Guide Lymphology

medi Care Guide
Lymphology
Guidelines for lymphological compression care
March 2014
medi. I feel better.

2 medi Lymphology Care Guide
The lymphatic
system
Compression
Principles of
4 58
The lymphatic system Upper limbs
Contraindications
6 Lymphoedema 59 Available variants
10 Lipoedema 60 Possible combinations of
Indications /
the variants
62 Examples of garments
12 64 mediven models
Principles of compression 68 General notes on
measuring techniques
69 Measuring techniques
illustrated
15
Treatment
procedure
76 Arm accessories
Indications /
Contraindications
16
Treatment procedure
Lower limbs
82
Accessories
Upper limbs
82 medi lymph pads
84 Topband variants
85 Gusset variants
18
Lower limbs 86
19 Available variants
Causes / Solutions
Accessories
20 Possible combinations of Fitting problems

the variants
24 mediven models 94
36 General notes on The optimum
Solutions fitting
complaints procedure Headquarters

37 Measuring techniques medi GmbH & Co. KG
illustrated Medicusstrae 1
problems
50 Leg accessories 96 95448 Bayreuth

Germany
98L05 / 05.2014
FAQ Treatment T +49 921 912-0
F +49 921 912-57
of oedema / flat knit lymphservice@medi.de
www.medi.de/en
F.A.Q.
Lymphology
Care Guide
Hosiery that fits perfectly, that is as effective as possible, and is suitable for
everyday life is particularly important for lymphological diseases.
Naturally, our aim is always to improve the quality of life of people with
chronic illness. But costs also play a role.
The medi Care Guide will support you with all the facets of your illness and, in
combination with your own experience, offers you the best possible help.
It can be used both as a reference work and as a way of systematically
increasing your knowledge.
If you have suggestions or ideas for improving this guide,

please let us know. The medi Care Guide is continually updated and we are
looking forward to your input. This helps us match the content even more
specifically to your requirements.
We in the medi Lymphology team hope you will enjoy reading this guide
and wish you every success.
medi Lymphology Care Guide 3

The lymphatic
The lymphatic
system
system
The lymph vessel system Lymph nodes
Compression
Principles of
Fluid from the blood passes from the blood capillaries Lymph nodes can be found in various sizes and
(blood vessels) into the interstitial space (tissue numbers in many parts of the body.
between the cells), where it supplies the bodys cells They act as filters for harmful substances. It is in
with nutrients, oxygen and hormones. Approximately the lymph nodes that lymphocyte production is
90 % of the plasma is then hoovered up by the completed. Lymphocytes are classified as white blood
capillaries. cells and form part of the bodys defence system.
Contraindications
The remaining 10 %, interstitial fluid together with

Indications /
protein, pathogens, cancer cells, dust and dyes, is

known as the lymph-obligatory load. In the
abdomen, this material is then joined by fatty
molecules from the gut.
This lymph-obligatory load is absorbed by the lymph
sinuses (from this point onwards it is known as
lymph) and transported via precollectors, collectors
and lymph nodes to the lymphatic trunks.
Treatment
procedure
From here it enters the bloodstream, principally via

the thoracic duct, which is located between the vena
cava and the heart.
Healthy adults produce between two and four litres
of lymph a day.
Lymph sinus
Lower limbs
Lymph nodes
The lymph sinuses project into the interstitium (tissue
between the cells) like fingers. The lymph-obligatory The route taken by lymph through the body
load is absorbed through pores.
The sinuses empty into precollectors which, in turn, Lymph fluid is transported by means of several very
drain into the larger lymph vessels (collectors). different mechanisms. The collectors and lymphatic
trunks have muscle cells in their walls and valves.
Upper limbs
The section between two valves is known as a

lymphangion. This acts as a lymph heart and, with
its rhythmic contractions and relaxations (six to ten
times a minute), allows the lymph to flow towards the
heart.
This transport mechanism is assisted by muscle
movements and the heart beat. It is also assisted by
Accessories
respiration, which generates negative pressure in the

chest, and by the pulsations of the neighbouring
arteries.
The lymph flows through numerous lymph nodes.

These contain lymphatic tissue and various cells, such
Solutions fitting
as B and T lymphocytes and macrophages, that

destroy the bodys enemies and forms antibodies to
problems
these. As the lymph flows very slowly, there is

Lymph sinus in the interstitial space (tissue between sufficient time for it to be purified.
the cells)
F.A.Q.
4 The lymphatic system medi Lymphology Care Guide

The lymphatic
system
1
1
Compression
Principles of
2 13
3
5 4 14
4 6
15
Contraindications
7
Indications /
1
Median sagittal watershed
10 10
8 2
9
Supraclavicular watershed
12 3
12
11 Junction of the thoracic duct
and venous angle
4
Treatment
procedure
Interaxillary anastomosis
5
Axillary lymph nodes
6
Suprascapular watershed
Lower limbs
7
Thoracic duct
8
Cisterna chyli
9
Transverse watershed
10
Upper limbs
Axillo-inguinal anastomosis
11
Inguinal lymph nodes

12
Interinguinal anastomosis
The lymph nodes play an important The lymph from the other three
13
role in defending the body against quadrants is taken back to the blood by
Superficial cervical lymph
Accessories
infection. the thoracic duct behind the left nodes

Anatomically speaking, the body can be collarbone. Here the fat-containing
14
divided into four quadrants, each with its lymph from the gut area (chyle),
Axillary lymph nodes
own direction of lymphatic drainage. produced by the digestive process in the
The quadrants (Latin, quadrans = small intestine, also returns to the blood 15
quarter) are separated from each other circulation. Axillary lymph plexus
Solutions fitting
by what are known as watersheds.

The lymph from the upper right quadrant
problems
flows through the lymph trunk on the

right behind the right collarbone and
into the circulatory system.
F.A.Q.
medi Lymphology Care Guide The lymphatic system 5

The lymphatic
What is Signs of lymphoedema Explanation

system
oedema?
*1 C DT = Complex
1. Gradual swelling of a limb, rarely decongestion therapy
*2 S temmer = Varicose vein
of several limbs specialist from Strasbourg
2. A feeling of heaviness at the affected ()
Oedema develops when fluid *3 M
RI = Magnetic resonance
accumulates in the tissues. site imaging
Compression
Principles of
This swelling can be seen and felt. 3. Positive Stemmers sign*2: the skin on
Oedema is either limited locally the second toe or finger cannot be
or it affects the whole body. raised between two fingers, instead
The word oedema is used to describe it feels taut and hard
a symptom, it is not a diagnosis! 4. Initially the skin pits when pressed
Contraindications
with a finger at the affected site

Experts distinguish between localised
5. The natural skin folds around the
Indications /
oedema, e.g. swelling of the eyelids,

joints become much deeper
swelling of an arm or leg, and generalised Stemmers sign: left side
oedema, in which the entire body is 6. At later stages, hardening (fibrosis) positive, right side negative
swollen. Of the numerous forms of of the affected site
oedema, lymphoedema, lipoedema and
phleboedema are most important for
compression therapy.
Treatment
procedure
Lymphoedema Diagnosis
Doctors with experience in lymphology

Lymphoedema develops when the can usually recognise which type of
lymphatic system can no longer fulfil oedema it is from the patients history
the function described above. and by inspection and palpation (feeling
Lower limbs
the surface of the body).

Lymphoedema consists of accumulated
fluid in the tissues, mainly in the limbs Modern medical imaging technology,
and occasionally throughout the body. such as ultrasound, indirect
lymphography, lymph scintigraphy and
Protein-rich oedema MRI*3, may be used in some cases, if the
is reorganised into tissue by the blood clinical picture is unclear and to rule out
proteins over the course of time. This malignant processes.
Upper limbs
eventually results in an increase in

connective tissue, which, without
treatment (CDT *1), sooner or later
becomes hardened.
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
Why does The course of the disease is divided
system
into various phases:
lymphoedema Stage 0 subclinical stage
develop? Damage to the lymph vessels, no visible
or palpable oedema.
Compression
Principles of
There are basically two types of
lymphoedema:
Stage 1 reversible stage
The soft oedema appears over the course
1. P
rimary lymphoedema is
of the day and is reduced or disappears
congenital.
entirely when the limbs are elevated.
Contraindications
In this case, some areas of the
The tissue pits when pressed and the
lymphatic system show defective
area holds the indentation for a short
Indications /
development.
time.
Although damage is present, there is
often little or no sign of primary
lymphoedema before puberty.
Stage 2 spontaneously irreversible
Hormonal changes lead to a more
stage
pronounced tendency for oedema and
The oedema persists even after
an increase in the lymph-obligatory
prolonged periods of rest. The skin is
load. The limited capacity of the
Treatment
procedure
often already fibrotic (hardened) and not
lymphatic system to transport it away
even elevation reduces the swelling.
is no longer adequate oedema
There is little or no pitting when the skin
develops and eventually becomes
is pressed.
evident.
Stage 3 lymphostatic elephantiasis

2. Secondary lymphoedema results
Lower limbs
Complicated swelling characterised by
from various conditions:
gross skin changes and fibrotic tissue,
The removal of lymph nodes in the
which may be wart-like or take the form
course of cancer surgery
of small blisters or fistulas which leak
Damage to the lymphatic system
lymph, sometimes resulting in huge
as a result of surgical interventions
swellings.
Radiotherapy
Infections with bacteria, fungi
Upper limbs
Source of photographs:
or tropical nematodes (filariasis) Lympho-Opt-Klinik,
Injuries Hohenstadt
Burns
Lipoedema
Complicated bone fractures Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Treatment
system
The fact is that consistent treatment compliance is the only way to prevent
lymphoedema from worsening.
Compression
Complex decongestion therapy (CDT *1) is the tried and tested first-line therapy in the
Principles of
treatment of lymphoedema.
By increasing drainage this removes the lymph congestion to reduce the swelling and
stimulates the activity of the bodys lymphatic system.
It may also serve to eliminate pre-existing connective tissue fibrosis.
Contraindications
Indications /
CDT phase 1 Decongestion phase

Depending on the stage of the disease, this is performed either in an outpatient setting
or in hospital.
1. Manual lymphatic drainage (MLD*3) daily, several times if needed
2. Skin care / hygiene
3. Subsequent compression bandaging with short-stretch bandages
4. Exercise
Treatment
procedure
5. Healthy diet and, if necessary, weight reduction

6. Psychological care / self-motivation
In addition, the use of intermittent mechanical compression (IMC*2) can have a
positive effect on lymphoedema and its sequelae. Magnetic-field, ultrasound, ozone
and CO2 therapy are also used in some cases. A slimming diet is also frequently
necessary, as obesity leads to a worsening of the oedema.
Lower limbs
CDT phase 2 Maintenance phase

1. MLD*3 one to three times a week (depending on the stage) and compression bandaging
with short-stretch bandages
2. Skin care / hygiene
3. Subsequently wearing flat knit compression garments
4. Exercise
Upper limbs
5. Healthy diet
6. Self-motivation
Accessories
Explanation
*1 C DT = Complex
Solutions fitting
decongestion therapy
*2 I MC = Intermittent
mechanical compression
problems
*3 M
LD = Manual lymphatic
drainage
F.A.Q.

The lymphatic
Compression garments
system
The prescribing doctor decides on the model and compression
class (CCL*5).
Compression
Stage 1
Principles of
The light flat knit model mediven sensoo
is recommended for firm connective
tissues. In many cases, care with the
models mediven mondi or mediven 550
leg, CCL 2, may be necessary from this
Contraindications
stage onwards.
Indications /
Source: Hanse-Klinik Lbeck
Stage 2
The main requirement for everyday life
and sport at this stage is wearing a flat
knit compression garment daily such as
mediven mondi (limited) or mediven 550
leg in compression class CCL 2 or 3.
Treatment
procedure
Source: Lympho-Opt-Klinik,
Hohenstadt
Stage 3
Consistent wearing of a flat knit
compression garment, i.e. mediven 550
Lower limbs
leg in CCL 2, CCL 3 or CCL 4, or double
hosiery (with a lower level of
compression) is essential.
Before decongestion
Upper limbs
Decongested with
Accessories
compression garments
Source: Lympho-Opt-Klinik,
Hohenstadt
Compression class CCL 1 is indicated*4 for the Explanation

following additional indications:
*4 Indicated = Medically
Solutions fitting
Arterial circulatory disorders useful

For paralysis *5 CCL = Compression class
After bypass surgery
problems
In stroke patients For further information

Joint problems (e.g. rheumatism,
Indication chart
osteoarthritis)
See page 98 for flat knit
When treating children
F.A.Q.

