cyst. Doctor called it, Hemangioma. It was not cancerous either after undergone biopsy. After two years, in the same area, the cyst like thing is again visible and it was also painful. For the s econd time around, I had an operation. This time, they called it Lymphoma. The 'cyst-like thing' was like a fat. They had it biopsied and it was found negative. Now, after 15 years, there's a swollen area beside the operated one and it is painful whenever I pressed. I noticed also that the skin coloring of the affected one is somewhat lighter than the surrounding skin. I am planning to consult my doctor about this. I am bothered. Is this Lymphedema? I noticed that treatment of this does not require surgery .

Thanks for your question. It is hard to tell from your description, but it sound like you have a lipoma, which is an accumulation of fat tissue and is not lymphedema. The treatment for a lipoma is to remove it surgically. You will have to consult your doctor to find out what the pathology studies show and make an accurate diagnosis.


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Can infections cause Lymphedema?

There have been several questions concerning the relationship between infection and lymphedema. The first appearance of lymphedema or significant worsening of lymphedema is frequently associated with the occurrence of infections. It is thought that these infections result in increased fibrosis of the lymphatic system, including the lymph nodes, resulting in increased lymphatic pressure, predisposing the patient to lymphedema. The growth factors involved in lymphatic and endothelial development can be alter ed in chronic or acute infections (see reference below and previous discussion of growth factors). In fact, worldwide, the most common cause of lymphedema is infection with parasites that cause obstruction of the lymphatic system. In some cases, even patients without prior surgery develop lymphedema after infections. One of the other situations where we see lymphedema with increasing frequency is among patients with HIV infections leading to Kaposi's sarcoma. The relationship between infections and lymphed ema is an area coming under increased scientific investigation. For now, it is important to contact your physician in the event of any infection of the affected limb. An ounce of prevention may prevent a pound of cure.

For further information on lymphedema and infection and growth factors see: Curr Opin Oncol 1997 Sep;9(5):433-9


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I have mild lymphedema as a result of mastectomy of the left breast, I would like to know more about the endothelial growth factor applied to lymphogenesis, who is working in that field, and if they are doing human trials?

See our eNews article here for a summary of growth factors for Lymphedema.


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Is lymphedema the same as edema?

No lymphedema is different from edema. Both result in swelling of the extremity but are due to different causes. Edema is due to increased fluid drainage into the tissue, but is due to injury or increased venous pressure. Lymphedema, in contrast, is due to lymphatic obstruction. The lymphatic channels drain the spaces between the cells. Lymphedema is generally due to an obstruction of the lymphatic outflow tract. This is generally caused by surgery, injury or radiation. Some patients have a genetic defect in the lymphatic channels and inherit a form of lymphedema.


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Just what exactly is edema? What causes it?

Read the question above on lymphedema vs. edema, and click here to view a more detailed discussion on lymphedema.


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How soon after surgery does Lymphedema happen? Can it happen years later?

Click here to read Dr. Reid's discussion of surgical management.


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Is lower extremity edema frequently caused by catherization of the femoral vein?

Procedures that involve the veins can result in a thrombosis. When this occurs, venous obstruction can result in edema of the extremity.


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