The lymphatic
Lipohypertrophy and lipoedema

system
Attention
Lipohypertrophy Lipoedema
Lipoedema is a painful
disorder of fatty tissue
Lipohypertrophy is a disorder of fatty This condition usually worsens over the distribution that causes
Compression
tissue distribution that affects both legs course of the years. In advanced stages, many symptoms.
Principles of
and is not diet-related. lymphoedema may also develop. Lipohypertrophy is a

This phenomenon was first described in Lipoedema occurs both in overweight painless disorder of fatty
the 1940s by the Americans Allen and women and in slender women. The latter tissue distribution.
Hines. have a slender upper body and slim hips,
whereas their legs are much enlarged.
Contraindications
The swelling extends from the iliac crest

Explanation
to the knees or ankles while the feet are Lipohypertrophy can develop into
Indications /
normal. lipoedema at any time. *1 P rogression means the

worsening of a disease
In rare cases, the arms are also affected. Lipoedema is a chronic disease with a *2 A namnesis = Greek, the
Lipohypertrophy of the limbs is seen progressive*1 course. patients medical history
almost exclusively in women. It is taken by the doctor with
regard to the current
therefore suspected that the cause of this In most cases, the attending physician disease
congenital replication of fatty tissue may will only be able to make a diagnosis by *3 I nspection = Latin,
be due to the effects of oestrogen. taking the patients medical history*2, examination and palpation
of the external appearance
inspection*3 and palpation*4.
Treatment
procedure
*4 p
alpation = Latin, feeling
If there is no other sign of obesity, the the surface of the body
difference between the slim face and
upper body and the proportionally
oversized hips and legs is often clear
Classification by location:
at first glance. The legs are funnel-
shaped or columnar, and only the thigh, Type I: Fatty tissue accumulation in the area of the buttocks and hips
saddlebags
Lower limbs
the buttocks or the lower leg may be

Type II: The lipoedema extends as far as the knees. Accumulations of fat in
affected. In particular, there are often the inside knee area
swellings on the insides of the knees. Type III: The lipoedema extends from the hips down to the ankles
Type IV: Affects the arms and legs
The onset of lipohypertrophy is usually
Classification by severity
gradual, depending on the course of
Stage 1: Orange peel skin; surface smooth in some areas, finely nodular
hormone changes in puberty, during elsewhere
pregnancy and sometimes during the
Upper limbs
Stage 2: Mattress skin, coarse modular skin surface with considerable

menopause. pitting
Stage 3: Additional large, disfiguring fat deposits
Those affected often suffer
psychologically as a result of their figure, Accompanying problems:
but have no objective symptoms. Dull, swollen sensation and sensitivity to touch or pressure. This can
The progression of lipohypertrophy is become so acute that even crossing the legs can be uncomfortable.
genetically determined and cannot be Many of those affected also describe the pain as a bursting pain. The
Accessories
predicted. many descriptions are very individual and cannot be classified. If the
disease progresses further, large bulges of tissue also develop on the
thigh and inside of the knees. This results first in a knock-knee
posture and second presents an obstacle to walking.
Solutions fitting
problemsF.A.Q.

The lymphatic
Treatment Stage 2 lipoedema
system
At this stage, the most important
The guidelines recommend a measure is wearing a flat knit
combination of conservative and compression garment every day, such
surgical measures. as mediven 550 leg or mediven mondi,
The former comprise MLD*6, compression, for everyday activities and during sport.
Compression
Principles of
exercise and, if necessary, a diet aimed at MLD*6 and IMC*5 or liposuction are
reducing any accompanying obesity. supplementary forms of treatment. Stage 1 lipoedema
Intermittent mechanical compression is
also used in lipoedema. Stage 3 lipoedema
Conservative treatment may alleviate CDT *4 is invariably successful in stage 3
the oedema and accompanying lipoedema with disfiguring fat deposits,
Contraindications
problems. Surgical interventions (as in lymphoedema).
involving liposuction can reduce the Compression bandaging requires
Indications /
abnormal fat deposits and normalise fat additional foam padding in the calf
distribution. region if the patient is experiencing
Every operation entails certain risks. pain. At this stage, wearing a flat knit Stage 2 lipoedema
Liposuction is the best currently available compression garment (e.g. mediven 550)
medical procedure for halting the consistently is indicated.
progression of lipoedema before the
lymphatic system is also damaged (after
Treatment
procedure
several years or even decades).
Lip-Lymphoedema
Here the capillary structure of the

Stage 3 lipoedema
lymphatic system has been compromised
and damaged over a number of years by
Compression garments fibrosis of the fatty tissue (due to
Lower limbs
untreated lipoedema).
Stage 1 lipoedema The combination of lymphoedema and
The light flat knit model mediven sensoo lipoedema is treated in accordance with
is usually adequate here. the therapeutic guidelines for
It is important that these should also lymphoedema, accompanied by MLD*6,
be worn during sporting activities compression, exercise physiotherapy and Lip-Lymphoedema, before
(all types of endurance sports such skin care. decongestion
Upper limbs
as cycling, walking, aerobics, training Treatment is also supported by efforts to
on a treadmill). Of course, the models reduce weight.
mediven mondi and mediven 500 can
also be used from this stage onwards.
Phlebo-lymphoedema
Phleboedema is a form of oedema caused

by venous disorders, whereby varicose
Accessories
veins*7, deep vein thrombosis or Lip-Lymphoedema,

Explanation superficial phlebitis*8 result in damage to decongested
* 4 CDT = Complex
the veins and venous valves.
decongestion therapy
* 5 IMC = Intermittent
mechanical compression
Solutions fitting
* 6 MLD = Manual lymphatic

drainage
* 7 Varicosis = Varicose veins
problems
* 8 Phlebitis = Inflammation of
a venous vessel
Lip-Lymphoedema, with
Hanse-Klinik, Lbeck
F.A.Q.

The lymphatic
Principles of compression
system
There are few forms of treatment The physics of compression

that have such a high proven level of
efficacy as compression and this We distinguish between two types of
Compression
treatment has no side effects. compression:

Principles of
The preconditions for this are a clear Concentric compression is that exerted
indication and correct selection of the by the circular pressure on a part of the
type of compression. body, as in compression stockings and
Eccentric compression - add
The effect and importance of bandages. padding
compression has been proved by
Contraindications
scientific studies and measurements. Eccentric compression is a local

This is the basic treatment for many increase in pressure (see Increasing
Indications /
individuals with diseases of the the padding) or smoothing out of

venous and lymphatic systems. anatomical irregularities, e.g. at joints
(see Decreasing the padding). Very high
In addition to providing some of the basic compression develops over projections
principles of compression therapy, we with a small radius such as the edge of
shall deal here with frequently asked the foot, the edge of the hand, the ankles, Eccentric compression -
questions, such as: and the shin. remove padding
Treatment
procedure
Why is the pressure in a glove greater

over the edges of the hand than over the The LaPlace equation*1 P=T/R
oedematous back of the hand?
Which method of compression is best? Compression acts on the arm or leg in
What is the difference between resting accordance with the LaPlace equation: A C
and working pressure? The pressure exerted by the stocking or
Lower limbs
What is the difference between round bandage is proportional to the tension

knit and flat knit stockings? of the elastic material and inversely
P = pressure exerted by the B
proportional to the radius of curvature.
bandage
In other words: if the tension is
T = Tension
Definition: compression means constant, the pressure decreases as R = Radius
pressure the circumference increases. When the
radius becomes smaller, the pressure
We distinguish between elastic and increases.
Upper limbs
non-elastic compression, which is C

applied under tension to part of the body. In practice this means:
This surface exerts pressure that is Uniform pressure distribution would
transmitted to the underlying tissue. only be possible if the leg / arm (A) were
ideally cylindrical. Very high compression B
Pressure units: develops over projections with a small Pressure: B > C

kPa = Kilopascal (1 kPa = 7.5 mmHg) radius, such as the edge of the foot,
Accessories
mmHg = millimetres of mercury ankles and shin (B).

Attention
(1 mmHg = 0.133 kPa)
On even surfaces such as the
dorsum of the foot, the back
of the hand, behind the ankles
etc. (C), there is little or no
compression.
Solutions fitting
Explanation
problems
*1 P
ierre-Simon Marquis de
Laplace (1749-1827) =
French mathematician and
astronomer
F.A.Q.
12 Principles of compression medi Lymphology Care Guide

The lymphatic
Means of compression Working pressure / Resting pressure:
system
The choice of the various forms of Resting pressure
compression should be made very Resting pressure is the pressure
carefully at the start of therapy. constantly exerted by compression alone
It depends on the stage of the disease when the muscles are resting.
Compression
Principles of
and on whether the patient is in the
decongestion phase or the maintenance Working pressure
stage. Working pressure is the pressure actively
exerted by the muscles from within the
The following are used: limb against the bandage or stocking. The Resting pressure
Compression dressings harder the muscle works and the less the
Contraindications
Compression garments compression garment gives, the higher
Intermittent mechanical compression the working pressure. High pressure
Indications /
develops during muscle contraction
Compression bandages (systole) and low pressure during muscle
are available with various levels of relaxation (diastole).
elasticity.
These are used: With long-stretch bandages and elastic,
During the decongestion phase round knit stockings, however, the
When compression hosiery is not yet pressure alters very little during muscle
Treatment
procedure
available activity.
In cases of weeping eczema and skin Working pressure
inflammation Summary: the firmer (less elastic) the
When compression stockings alone are bandage or the stocking, the better
not sufficient the effects in the deeper regions of
For open wounds the leg.
Explanation
Lower limbs
After the decongestion phase, there Partsch*2 : The decisive factor is that *2 P
rof. Hugo Partsch MD,
should be a seamless transition to the compression therapy first achieves its full Specialist in dermatology,
compression stocking, in order to effect when interacting with appropriate Vienna
maintain the successful decongestion activation of the venous leg pump. This
already achieved. is achieved in mobile patients with
consistent gait training while repeated
Compression machines and generous plantar and dorsal
Upper limbs
are frequently prescribed if the Phase II flexion of the ankle is recommended for
CDT alone is not sufficient. bedridden patients.
In lymphoedema, such equipment should
be used only in combination with manual
lymphatic drainage, as fibrosis can
otherwise develop at the root of the
limbs.
Accessories
If the health insurance company has paid

for equipment of this kind, this often
wrongly results in the discontinuation of
reimbursement for manual lymphatic
drainage!
Solutions fitting
problems
F.A.Q.
medi Lymphology Care Guide Principles of compression 13

The lymphatic
Compression therapy difference between

system
round and flat knit

Factors such as working pressure, wall stability and micromassage are decisive in the
Compression
treatment of oedema. The elasticity of the knitted fabrics should be the same as the
Principles of
elasticity of short-stretch bandages. Only flat knit compression stockings have these
properties. Equally important is matching the fit of the garments to the limbs, which
are often deformed.
The action of flat knit compression garments:

Contraindications
Reduce oedema by displacing fluids in the interstitial tissues

Reduce venous pressure
Indications /
Reduce lymph-obligatory load in the interstitial tissues

Increase lymph production
Increase lymph transport capacity
Differences Round knit compression stockings Flat knit compression stockings

Treatment
procedure
Lower limbs
Seam seamless seamed

Knit knitted on a circular cylinder knitted in a flat row
Number of uniform variable
stitches
Shape Shaped by variable mesh size & pre-tensi- Shaped by variable number of meshes,
on of the weft thread weft thread is inlaid
Upper limbs
Stretch high low

Accessories
Weave not covered covered

Working low high
pressure
Effect Effect on vessels veins Primary effect: increase tissue pressure,
Solutions fitting
secondary effect on the vessels

problemsF.A.Q.
14 Principles of compression medi Lymphology Care Guide

The lymphatic
Indications for flat or round knit
system
compression hosiery
Please note!
Made to measure flat knit Contraindications
compression garments are now the These recommendations
Compression
Principles of
are based on decades of
gold standard in lymphological Absolute contraindications experience.
therapy and must be correctly fitted Advanced peripheral arterial occlusive A rigid, indication-related
by a specialist. The necessary fit and disease allocation of compression
classes is not helpful.
therapeutic effectiveness (working Heart failure in decompensation The general aim is an
pressure, micromassage, wall Oedema associated with heart failure improvement in the clinical
Contraindications
stability) can only be achieved in this Septic phlebitis findings.
way, because of the anatomy of these Phlegmasia coerulea dolens
Indications /
forms of oedema. Made to measure Scleroderma (sources*2)
Explanation
round knit garments should only be
used for lymphoedema in justified Relative contraindications *1 A
OD = Arterial occlusive
disease
exceptional cases. Erysipelas *2 A
WMF (Working Group of
Marked weeping dermatitis Scientific Medical
Intolerance of compression stocking Societies)
S2 Guideline Medical
material compression garment
Severe sensitivity disorders of the limbs S1 Guideline Diagnostic
Treatment
procedure
Indication with respect to Advanced peripheral neuropathy investigations and therapy
of lymphoedema
compression class Diabetes mellitus
Primary chronic polyarthritis
Compression Class 1 Sudecks atrophy (sources*2)
may be indicated in justified exceptional
cases:
Medical Indications: Oedema resulting Risks and side effects
Lower limbs
from inactivity (neurological deficits), Badly fitting medical compression
early AOD*1, children, cardiac stockings can cause skin necrosis,
comorbidities, Sudecks atrophy, pressure damage to peripheral nerves
patients with rheumatism, diabetic and deep leg vein thrombosis.
complications, for care at night
Patient-related indications: physical
disabilities Indication for compression pads
Upper limbs
Compression Class 2 Compression pads are used specifically
Lymphoedema of the arm stage I II in problem areas, e.g. in the region of the
Lymphoedema stage I malleolus (joint region), over the back of
Lipoedema stage I-II without oedema the hands or feet, in order to distribute /
and signs of lymphostasis (signs of increase the pressure more effectively.
lymph pooling) Silicone and foam materials are used
Accessories
for the pads, which can be individually

Compression Class 3 manufactured and / or fitted.
Eccentric padding out
Stage III arm lymphoedema, without These pads can be inserted as liners or
secondary diseases placed in pockets.
Lymphoedema stage II
Lipoedema stage II For further information, see pages
Solutions fitting
54 and 78.
Compression Class 4
problems
and / or double compression garments

Lymphoedema Stage III
F.A.Q.
medi Lymphology Care Guide Indications / Contraindications 15

The lymphatic
Treatment procedure
system
Tip
Treatment procedure for patients with lymph- and lipolymphoedema
It is essential to document
the body measurements in
the following situations:
1. Diagnosis and prescription of 4. The right time to measure for Determine of the best time
Compression
Principles of
initial garment and replacements compression garments to measure for the garment
Lymphological compression garments The limbs should not be measured Dealing with fitting
problems
are prescribed by the doctor treating until decongestion has been achieved Comparative measurement
the patient, who determines the in consultation with the lymph for spare and replacement
required model (including any therapist concerned and the doctor garments
A ssessment of garments
possible necessary accessories and treating the patient.
Contraindications
supplied after changing the

the CCL*1). The appointment for measurement person providing care / CPO
Indications /
should always be arranged in carrying out the

measurements
2. CDT*2 in accordance with the collaboration with the therapist
guidelines of the Lymphology Quality concerned and should not be before This can be done with the aid
Circle of the German Association of approximately 80 % MLD*3 has been of our software LymphVis
please contact your medi
Statutory Health Insurance Fund achieved. sales representative.
Accredited Physicians (see Article in
Lymph-Forsch, Jungkunz 1 / 01, The measuring itself is carried out Attention
Ambulante Betreuung directly after MLD in the To avoid jeopardising the
Treatment
procedure
lymphologischer Patienten physiotherapists practice or by the treatment outcome,

[Outpatient care of patients with specialist retailers. bandaging must be continued
after measuring until delivery
lymphoedema]). However, at the special retailer the of the compression garment
need to bandage the limb after and the made to measure
3. Advisory consultation with the completion of the measurements compression garment must
be available immediately
patient on receipt of the can be an issue. after CDT1.
prescription instructing the Alternatively, measurements can also
Lower limbs
patient on the garment provided be taken three to four hours after Explanation
After taking the history (for the MLD with compression bandaging *1 CCL = Compression class
appropriate form, see section (with exercise therapy in the *2 CDT = Complex physical
History form on the CD) and meantime). Always record the skin decongestion
therapy
photographic documentation, measurements in addition to the *3 MLD = Manual lymphatic
determine the model, manufacturer measurements taken under tension. drainage
and the grade required. Explain the
Upper limbs
style of hosiery (e.g. pantyhose or Then complete the history form and
2-piece garment and the necessary record the progress of the treatment
accessories). Any modifications that to date with photographs.
might be required should only be
carried out after consulting the 5. Ordering the garment
prescribing doctor. Fax the completed measurement
You can then inform your patient sheet to us with:
Accessories
about the costs and the statutory T

he required delivery date and
contribution that has to be paid. T he name and telephone number
At this point, you should determine of the employee placing the order,
the measurements and enclose the to +49 (0) 921 912 540
cost estimate if applicable. We will be pleased to
For complex garments, please mail the advise and help you with
Solutions fitting
photographic documentation to: complex cases.

export@medi.de. Photographic
problems
documentation is also
very helpful here.
F.A.Q.
16 Treatment procedure medi Lymphology Care Guide

The lymphatic
system
6. Checking goods on receipt by the 10. Alls well that ends well Tip
specialist retailer Obtain your final Fit OK by Patients with oedema need
This is carried out by the person who telephoning the patient, arranging for time to adjust to their new
placed the order, who verifies that the the patient to telephone you, or at a garments.
Patients with their first
Compression
goods supplied are identical with final acceptance appointment on
Principles of
compression garments often
those ordered (CCL, colour, all the specialist retailers premises. You only notice problems in
accessories included, correct should preferably arrange the everyday life after they have
worn and washed their
garment model) delivery date for the next garment in hosiery a number of times.
good time send the order for the You may report problems with
7. Arranging the appointment for spare garment immediately after / at fit etc. to medi Customer
Contraindications
Services within the first eight
fitting on the suppliers premises Fit OK. Send the order for weeks after delivery.
Fitting should ideally take place replacement garments after five Use this service and give your
Indications /
directly after MLD on the specialist months at the latest. patients the opportunity to
familiarise themselves with
retailers premises, on the their mediven garments.
physiotherapists premises, or during Take new measurements for each
a home visit. lymphological compression garment
and make sure the documentation is
8. Fitting the garment complete.
The patient is instructed in the
correct procedure for donning and
Treatment
procedure
Treatment recommendations
doffing the garment (see Tips for
Donning and Doffing CD), and the Shortening of the therapeutic
fit is assessed using the trial protocol effectiveness and working life in
(for form, see Trial protocol CD) and comparison with phlebological dressings
photographic documentation should is unavoidable because of the higher
be recorded (please always send in pressure of the lymphological garment.
Lower limbs
the event of fitting problems). Therefore, in many cases, the product
will need to be replaced after just three
A final fit assessment, however, is to four months, or after six months at the
only possible after wearing and latest.
washing at least three times.
Any special features that are For hygienic reasons and in order to
necessary (e.g. padding materials, ensure the continuity of the
pads prefabricated or individual
Upper limbs
treatment, a spare garment is
can now be adjusted, their position absolutely essential in compression
marked and incorporated. therapy.
9. Handover Documentation forms

You should give your patient detailed
instructions for handling her new The patient file should contain the
garment when it is first supplied. following:
Accessories
Instructions for washing and the 1. Medical prescription (copy for the
necessary skin care are particularly records), documentation and
important. monitoring sheet
Also general tips (see Tips for
2. Inspection report (case history form)
handling CD) will help your patient
to achieve even more successful 3. S chematic drawing for additional
Solutions fitting
treatment in everyday use. This information (e.g. position of

should also be recorded in the ulcerations)
problems
Handover Report (for form, see 4. P

hotos (if applicable on a CD or note
Handover Report CD) with fit on file)
feedback within 10 14 days. 5. Measurement sheets
6. Record of fitting and handover
F.A.Q.
medi Lymphology Care Guide Treatment procedure 17

Solutions fitting Treatment Indications / Principles of The lymphatic
F.A.Q. problems Accessories Upper limbs Lower limbs procedure Contraindications Compression system
18 Lower limbs medi Lymphology Care Guide

Lower limbs
The lymphatic
Versions available
system
For a lot of individual hosiery possibilities
AA1-toe cap AB - sock & AB1- sock AD-stocking AF-stocking

& AG - stocking
Compression
Principles of
AA1 AB AB1 AD AF AG
Contraindications
Indications /
I ndividual toe cap for use A s double stockings to Single stocking Single stocking
at night increase pressure A s a double stocking to A s a double stocking to
I n combination with other increase pressure in increase pressure in
garments combination with a combination with
pantyhose or knee-length pantyhose
stocking I n combination with
I n combination with Capri Bermuda shorts (ET shorts)
shorts (CT shorts) as a as a two-pieces garment
two-part garment
Treatment
procedure
AT- Pantyhose ATE - Pantyhose ATU - Maternity panty CT- & B1T - Capri shorts
& ATH -men's leotard with one leg
AT ATH ATE / ATU CT / CTH
ATEH B1T / B1TH
Lower limbs
For unilateral I n pregnancy A s a double stocking to
lymphoedema up to and increase pressure in
including the affected combination with an AG
lower torso quadrant stocking
I n combination with an AD
Upper limbs
stocking as a two-part garment
BT - leggings ET- & FT- Cycling shorts Cuffs Attention

BT / BTH ET / ETH BG CG All mediven leg garments
FT / FTH are supplied with an oblique
border at the proximal*1 end
and at the foot as standard!
Accessories
A
s a double stocking to In combination with an AD A
s a double stocking to
increase pressure in stocking as a two-part increase pressure in
combination with an AD garment combination with an AD
Solutions fitting
or AG stocking In combination with an AD stocking as a two-part

stocking and a BG cuff as a garment
three-pieces garment A
problems
increase pressure in
combination with an AD
stocking and cycling
shorts as a three-part
garment
F.A.Q.
medi Lymphology Care Guide Lower limbs 19

The lymphatic
Possible
system
combinations
of the versions
Compression
Principles of
Lymphological treatment with compression

garments does not always involve a pair of
stockings or pantyhose.
We distinguish between multi-part hosiery and
double garments. AG + FT
Contraindications
Indications /
Multi-part garments
Patients being fitted with multi-part hosiery must
always be assessed individually. Due to the
anatomical features of the clinical picture, some of
which can be extreme, therapeutic efficacy and the
fit can only be achieved by dividing the hosiery into
several segments. The doctor is responsible for
Treatment
procedure
treatment and may have to justify the need to the

statutory health insurers.
AD + CG + FT AD + CT
The need arises primarily from the anatomical

conditions:
Important points to observe when measuring
Formation of deep skin folds or pads of tissue
for multi-part garments:
Pronounced natural skin and joint folds, e.g. in the
Lower limbs
hollow of the knee

Use a separate measurement sheet for each
Pads of tissue hanging down over joints
compression garment segment, because the same
Conical and funnel-shaped limbs
measuring points often differ with regard to size and
Unusual shapes
position in the overlap zone. Furthermore, different
Elephantiasis
accessories are usually necessary for the different
types of hosiery.
Multi-part hosiery provides for more practical
Upper limbs
handling in everyday life, e.g. donning and doffing.

Move the distal measuring point for Capri shorts,
Particularly patients with limited mobility or physical
Bermuda shorts and leggings to an ideal suspension
strength gain quality of life from being able handle
point (anatomical suspender) to prevent the
their compression garments themselves this
garment slipping proximally.
ensures compliance!
The continuous pressure gradient must be
maintained in order to guarantee optimum lymphatic
Accessories
return and avoid pooling and constriction. If

necessary, regulate this at the overlap zone with the
measurement under tension. Order part of the
overlapping garment as porous in order to ensure
the optimum pressure gradient and a homogeneous
Solutions fitting
transition.
problemsF.A.Q.

The lymphatic
Double compression garments
system
Double compression garments are used to increase
the compression pressure. High grade oedema often
exerts powerful forces. In many cases the
compression pressure and stability of simple
Compression
Principles of
garments are no longer adequate. Two garments can
be worn on top of each other to increase the local
pressure and wall stability.
When combining compression garments please

remember that the compression classes are not to be
Contraindications
added together, but rather the pressures they exert.
Indications /
Example:
CCL 1 = 18 21 mmHg (RAL-GZ-387)
If two CCL 1 stockings are worn on top of each other
the mean pressure amounts to 2 x 20 mmHG = 40
mmHG = CCL 3.
Treatment
procedure
Examples of more Examples of more
Important points to observe when measuring for pronounced oedema: pronounced proximal
AT + AD oedema AG + ET
double compression garments: (e.g. with lipoedema)

compression garment segment because the same
measuring points often differ in size and position in
Lower limbs
the overlap zone. Furthermore, different accessories
are usually necessary for the different types of
hosiery.
The measurements of the garment worn on top

depend on the indication and how well the patient
tolerates pressure this varies between the skin
Upper limbs
measurement and the stretch measurement. Here
again you must ensure that the pressure gradient is
maintained. A porous border for the garment worn on
top such as ET / FT, CT, BT or leggings as well as a
topband with AD and AG stockings offers the
optimum transition.
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Examples of care in words and pictures

system
Indications Possible combinations of two variants

Compression
Principles of
Primary Variant A Variant B

lymphoedema One piece garment + toe cap Two-pieces garment + toe cap
Left
Contraindications
Indications /
AA1 ATE AA1 to AG with FT

topband, oblique
border and high
front
Treatment
procedure
Secondary Variant A Variant B

lymphoedema One piece garment + toe cap Two-pieces garment + toe cap
on Right
Lower limbs
AA1 AT with oblique, AA1 to AD with AT with oblique foot

open foot topband, oblique
border
Upper limbs
Type III Variant A Variant B

lipoedema Three-pieces garment (newcomers, with a donning Two-pieces garment
handicap)
Stage 3
Accessories
with secondary AD with topband BG with topband, ET with porous AG with topband, BT with porous
and oblique border oblique border and rows at the lower oblique border and rows at the lower
Lymphoedema, as well as an high front border high front as well as border
Solutions fitting
Stage 1 oblique, closed tip oblique closed tips

of the toe of the toes
problemsF.A.Q.

The lymphatic
When do I use which model?
system
Lower limbs
Compression
Principles of
This indication table is a guide, i.e. recommendation on caring for the lower limbs. The type of garment and
the compression class depend on the diagnosis, the localisation, clinical findings, and the tendency for
oedema to form. Please also consider the patient's individual condition and circumstances (accompanying
disorders, mobility, BMI, state of their skin and tissue, etc.).
Indication Diagnosis Cardinal symptom mediven mediven mediven
Contraindications
550 leg mondi * sensoo *
Indications /
for connec- for connec- for connective
tive tissue tive tissue tissue that is:
that is: that is:
soft
normal normal normal
firm firm
Lipoedema Stage 1 Orange peel skin with a finely
nodular surface AT CCL 2 CCL 2 CCL 2
Stage 2 Mattress skin, coarse, nodular

skin surface with larger dimples CCL 2 CCL 2
Treatment
procedure
AT
CCL 3 CCL 3
Stage 3 Large misshapen fatty pads

AT CCL 3
Lower limbs
Lymphoedema Stage 1 Spontaneously reversible, soft
and doughy swelling, pitting on
AD AG AT CCL 2 CCL 2 CCL 2
pressure, no skin changes
Stage 2 Not spontaneously reversible,

early fibrosis, pitting hardly pos- CCL 2 CCL 2
AD AG AT
sible, sometimes skin changes CCL 3 CCL 3
Stage 3 Pronounced form, elephantiasis,

CCL 2
Upper limbs
fibrosis, typical chronic skin
AD AG AT CCL 3
changes
CCL 4
Attention Explanation
mediven mondi and mediven 550 leg in *M

ediven sensoo and mediven mondi do not
Accessories
compression class I are indicated for the have sufficient wall stability to model the
following comorbidities or accompanying tissues in patients with very lax connective
conditions: tissue. They creep into skin creases, which
leads to constrictions.
Arterial circulatory disorders
For paralysis
After a stroke
Solutions fitting
For joint problems

problems
The corresponding reason must be noted

on the prescription.
F.A.Q.

a good feeling
Give your patients

The lymphatic
There are so many good reasons
system
for choosing mediven.
These powerful product features speak for themselves.
Compression
Principles of
Feel-good products with deep Clima Fresh for complete
functional effects. freshness for the whole leg
The medi compression seal identifies Antibacterial effect in the knit
Contraindications
selected high-tech products from Prevents odour formation
medi in medicine, lifestyle and Special spinning technique
Indications /
sports. medi stands for six decades guarantees the effect, even after
of experience in research and washing
development of products with
compression made in Germany. Perfect Fit for an exact size match
The manufacturing process provides Very precise compression dosing
for a precise dose of compression on Optimum medical care conditions
the body for demonstrably positive
Treatment
procedure
effects on health, performance and Power yarn for pressure over a
well-being. large area
Deep acting pressure over large
Standard anatomical oblique areas
borders (distal and proximal) More stable and less elastic for
Unimpeded lymph drainage effective treatment of oedema
Anatomic Fit without circular constriction Optimum pressure stability all day
Lower limbs
Optimum fit and better hold long
Made to measure garments for Flat seam with elastic seam tape
personal needs Resistant to chafing and
For severe indications wear-and-tear
rotatable Variety Perfect Fit
For unusual Soft Elastic
leg shapes For more freedom of movement
Due to special features
Upper limbs
Easy to care for
Clima Comfort* for perfect Suitable for washing machines and
climate exchange the delicates programme in tumble
Feeling of well-being all year round driers
Highly active breathing
Prevents itching Very good skin tolerability and
highly suitable for everyday wear
Without cotton & latex free
Accessories
* Clima Comfort
Scientifically tested by the French Institut

IFTH. The test result shows that Clima The practical info guide
Comfort technology from medi guarantees At the top right-hand corner of each product
Solutions fitting
climate exchange between the skin and the page, you will find the stages of oedema
garment. medi achieved an outstanding under the CCL. If the box is magenta, the
total score with 11 out of 12 points.
problems
garment is suitable for that particular stage

of oedema. If it is grey, it is not suitable.
1 2 3
F.A.Q.

The lymphatic
mediven
system
550 Leg
Maximum wall stability and endless
variety for oedema up to stage 3.
Compression
Principles of
Indications
Primary and secondary lymphoedema
stages 1, 2 and 3
Lipoedema stages 1, 2 and 3
Contraindications
Elephantiasis
Severe phlebological indications with a
Indications /
tendency for oedema to form

Caring for keloid, e.g. after burns
Postoperative and post-traumatic
oedema
Mixed forms: phlebo-lymphoedema,
lipo-lymphoedema
Consistency of the connective tissue

Treatment
procedure
Recommended for lax to firm

connective tissue
Product strengths
Highest working pressure
Over 5,600 possible combinations with
special extras such as soft toe
Lower limbs
Numerous variants, e.g. leg segments

for double and multi-part garments
Fashionable variety: three standard
colours, five trend colours and three
unique design elements
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
Versions available Compression
system
AD AF AG AT / ATH / ATU ATE / ATEH CCL 1, 2, 3, 4
Optionally left
with right Oedema stage
suspender belt
1 2 3
Compression
Principles of
BT / BTH B1T / B1TH ET / ETH
CT / CTH FT / FTH Colours
Sand
Contraindications
Caramel
Caramel
Indications /
Black
AB AB1 BD BF BG
Standard colours
Aqua
CF CG DF DG EG medi Magenta
Treatment
procedure
Navy
Anthracite
Moss-green
Lower limbs
Standard models
Border Flat oblique with all stocking variants
Cherry-red
Models Flat oblique at the thigh and perforated tape with all pantyhose
variants
Gusset / Panty top Mens leotard: ATH, ATEH, FTH, ETH, CTH, BTH Cashmere
non-compressive front panty top: ATU, ATEU, FTU, ETU, CTU, BTU
Foot Oblique, open toe Trend colours
Delivery period up to ten
working days
Upper limbs
Design elements
Stars
Accessories
Ribs
Material composition
Elastane (EL) Polyamide (PA)
CCL 1 23 % 77 %
Solutions fitting
CCL 2 25 % 75 %
Pyradmids
CCL 3 28 % 72 %
problems
The design elements can be

CCL 4 32 % 68 %
freely combined with the
standard and trend colours.
F.A.Q.

The lymphatic
mediven
system
550 toe-cap
Maximum wall stability for oedema up to
stage 3.
Compression
Principles of
Indications
Lymphoedema of the toes
Lymphoedema over the dorsum of the foot
Contraindications
Product strengths
Toe cap with Clima Fresh: reliably prevents
Indications /
odours and colonisation of bacteria

Unique top and bottom principle: seam moved
to the upper and lower surfaces of the toes in
the direction of lymph drainage
- Lateral seams give each toe stability
for effective action
- Each individual toe anatomically
made to measure for an optimum fit
Treatment
procedure
Optional incorporation of medi lymphpads for

additional pressure for lymphoedema over the
dorsum of the foot
Fully integrated toe cap:

Safer measurements (overlap no longer has to
be calculated)
Lower limbs
Care matched to the indication for optimum

lymph drainage (no circular seams)
Very comfortable to wear, without circular
seams
Outstanding hold, no slipping
Available in the variants AD and AG
Upper limbs
Single toe cap:

Increased wall stability with double
compression garments for very pronounced
forms of oedema over the dorsum of the foot
Increased treatment compliance due to quick
and easy donning and doffing
Individual care options, e.g. nightwear or in
Accessories
combination with other product variants
Sewn on toe cap:

Individual care possible, if different compression
classes are needed in the leg and toe regions
Outstanding security of fit, no slipping
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Closed
toe cap
Toe cap
closed,
Toe cap
open
Toe cap
open,
CCL 1, 2, 3
without without
small toe small toe
Oedema stage
Compressive toe section / toecap 1 2 3
Compression
Principles of
Standard models
Colours
Foot Open, with small toe
Sand
Contraindications
Elastane (EL) Polyamide (PA) Caramel
Caramel
Indications /
CCL 1 23 % 77 %
CCL 2 25 % 75 % Black
CCL 3 28 % 72 %
Standard colours
Aqua
medi Magenta
Treatment
procedure
Navy
Anthracite
Moss-green
Lower limbs
Cherry-red
Cashmere
Trend colours
Fully integrated toe cap Delivery period up to ten
working days
Upper limbs
Design elements
Stars
Accessories
Single toe cap

Ribs
Solutions fitting
Pyradmids
problems

Sewn on toe cap

F.A.Q.

The lymphatic
mediven
system
mondi
Comfortable and effective
for oedema up to stage 2.
Compression
Principles of
Indications
stages 1 and 2
Lipoedema stages 1 and 2
Contraindications
Severe phlebological indications with

tendency to oedema
Indications /
Keloid care, e.g. after burns

oedema

Recommended for normal to firm
connective tissue
Treatment
procedure
Product strengths
Available with silver segments:
- Y-C, Y-D, Y-G
- Antibacterial effect, for patients with
e.g. chronic wounds, atopic
dermatitis
- Segments allow for specific and
Lower limbs
cost-effective use
Supple knit
Many possible combinations with
special accessories e.g. Y knitting mark
colours and five trend colours
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
AD AF AG AT / ATH / ATU ATE / ATEH
CCL 1, 2, 3
Optionally left
right
with Oedema stage
suspender
belt
1 2 3
Compression
Principles of
Sand
Contraindications
Caramel
Caramel
Indications /
Black
Standard models
Standard colours
Model Flat oblique at the thigh and perforated tape

with all pantyhose variants Aqua
Gusset / Panty top Men's leotard:

ATH, ATEH, FTH, ETH, CTH, BTH medi Magenta
Treatment
procedure
non-compressive front panty top:
ATU, ATEU, FTU, ETU, CTU, BTU
Navy
Foot Oblique, open toe
Available silver segments Y-C, Y-D, Y-G

Anthracite
Material composition mediven mondi

Moss-green
Lower limbs
Elastane (EL) Polyamide(PA)
CCL 1 22 % 78 %
Cherry-red
CCL 2 24 % 76 %
CCL 3 28 % 72 %
Cashmere
Material composition mediven mondi with silver thread
Elastane (EL) Polyamide(PA) Silver cover
Trend colours
CCL 1 22 % 77 % 1% working days
Upper limbs
CCL 2 24 % 75 % 1%
CCL 3 28 % 71 % 1%
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
mediven mondi
system
toe-cap
Compression
Principles of
Indications
Contraindications
Product strengths
Toe cap with Clima Fresh: reliably prevents
Indications /
odours and colonisation by bacteria

Unique top and bottom principle:
- Seam moved to the upper and lower surfaces
of the toes in the direction of lymph drainage
Treatment
procedure
Fully integrated toe cap

More reliable measurements
(overlap no longer has to be calculated)
Lower limbs
seams
Single toe cap

Upper limbs

and easy donning
Sewn on toe cap

Accessories

Solutions fitting
problemsF.A.Q.

The lymphatic
system
Closed
toe cap
Toe cap
closed,
Toe cap
open
Toe cap
open,
CCL 1, 2
without without
small toe small toe
Oedema stage
Compression
Principles of
Standard models
Colours
Sand
Contraindications
Caramel
Indications /
CCL 1 22 % 78 %
CCL 2 24 % 76 % Black
Standard colours
Aqua
medi Magenta
Treatment
procedure
Brown
Navy
Anthracite
Lower limbs
Trend colours
working days
Upper limbs
Accessories
Single toe cap

Solutions fitting
problems
Sewn on toe cap

F.A.Q.

The lymphatic
mediven
system
sensoo
Supple and soft
Compression
Principles of
Indications
stage 1
Lipoedema stage 1
Contraindications

oedema, mild stages
Indications /
Caring for keloid

Recommended for normal connective
tissues
Product strengths
Soft, sheer knit
Treatment
procedure
Material that is easy to put on

Soft and smooth surface
Selected extras
Lower limbs
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
AD AG AT / ATH
CCL 2
Oedema stage
1 2 3
Compression
Principles of
Colours
Standard models
Border Flat oblique with all stocking variants Sand
Contraindications
with all pantyhose variants
Caramel
Gusset Men's gusset: ATH Caramel
Indications /
Black
CCL 2 25 % 75 %
Treatment
procedure
Lower limbs
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Basic guidelines on measuring techniques

system
for lymphological garments

A number of additional important tips you measure the lengths close to the
Compression
from medi can be found below body and with the patient standing to
Principles of
lK1 along the inside leg.

Measure the toe areas accurately to the BUFA guideline: measure length
nearest millimetre measurements to vertically.
the nearest 5 millimetres are sufficient
Always measure foot lengths on the
for the legs.
Contraindications
weight-bearing foot with the patient

Never measure circumferences in skin standing.
Indications /
creases.
Generally flat-knitted garments are l K1T l K2T Tips
measures under tension with the Always document the skin and
exception of cY. According to the lH tension measurements to
measuring point we distinguish: l K1 enable an objective
assessment of any changes
Skin measurments = absolutly loose lG l K2 that may occur.
Measuring to the first resistance= Photographic documentation
Treatment
procedure
lF is always helpful
measuring under tension without force
Full tension = absolutly compression of
lE close to perpendicular
the tissue. the body
lD
Measure circumferences and lengths
lC
up to measuring point F with the
patient lying down. In case of very soft
l B1
Lower limbs
connective tissue, projecting forms and

lB
overhanging tissue at the knee due to
oedema or obesity, only to measuring
point D.
Make sure you carry out the measuring
procedure quickly. Patients with
oedema should only be required to medi sets new standards
Upper limbs
stand for as short a time as possible

without their hosiery. At medi, it is standard practice to
produce all garments with an oblique
If the shapes of the limbs differ from
border at the foot and at the proximal
standard anatomy, you can base your
end (see Tips for measuring points).
measurements on the following: normal
This prevents circular constriction!
height of the B measurement is approx.
8-12 cm.
Accessories
Always mark the measuring points with

a soft pencil (kohl pencil) on the medial
side of the leg with the exception on
point H.
In the case of products with little
Solutions fitting
longitudinal stretch, medi recommends

problemsF.A.Q.

The lymphatic
Measuring techniques
system
Measuring point A according to BUFA guidelines
Measuring point A
Compression
Principles of
Foot fully Length (l ) A Tips on measuring point A
weight-bearing Straight border: distance from heel to
Always measure the foot length on the weight-bearing
-metatarsophalangeal joint of little
foot with the patient standing.
toe (Fig. 1)
For the oblique border, medi requires both the foot length
on the medial as well as the lateral side of the foot.
Particularly for the open variants, ensure that the inner
and outer foot length measurements are not too short.
Contraindications
You should always measure over the
metacarpophalangeal joint of the big and little toes as far
Indications /
Fig. 1 Source: BUFA as the beginning of the toes.
Length (l ) Z edia
l
lA m
Closed toe: distance from
heel to longest toe (Fig. 2)
lA
Treatment
procedure
Tips on length A
Fig. 2 Source: BUFA
If the second toe is longer than the big toe, add the Special
Request Sew the tip of the toe on round.
Length (l ) A / A1
Oblique border:
Lower limbs
Distance from the heel.
- Distance from heel to
metatarsophalangeal joint of little
toe (= outer length) & distance from
heel to metatarsophalangeal joint
of big toe (= inner length) including
joint (Fig.3)
Upper limbs
Fig. 3 Source: BUFA
cA (for straight and oblique border) Tips on measuring point A
With feet and / or hallux valgus that are sensitive to

pressure, do not measure too tightly. Often the option of
a long soft toe with a straight border is recommended,
which then begins, as an exception, behind the hallux
Accessories
Circumference (c) A valgus.

Apply tape measure around the When measuring feet with oedema over the dorsum of
Joint line metatarsophalangeal joints (first the foot, press the tape measure gently into the oedema
joints of toe) (Fig. 4) to build up compression. A pad is needed to achieve
Fig. 4 Source: BUFA
optimum pressure.
Measuring an Measuring a straight

Solutions fitting
oblique border border with the tape

with the tape
problems
Joint line
F.A.Q.

The lymphatic
system
Lower limbs Y, P1 / P2, B, B1 according to BUFA guidelines
Measuring point Y
Compression
Principles of
Tips on measuring point Y
Always measure measuring point Y in maximum

dorsiflexion.
Without exception, never measure cY under tension.
Circumference (c) Y A reduction in this circumference causes increased
Take the measurements over the heel pressure on the tendon area.
Contraindications
and arch in dorsal flexion with The standard comfort heel is adequate in many
tendons taut; take body cases. In addition, Y shaping can be added to reduce
Indications /
measurements without tension; take pressure on the flexor tendons over the ankle and to
soft tissue projections into account bridge joint folds (see page 52 Accessories).
(Fig. 5)
Fig. 5 Source: BUFA
Measuring point P1 / P2
Length ( l ) P1 / P2 Tips for pads
Additional measurement for profile Please simply mark the position where the pads (e.g.
stockings Levamed) are to be incorporated with a cross on our
Treatment
procedure
order form. The pads will be sewn in when the garment

We do not require these is being made ready to give the anatomically correct
dimensions! fit.
You can also send us a sketch or drawing.
Circumference (c) P1 / P2 For the individually made variants, mark the position
Dorsal circumference over the of where the pad is to be fitted and return the stocking
Achilles tendon from the middle of to us.
the lateral to the middle of the
medial malleolus (P1). Plantar
Lower limbs
circumference over the sole of the

foot from the middle of the lateral to
the middle of the medial malleolus
Fig. 6 Source: BUFA (P2) (Fig. 6)
Measuring point B Tips for measuring point B
Measure circumference cB at the narrowest point of

Length ( l ) B
the ankle.
From sole of foot to above (proximal)
Exception: if there is oedema in this area the
to the ankle (Fig. 7)
measuring point moves to where the oedema starts;
Upper limbs
never measure in the skin fold around the joint.

The compression pressure starts at cB. So, from here up
measure under tension depending on the indication
Circumference (c) B and the tissue structure. The higher the material's wall
Measure circumference depending stability, the more tension it requires and tolerates.
on indication, tightly if necessary In many case, it is difficult to define the individual
(Fig. 7) measuring points due to the patient's anatomy. In
order to guarantee the optimum fit and the optimum
Fig. 7 Source: BUFA pressure gradient, try to divide the lower leg into three
sections of equal size between measuring points
Accessories
Measuring point B1 B to D.
Circumference (l ) B1
From sole of foot to start of calf
(Fig. 8)
Solutions fitting
problems
Fig. 8 Source: BUFA

F.A.Q.

The lymphatic
system
Lower limbs C, D according to BUFA guidelines
Measuring point C
Compression
Principles of
Length ( l ) C
From the sole of the foot to the
largest calf circumference (Fig. 9)
Contraindications
Circumference (c) C
Measure circumference depending
Indications /
on indication, tightly if necessary
(Fig. 9)
Fig. 9 Source: BUFA
Measuring point D
Tips on measuring point D
Length ( l ) D
From the sole of foot to the head medi garments are manufactured with the flat
of the fibula* (approx. two fingers'- oblique top border as standard.
Treatment
procedure
width below kneecap) (Fig. 10) Due to the oblique border (larger distance = more
volume) and depending on the indication and the
tissue structure, we recommend you measure
measuring point D under tension. The length of the
Circumference (c) D stocking (AD to the first resistance, AG and AT between
Measure circumference depending the first resistance and full tension) is decisive for the
on indication, tightly if necessary intensity of the measurement under tension.
Optional borders include a steep oblique and a
Exception straight border. Check the course of the fold at the
Lower limbs
AD stocking = Body dimension, with back of the knee. Measure lD along the inside leg too,
addition if necessary (Fig. 10) the oblique is calculated automatically (see Page 46).
Fig. 10 Source: BUFA The difference between lC and lD or lD and lE
should be at least 6 cm to allow for the manufacture of
* The head of the fibula is palpable on the outer aspect directly below the knee widely differing circumferences.
joint (but is not part of the knee joint).
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
system
Lower limbs E, F according to BUFA guidelines
Measuring point E
Compression
Principles of
Length ( l ) E Tips on measuring point E

From sole of foot to middle of With projecting shapes and voluminous knees the
kneecap connective tissue gives different circumferences
(Fig. 11) and lengths when the patient is standing as opposed
to lying down. It is recommended that these
measurements should be checked again close to the
Contraindications
body when standing and averaged out if necessary.

For those patients who mainly have a sedentary or
Indications /
kneeling occupation and for those in a wheelchair, an

Fig. 11 Source: BUFA ellipse form at E can be chosen as an accessory to
relieve pressure on the back of the knee
(see page 52 Accessories). In this case, please give
the extra measurement Long back of knee on the
measurement sheet.
Circumference (c) E
Circumference (c) E is generally not
measured tightly; with the leg bent
(angle 30 45), take the
Treatment
procedure
circumference measurement one

fingerbreadth proximal to the back of
the knee and two fingerbreadths
proximal to the kneecap. Do not place
tape in the back of the knee or folds
of skin (Fig. 12)
Fig. 12 Source: BUFA
Lower limbs
Length back of knee

Measuring point F
Length ( l ) F Tip on measuring point F
For large projecting shapes and deep skin folds it is
middle of the thigh (Fig. 13)
advisable to determine this circumference and length
measurement (as always close to the body) while the
patient is standing (cf. p. 36).
Upper limbs
Circumference (c) F
The circumference is generally
measured fairly tightly, depending on
the indication (Fig. 13)

Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Lower limbs G, K according to BUFA guidelines
Measuring point G
Compression
Principles of
Length ( l ) G Tips on measuring point G
AG stocking dimension: The length lK2 (= length of the back of the leg) is an
Sole of the foot to the widest part important leg length (see P. 42): it forms the basis for
(medial) below the transverse gluteal AG stockings and all pantyhose variants. Nevertheless,
fold (incl. non-slip topband) (Fig. 14) do not neglect length lG.
For AG stockings with a topband a circumference
Contraindications
check measurement should be taken. This should
roughly follow the desired position of the topband
Indications /
(see Fig. A). Measure this dimension tightly.
Circumference (c) G
Depending on the indication, the
circumference is generally measured
fairly tightly
Warning: measure AG stockings with
a non-slip topband under tension,
Treatment
procedure
but avoid constriction! (Fig. 15)
Fig. A
Lower limbs
Measuring point K (=K1)
Length ( l ) K Tips on measuring point K
From the sole of the foot to front of
medi always needs the circumference measurement cK
crotch (Fig. 16)
for all pantyhose variants. Measure this in a circle
(depending on the manufacturer) around both thighs below the buttock fold under
tension (Fig. B). The intensity of the tension should be
Upper limbs
proportional to the reduction of circumference cG, so
that the legs and the panty top match perfectly when
Circumference (c) K the garment is made ready.
Length dimensions only required Length lK1 is only needed for the accessory high
front. Start this measurement in the groin at the level
Obligatory measurement for medi! of the lower border of the pubic bone and measure
close to the body along the inside leg down to the sole
Fig. 16 Source: BUFA of the foot (see Fig. C).
The high front is calculated from the difference
between lK2 and lK1. Maximum high front AG: 8 cm.
Accessories
Maximum high front for pantyhose: 5 cm.

Solutions fitting
Pubic
bone
problems
Fig. B Fig. C
F.A.Q.

The lymphatic
system
Lower limbs K2, H according to BUFA guidelines
Measuring point K2
Compression
Principles of
Length ( l ) K2 Tips on measuring point K2

From sole of foot to transverse Important length for medi
gluteal fold (Fig. 17) Please always measure lK2 close to the body at the
(depending on the manufacturer) back of the leg, slightly medially, from the transverse
gluteal fold to the sole of the foot. The optimum
starting point here is where the groin area joins the
Contraindications
transverse buttock fold (see Fig. D).

Circumference (c) K2 If the AG garment is too short, it will slip down and
Indications /
Only the length dimensions are may chafe the skin over the inside of the thigh. If the
required AG garment is too long, the topband folds over or the
surplus material slips down into the hollow of the
knee.
Treatment
procedure
Fig. D
Lower limbs
Measuring point H
Length ( l ) H Tips on measuring point H
From the sole of the foot up to the l H is the only length measured down the outside of
widest part of the pelvis (Fig. 18) the leg.
If possible, select the compression class for the panty
top so that it is at most only one compression class
Upper limbs
below the compression class for the legs.
Circumference (c) H
Accessories
Circumference of pelvis at the widest

point, measure tightly depending on
indication (Fig. 19)
Solutions fitting

problemsF.A.Q.

The lymphatic
system
Lower limbs T according to BUFA guidelines
Measuring point T
Compression
Principles of
Length ( l ) T Tips on measuring point T
From sole of foot to upper border of This measurement is only required for AG stockings
pantyhose (patient-specific) (Fig. 20) with a suspender belt.
Contraindications
Indications /
Length (c) T
Circumference of trunk, moderately
tightly if necessary (Fig. 21)
Treatment
procedure
Lower limbs
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
system
Measuring points for the front (l K1T) and back (l K2T) panty
top according to the BUFA guidelines
Compression
Front (l K1T) and back (l K2T) panty top

Principles of
Tips on measuring points l K1T and l K2T

Length ( l ) TK1
Front length TK1 (Fig. 22): The panty top has a therapeutic effect and also keeps
the garment from slipping down. In order to satisfy
Measure vertically next to body at
Contraindications
these criteria as well as possible, the panty top must

the level of the inguinal fold from the extend at least as high as the waist = lowest
crotch to the top border anatomical support. The more pronounced the
Indications /
abdomen, the higher the panty top must be measured,

up to just below the bust if necessary.
Measure the front panty section length from
measuring point K1 up to the optimum border
(s. Fig. E) = front anatomical suspender.
Measure the back panty section length from
Fig. 22 Source: BUFA measuring point K2 up to the optimum border
(s. Fig. F) = rear anatomical suspender.
Length (l ) TK2 Since the border fits the waist differently during
movement (e.g. when sitting down), consider the width
Rear length TK2 (Fig. 23):
Treatment
procedure
of the top border when measuring lK2T to ensure that

Measure vertically close to the body, the panty top fits properly (e.g. lK2T = 30 cm + 4 cm
from the transverse gluteal fold to waistband).
the top border. For patients with soft connective tissues, refer to the
Note: for soft connective tissue, the BUFA note on panty top lengths. medi offers
lengths should be measured under individually made up braces for additional
tension. The measurement for the attachment. Measure the length for this as shown in
panty section, where circumferences Figs. G + H.
are large, should never be too short
Lower limbs
and should be ordered with an

adjustable pull-through elastic band,
possibly with additional security Waist =
aids. anatomical
Fig. 23 Source: BUFA suspender
Pubic
bone
Upper limbs
Fig. E Fig. F
Accessories
Fig. G Fig. H
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Measuring positions for a pouch
Compression
Principles of
Measuring for a pouch
Measure the length as shown
in Fig. 1
Begin at the root of the penis and
Contraindications
measure down to the base of the
scrotum over the highest point of the
Indications /
Length oedema.
Width
Fig. I
Measure the width from groin to
Treatment
procedure
groin, also over the highest point of
the oedema (Fig. J).
Ideally, take the measurements over

the lymphological compression
Width
dressing.
Lower limbs
h Measurements can be taken over
ngt
Le underwear.
Fig. J
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
system
Lower limbs A, A1, toes 1 4

according to BUFA guidelines
Measuring point A
Compression
Principles of
Length ( l ) A1 Tips on measuring point A

Lateral length: from the
Reduce measurement cA if oedematous. Press the
metatarsophalangeal joint of the
measuring tape gently into the oedema to prevent
small toe to the root of the instep
excessive pressure on the lateral borders of the feet.
(roughness of the 5 th metatarsal
Incorporation of a medi lymph pad gives the best
bone).
pressure distribution (see page 54).
Contraindications
Medial length: from the Measure the medial and lateral length of the toe cap
metatarsophalangeal joint of the big as the anatomical situation allows. Remember the
Indications /
toe to the end (Fig. 24) shorter the toe cap in this area, the greater the risk
that it will migrate forwards.
The difference between the medial and lateral
lengths should be at least 1.5 to 2.5 cm for optimum
manufacture of the toe piece.
Please also note our option of either having the toe
cap sewn directly onto the stocking or a fully knitted
stocking and toe cap.
Measuring point A1
Treatment
procedure
Circumference (c) A
Pass the tape measure around the
metatarsophalangeal joints (first
joints of toe) (Fig. 25)
Circumference (c) A1
Measure straight across middle of
Lower limbs
foot (final length)
Measuring point toes 1 4

Circumference (c) Tips on measuring the toes
Generally measure dimensions X and Never measure toes under tension!
Z (W) to the millimetre and without
Upper limbs
Please ensure a loose skin measurement at cX and a

tension. The X measurement must skin measurement accurate to 1 mm at cZ.
not be smaller than the Z
measurement and must be adjusted
to the Z measurement if necessary
(Fig. 26).
Accessories

Solutions fitting
problemsF.A.Q.

The lymphatic
system
Lower limbs toes 1 4
Compression
Principles of
Length Tips on measuring the toes
Shortest length from web (X) to
medi recommends measuring the lengths too long
middle of nail (Z) (Fig. 27)
rather than too short:
1. Toes that are too long can be marked when trying
Exception:
on and returned to us for shortening.
for closed toes, measure to end of
2. If the toe length is measured too short the patient
Contraindications
toes.
will be walking on the edge of the border, which is
very painful and can lead to ulceration.
Indications /
T he variant without little toe is generally made with
an anatomical opening (see Fig. K).
Variations for measuring on the top of the toes:

F or this variant try to straighten these generally short
Fig. 27 Source: BUFA and bent toes slightly and to separate the adjacent
toes laterally as far as possible so that the webs are
clearly visible (see Fig. L / M).
N ow mark the beginning on the imaginary line
Treatment
between the webs in the middle of the toe (see Fig. M).
procedure
Measure the length from this beginning to the end of
the toe (see Fig. N).
Lower limbs
Fig. K Fig. L
Upper limbs
Fig. M Fig. N
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Possible toe cap versions

system
Measuring technique toe cap
In addition to the variants where the toe cap is worn under the hosiery,
you can offer your patient a fully integrated toe cap or one sewn to the
Compression
Principles of
hosiery.
Ordering a fully knitted toe cap

Measure the toe circumferences cX and
cZ, their lengths and the circumference
Contraindications
cA across the metatarsophalangeal joints

as usual.
Indications /
Enter the dimensions in the measuring

A lAi chart Toe garments and mark Fully
integrated stocking and toe cap with a
cross for the model.
lA
The length of the foot is equivalent to

the measurements for an open oblique
Treatment
procedure
Fig. O Possible with mediven mondi and foot. Measure lAi and lA from where the
mediven 550 toe cap heel meets the ground to just distal to
the balls of the big and small toes (Fig. O).
Mark Toe cap with a cross in the Foot
field on the measuring chart.
Note
Lower limbs
The fully knitted variant is available for AD and AG

stockings.
Fully knitted stocking and toe cap

Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Compression
Principles of
Ordering a toe cap sewn to the hosiery
Based on the existing anatomy, mark the
best position for the seam. Measure the
Contraindications
inner and outer lengths for the toe cap
up to the mark. Order the garments, onto
Indications /
which the toe cap is to be sewn post-
A1
manufacture, with a straight border and
A
foot length lA up to the mark (Fig. P).
Enter Toe cap sewn to hosiery in
lA
hos
iery the Model field in the Toe garments
A1 measuring chart.
lA - ap
ec
To Mark the field Toe cap with a cross in
Treatment
procedure
Fig. P Possible with mediven mondi and the Leg garments measuring chart.
mediven 550 toe cap
Tip
The incorporation of a lymph pad helps achieve

optimum pressure distribution over an
oedematous dorsum of the foot.
Lower limbs
A1
A
Se
am
lA
iery
hos
A1
lA - cap
T oe
Toe cap sewn on
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Lower limbs
system
Leg accessories
3D panty top Benefit

Compression
Principles of
Anatomically shaped panty The perfect fit on the abdomen and

top bottom shaping of the abdomen and
The shape of the 3D panty top is bottom.
obtained from the determined
circumferential measurement
and length in the panty area
Contraindications
Indications /
Oblique borders Benefit
Flat oblique Optimum anatomical fit, no risk of stasis

Anatomically correct border due to circular borders basic
Standard for all mediven flat requirement for a garment that is
knit garments. Knitted fabric appropriate to the indication.
Treatment
procedure
for outer leg longer by x cm
Steep oblique Optimum anatomical fit, also for large

Anatomically correct border local accumulation of tissue, particularly
Knitted fabric for outer leg in cases of lipoedema that show the
longer by x cm classical saddlebag syndrome, no risk of
stasis due to circular borders.
Lower limbs
Anterior thigh longer Benefit
Accurate pressure gradient Optimum anatomical fit due to individual

up to groin adaptation to the course of the groin,
Upper limbs
Anterior thigh longer particularly in cases of local accumulation

of tissue in the region of the front of the
thigh.
Anterior view Lateral view

Accessories
Comfort heel = standard heel Benefit
Individual angle at the heel Better fit due to reduced wrinkling in this
The individual angle is often difficult area. Even the standard
calculated from the heel takes the individual requirements of
Solutions fitting
measurements you supply each patient into account. The number

cY= Standard and angle of the knitting marks are
calculated individually.
problemsF.A.Q.

The lymphatic
system
Ordering information
Compression
Principles of
Contraindications
Indications /
Tips Field: Standard border c.f. Fax Order
medi always produces flat knit products with an oblique border at the The flat oblique is standard 3 + 4
proximal end, i.e. the lateral side of the garment is x cm longer. for all mediven garments.
The level of the oblique depends on the circumference of the border (cD for You do not need to make a at the top of
knee-length garments and cG for thigh-length garments and pantyhose). selection. fold-out page 104
Treatment
procedure
The standard is flat oblique = approx. 5 % of the circumference. Field: Optional border
A steep oblique = approx. 10 % of the circumference can be selected
as an option. Cross steep oblique!
The obliques optimise the fit they compensate for the longer distances
caused by the accumulation of tissue (e.g. jodhpur syndrome).
Please consider the patient's anatomy when choosing the oblique.

Incorporation of a longer knit also means a higher volume.
This can lead to wrinkling in the inguinal region with pantyhose.
Lower limbs
You must also consider the course of the gluteal fold. With gluteal folds that
are straight or dip downwards laterally, the topband may fold over.
c.f. Fax Order
Tips Field: Accessories 5
The high front optimises the fit. Voluminous thighs caused by tissue Give lK1 and cross high front at the top of
accumulation at the front of the thigh make this distance longer. This can be fold-out page 104
compensated for with the high front.
Upper limbs
The high front is calculated from the difference between the front leg length
lK1 and the back leg length lK2. Please note here the maximum lengths:
pantyhose = 5 cm AGs = 8 cm.
The lK1 measurement is only needed for measuring the high front!
When choosing the high front, please consider the patient's anatomy and the
garment style. Incorporation of a longer knit also means a higher volume.
Accessories
Tips
In many cases, you can already achieve an optimum fit in this area simply
with our standard heel (= comfort heel). The standard heel is particularly
suitable for slim, non-oedematous feet or for feet with a high arch.
Solutions fitting
problems
F.A.Q.

The lymphatic
Lower limbs
system
Leg accessories
Elliptical form at E Benefit

Compression
Principles of
Additional knitting material To reduce excessive pressure on the veins

in the front of the knee area at the back of the knee and the major
lymphatic trunks.
For patients who only sit Also reduces wrinkles forming when
(e.g. people in wheelchairs) sitting.
Contraindications
Indications /
Y knitting marks = 90 heel Benefit
Additional Y knitting marks in Reduces pressure on the instep and to

heel and arch areas bridge skin creases.
Treatment
procedure
Oblique forefoot Benefit

Lower limbs
Oblique line of compressive Optimum pressure gradient as far as the

knitted fabric joints at the base of toes due to the
Standard for all mediven flat anatomical gradient, no circular
knit garments constriction in the forefoot area.
Upper limbs
Extension of foots sole Benefit
Extension of the compressive Optimises the fit in the forefoot, relieves

knitted fabric along the sole pressure on the toes with closed
of the foot garments.
Accessories
Soft toe Benefit
Particularly soft and elastic More comfortable to wear for particularly

Solutions fitting
knitted fabric for the toe area sensitive toes in diabetics and with severe
hallux valgus.
mediven 550 leg only
problemsF.A.Q.

The lymphatic
system
Tips Field: Accessories c.f. Fax Order
Compression
Principles of
The ellipse makes the garments more comfortable to wear for people who Mark Ellipse form with a 5
spend most of their time sitting down or kneeling. It compensates for the cross. Please also show the
longer distance at the knee when sitting and thus reduces increased pressure height of the back of the knee at the top of
on the patella and wrinkling in the back of the knee. separately. fold-out page 104
Always give the measurement l back of the knee. Measure this close to Standard = 4 cm
the body from the fold in the back of the knee to the heel with the patient Minimum = 2 cm
standing. Note that lE must be at least 1 cm longer than l back of the knee.
Contraindications
Maximum = 8 cm
Attention! In patients with voluminous knees (lipoedema) or a large cE
measurement, the incorporation of ellipses increases wrinkling in the knee Give any deviation from
Indications /
region. Wrinkles may also form below the patella. standard in cm in the field
Do not use ellipses here. Special Requests.

The incorporation of Y knitting marks at the ankle holds the foot in about Mark Y knitting mark with a 5
90 flexion. This increases the volume at the ankle. Use the Y knitting mark cross.
specifically for patients who need a different foot position to lower pressure at the top of
and reduce wrinkle formation. Reasons for this could be: foot architecture, fold-out page 104
oedema or the accumulation of tissue as well as pronounced tissue folds at
Treatment
procedure
the ankle (e.g. due to lipoedema). In case of oedema around the malleoli, the
Y knitting mark in conjunction with pads (e.g. Levamed) ensures optimum
pressure distribution. Never reduce cY because this increases the pressure on
the flexor tendons of the foot.
Tips Field: foot c.f. Fax Order
medi produces all flat knit garments with an oblique foot border. Mark open or closed with a 1
Lower limbs
This guarantees the best possible fit to follow the anatomical line of the cross.
metatarsophalangeal joints. It also prevents constriction of the forefoot. at the top of
The oblique border is standard for both open and closed toes. The oblique Please also give fold-out page 104
border of the compressive knit is calculated from the difference between the lZ (overall measurement)
inner length of the foot lAi and the outer foot length lA. The maximum lAi (inner length)
possible oblique is 4 cm. lA (outer length).
Upper limbs
The long sole optimises the fit in the forefoot region in the case of foot Mark Long sole field with a 5
deformities such as hallux valgus or hammer toe. cross.
Knitting the compressive knit along the sole of the foot gives the stocking at the top of
a circular grip at the metatarsophalangeal joints. fold-out page 104
This stops the foot section slipping back towards the heel.
The length of the long sole depends on cA and is produced automatically.
Accessories

Do not choose the length of the foot longer than necessary for this variant Mark Soft toe with a cross. 1
- a maximum of 5 cm tricot length is usually sufficient.
Solutions fitting
Exceptions: inflamed hallux valgus - in this case, the soft toe also includes at the top of
this pressure-sensitive region. fold-out page 104
problems
F.A.Q.

The lymphatic
Lower limbs
system
Leg accessories
Compression pads Benefit

Compression
Principles of
Incorporation of medi lymph Compensate for concave areas (curving

pads, pre-formed silicone inwards) to achieve the best possible
pads (Levamed) and padding pressure distribution (e.g. malleoli)
materials Better pressure distribution over the
back of the hands and feet
Loosen fibrosis
Specific pressure increase over the
Contraindications
oedematous region
Indications /

Incorporation of medi lymph Local relief of pressure over sensitive
pads regions or around joints such as the back
of the knee or anterior (subtalar) ankle
Treatment
procedure
joint.
Lining material Benefit

Lower limbs
Lining with soft smooth The skin in particularly sensitive areas,

material (texture similar to irritated skin areas (e.g. after psoriasis,
that of microfibre) ulcer, or burns) is not subject to additional
irritation and calms down.
Unpleasant itching is avoided.
Upper limbs
Attachments / Fasteners Benefit

- Topband
Most common method of Circular support, simple handling

Accessories
securing stockings (AG, AF

and AD) without circular
constriction with oblique
borders

Solutions fitting
- Suspender belt
Support of AG stockings at Alternative fastening, e.g. if topband is
problems
the waist not tolerated, or for men with very hairy

legs.
F.A.Q.

The lymphatic
system
Tips Field: Other accessories c.f. Fax Order
Compression
Principles of
If additional local compression is necessary or if support is required for Please state choice and 8
dispersing fibrosis, we recommend using only the mediven 550 models. document the position, shape
When ordering pads that are made up individually, we recommend you send etc. medi will then make these at the top of
the pads back to us for alteration after the trial fitting. according to your individual fold-out page 104
For this, mark the exact shape and position of the pads with our medi textile instructions (Special
pencil (Art. 25.460). Requests).
Levamed pads and medi lymph pads that are positioned on the basis of
Contraindications
measuring points can be incorporated directly during manufacture.
For this, please give the exact size and positioning points.
Indications /
A picture or a sketch often makes this more understandable.
Please always write the original sizes on the sketch because the scale can
change when faxing or mailing.
Field: Other accessories c.f. Fax Order
Please state choice and 8

document the position, shape
etc. medi will then make these at the top of
Treatment
procedure
according to your individual fold-out page 104
instructions (Special
Requests)
Lower limbs
Please always give us the exact size and positioning of the lining material. Please state choice and 8
Lining material can also be added retrospectively. document the position, shape
Requests).
Tips Attachment field c.f. Fax Order Upper limbs

For each quality and each topband type, medi uses the appropriate Please select the required 7
circumference conversion, i.e. the table measurement for the topband is topband and give any
based on years of experience and numerous tests. possible non-standard at the top of
Accessories
If, in exceptional cases, it is necessary to fit a tighter or looser topband than topband circumference fold-out page 104
usual, please show the respective circumference in cm after the variant. measurements.
Tips Attachment field c.f. Fax Order

Solutions fitting
medi needs the overall length lT for making up AG stockings with a waist Cross Waist attachment 7 + 8
attachment! If the fabric over the inner thigh tends to roll down, and the positions on the left /
problems
we recommend our skin adhesive medi fix (Art. 1023105). right and write lT in the field at the top of
Alternatively, the medi waist attachment can also be combined with Special Requests fold-out page 104
a topband border.
F.A.Q.

The lymphatic
Lower limbs
system
Leg accessories

Compression
Principles of
- Topband stoppers
Additional support for leg Additional security of fit for voluminous

garments. thighs.
Only possible along the panty
form, longitudinally above
the patella or longitudinally
on the back of the thigh.
Contraindications
Indications /
Open crotch Benefit
Pantyhose without gusset Solution for patients with incontinence

Treatment
procedure
issues or frequent fungal infections,

quicker and easier handling of garments
for this additional indication.
Lower limbs
Maternity pantyhose Benefit
Compression pantyhose with Gentle care also during pregnancy,

front of panty top in knitted precisely when it is particularly needed.
material (no compressive
fibres in the knitted fabric)
Upper limbs
Incorporation of zips / Velcro Benefit

fasteners
Earliest possible start of treatment and

optimum therapeutic outcome, enables
donning and doffing for
Unusual shapes
Fresh scars (following burns)
H andicap (e.g. osteoarthritis,
Accessories
rheumatism)
Porous series - half Benefit

compression
Solutions fitting
Compression weft fibres in Ease of handling of compression garment

every other row in the area without the risk of congestion, correct
problems
that overlaps with the pressure gradient at the overlapping

optimum border junction with multi-part garments.
F.A.Q.

The lymphatic
system
Compression
Principles of
Additional attachments for the thigh may be necessary due to large Please specify the type of 6
circumferences, lax connective tissue, deep skin and joint folds as well as topband stopper.
conical and cylindrical limbs. Have the topband stoppers sewn on later, Pay attention to the at the top of
always use these specifically and position them only if necessary in a region standard here. fold-out page 104
where additional grip is required, e.g.:
Topband stopper along the oblique for jodhpur syndrome
Topband stopper at the back on the seam for deep folds in the back
Contraindications
of the knee
Topband stopper above the knee for voluminous thighs.
Indications /
However, please note that additional sewn in topband stoppers reduce the
stretch of the compression knit.
No extra topband stoppers are fitted on the medial surface of the thigh (the
inside of the thigh) as more lymph ducts run across this area and there is an
added risk of chafing.
Tips Field: Special Requests c.f. Fax Order
Two-part garments (AD+ CT, AG + FT) can also make donning and doffing the Please specify the open 8
garment easier for patients. mediven 550 and mediven mondi models are to crotch request separately.
Treatment
procedure
be particularly recommended for those who suffer from frequent fungal at the top of
infections because of the use of antibacterial yarn (prevents colonisation by fold-out page 104
bacteria and micro-organisms).
Lower limbs
Tips Field: Variants c.f. Fax Order
During pregnancy the circumference measurements of the legs hardly Mark the variant ATU with a 2
change at all if appropriate and optimum treatment is continued. cross.
In the abdominal area, however, sizes often change very rapidly. at the top of
Here again, two-part garments can be used economically to accommodate fold-out page 104
the change in circumference
The pleasant side effect for the mother-to-be is the ease of donning and
doffing of the cycling shorts (in combination with AC stockings) compared
with AT.
Upper limbs
Zips are a compromise solution and should only be used in individual Please specify the type of 8
cases. For AD stockings the incorporation of a zip on the inside of the leg is fastener (fine or coarse zip,
recommended - this zip is similar to the zip on a boot. Velcro fastener), its position at the top of
No zip should be sewn on the inside of the thigh of AF-AG garments. The (drawing) and length. fold-out page 104
problem of donning and doffing pantyhose may be improved by using zip in
the following positions:
Centre front of panty top
Accessories
In the side seam on the right (for right-handed patients) or left (left-handed
patients)
In the side seam on the right and left
A zip can be incorporated into the seam at any time at a later stage.

Do not have the entire overlap area made porous. Please specify the length of 5
Solutions fitting
This will not give a stabilising transition and the material will slip upwards. the porous rows
at the top of
fold-out page 104
problems
F.A.Q.


Lower limbs
The lymphatic
Available variants
system
from AA1 toe cap to BG cuff
AA1-toe cap AB - sock & AB1- sock AD-stocking AF-stocking

& AG - stocking
Compression
Principles of
AA1 AB AB1 AD AF AG
Contraindications
Indications /
Individual toe cap for use A s double stockings to Single stocking Single stocking
at night increase pressure A s a double stocking to A s a double stocking to
In combination with other increase pressure in increase pressure in
garments combination with a combination with
pantyhose or knee-length pantyhose
stocking I n combination with
I n combination with Capri Bermuda shorts (ET shorts)
shorts (CT shorts) as a as a two-piece garment
two-part garment
Treatment
procedure
AT- Pantyhose ATE - Pantyhose ATU - Maternity panty CT- & B1T - Capri shorts
& ATH -men's leotard with one leg
AT ATH ATE / ATU CT / CTH
ATEH B1T / B1TH
Lower limbs
For unilateral I n pregnancy A s a double stocking to
lymphoedema up to and increase pressure in
including the affected combination with an AG
lower torso quadrant stocking
I n combination with an AD
Upper limbs
stocking as a two-part garment
BT - leggings ET- & FT- Cycling shorts Cuffs Attention

BT / BTH ET / ETH BG CG All mediven leg garments
FT / FTH are supplied with an oblique
border at the proximal*1 end
and at the foot as standard!
Accessories
Explanation
*1 Closer to the body
A s a double stocking to In combination with an AD A

increase pressure in stocking as a two-part increase pressure in
combination with an AD garment combination with an AD
Solutions fitting
or AG stocking In combination with an AD stocking as a two-part

stocking and a BG cuff as a garment
three-piece garment A
problems
increase pressure in
combination with an AD
stocking and cycling
shorts as a three-part
garment
F.A.Q.

The lymphatic
Possible
system
combinations
of the variants
Compression
Principles of
Lymphological treatment with compression

garments does not always involve a pair of
stockings or pantyhose.
We distinguish between multi-part hosiery and
double garments. AG + FT
Contraindications
Indications /
Multi-part garments
always be assessed individually. Due to the
anatomical features of the clinical picture, some of
which can be extreme, therapeutic efficacy and the
fit can only be achieved by dividing the hosiery into
several segments. The doctor is responsible for
Treatment
procedure
treatment and may have to justify the need to the

statutory health insurers.
AD + CG + FT AD + CT
The need arises primarily from the anatomical

conditions:
Important points to observe when measuring
Formation of deep skin folds or pads of tissue
for multi-part garments:
Pronounced natural skin and joint folds, e.g. in the
Lower limbs
hollow of the knee

Pads of tissue hanging down over joints
compression garment segment, because the same
Conical and funnel-shaped limbs
measuring points often differ with regard to size and
Unusual shapes
position in the overlap zone. Furthermore, different
Elephantiasis
accessories are usually necessary for the different
types of hosiery.
Multi-part hosiery provides for more practical
Upper limbs
handling in everyday life, e.g. donning and doffing.

Move the distal measuring point for Capri shorts,
Particularly patients with limited mobility or physical
Bermuda shorts and leggings to an ideal suspension
strength gain quality of life from being able handle
point (anatomical suspender) to prevent the
their compression garments themselves this
garment slipping proximally.
ensures compliance!
The continuous pressure gradient must be
maintained in order to guarantee optimum lymphatic
Accessories
return and avoid pooling and constriction. If

necessary, regulate this at the overlap zone with the
measurement under tension. Order part of the
overlapping garment as porous in order to ensure
the optimum pressure gradient and a homogeneous
Solutions fitting
transition.
problemsF.A.Q.

The lymphatic
system
Double compression garments are used to increase
the compression pressure. High grade oedema often
exerts powerful forces. In many cases the
compression pressure and stability of simple
Compression
Principles of
garments are no longer adequate. Two garments can
be worn on top of each other to increase the local
pressure and wall stability.

remember that the compression classes are not to be
Contraindications
added together, but rather the pressures they exert.
Indications /
Example:
CCL 1 = 18 21 mmHg (RAL-GZ-387)
If two CCL 1 stockings are worn on top of each other
the mean pressure amounts to 2 x 20 mmHG = 40
mmHG = CCL 3.
Treatment
procedure
Examples of more Examples of more
Important points to observe when measuring for pronounced oedema: pronounced proximal
AT + AD oedema AG + ET
double compression garments: (e.g. with lipoedema)

compression garment segment because the same
measuring points often differ in size and position in
Lower limbs
the overlap zone. Furthermore, different accessories
are usually necessary for the different types of
hosiery.

Upper limbs
measurement and the stretch measurement. Here
again you must ensure that the pressure gradient is
maintained. A porous border for the garment worn on
top such as ET / FT, CT, BT or leggings as well as a
topband with AD and AG stockings offers the
optimum transition.
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic

system

Compression
Principles of
Primary Variant A Variant B

lymphoedema One piece garment + toecap Two-piece garment + toecap
Left
Contraindications
Indications /
AA1 ATE AA1 to AG with FT

topband, oblique
border and high
front
Treatment
procedure
Secondary Variant A Variant B

lymphoedema One piece garment + toecap Two-piece garment + toecap
on Right
Lower limbs
AA1 AT with oblique, AA1 to AD with AT with oblique foot

open foot topband, oblique
border
Upper limbs
Type III Variant A Variant B

lipoedema Three-piece garment (newcomers, with a donning handicap) Two-piece garment
Stage 3
Accessories
with secondary AD with topband BG with topband, ET with porous AG with topband, BT with porous
and oblique border oblique border and rows at the lower oblique border and rows at the lower
Lymphoedema, as well as an high front border high front as well as border
Solutions fitting
Stage 1 oblique, closed tip oblique closed tips

of the toe of the toes
problemsF.A.Q.

The lymphatic
system
Lower limbs
Compression
Principles of
This indication table is a guide, i.e. recommendation on caring for the lower limbs. The type of garment and
the compression class depend on the diagnosis, the localisation, clinical findings, and the tendency for
oedema to form. Please also consider the patient's individual condition and circumstances (accompanying
disorders, mobility, BMI, state of their skin and tissue, etc.).
Indication Diagnosis Cardinal symptom mediven mediven mediven
Contraindications
550 leg mondi * sensoo *
Indications /
for connec- for connec- for connective
tive tissue tive tissue tissue that is:
that is: that is:
soft
normal normal normal
firm firm
Lipoedema Stage 1 Orange peel skin with a finely
nodular surface AT CCL 2 CCL 2 CCL 2
Stage 2 Mattress skin, coarse, nodular

skin surface with larger dimples CCL 2 CCL 2
Treatment
procedure
AT
CCL 3 CCL 3

AT CCL 3
Lower limbs
Lymphoedema Stage 1 Spontaneously reversible, soft
and doughy swelling, pitting on
AD AG AT CCL 2 CCL 2 CCL 2
pressure, no skin changes
Stage 2 Not spontaneously reversible,

early fibrosis, pitting hardly pos- CCL 2 CCL 2
AD AG AT
sible, sometimes skin changes CCL 3 CCL 3
Stage 3 Pronounced form, elephantiasis,

CCL 2
Upper limbs
fibrosis, typical chronic skin
AD AG AT CCL 3
changes
CCL 4
Attention Explanation
mediven mondi and mediven 550 leg in *P

lease remember that mediven sensoo
Accessories
compression class I are indicated for the and mediven mondi models are for mild
following comorbidities or accompanying to moderate indications.
conditions: They do not have sufficient wall stability to
model the tissues in patients with very lax
Arterial circulatory disorders connective tissue. They creep into skin
For paralysis creases, which leads to constrictions.
After a stroke
Solutions fitting
For joint problems

problems

F.A.Q.

good feeling

Give your patients a
for successful sales

The lymphatic
There are so many good reasons
system
for choosing mediven.
These powerful product features speak for themselves.
Compression
Principles of
Feel-good products with deep Clima Fresh for complete
functional effects. freshness for the whole leg
The medi compression seal identifies Antibacterial effect in the knit
Contraindications
selected high-tech products from Prevents odour formation
medi in medicine, lifestyle and Special spinning technique
Indications /
sports. medi stands for six decades guarantees the effect, even after
of experience in research and washing
development of products with
compression made in Germany. Perfect Fit for an exact size match
The manufacturing process provides Very precise compression dosing
for a precise dose of compression on Optimum medical care conditions
the body for demonstrably positive
Treatment
procedure
effects on health, performance and Power yarn for pressure over a
well-being. large area
Deep acting pressure over large
Standard anatomical oblique areas
borders (distal and proximal) More stable and less elastic for
Unimpeded lymph drainage effective treatment of oedema
Anatomic Fit without circular constriction Optimum pressure stability all day
Lower limbs
Optimum fit and better hold long
Made to measure garments for Flat seam with elastic seam tape
personal needs Resistant to chafing and
For severe indications wear-and-tear
rotatable Variety Perfect Fit
For unusual Soft Elastic
leg shapes For more freedom of movement
Due to special features
Upper limbs
Easy to care for
Clima Comfort* for perfect Suitable for washing machines and
climate exchange the delicates programme in tumble
Feeling of well-being all year round driers
Highly active breathing
Prevents itching Very good skin tolerability and
highly suitable for everyday wear
Without cotton & latex free
Accessories
* Clima Comfort
Scientifically tested by the French Institut

IFTH. The test result shows that Clima The practical info guide
Comfort technology from medi guarantees At the top right-hand corner of each product
Solutions fitting
climate exchange between the skin and the page, you will find the stages of oedema
garment. medi achieved an outstanding under the CCL. If the box is magenta, the
total score with 11 out of 12 points.
problems
garment is suitable for that particular stage

of oedema. If it is grey, it is not suitable.
1 2 3
F.A.Q.

The lymphatic
mediven
system
550 Leg
variety for oedema up to stage 3.
Compression
Principles of
Indications
stages 1, 2 and 3
Contraindications
Elephantiasis
Severe phlebological indications with a
Indications /
tendency for oedema to form

Caring for keloid, e.g. after burns
oedema
Mixed forms: phlebo-lymphoedema,
lipo-lymphoedema

Treatment
procedure

connective tissue
Product strengths
special extras such as soft toe
Lower limbs
Numerous variants, e.g. leg segments

for double and multi-part garments
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
AD AF AG AT / ATH / ATU ATE / ATEH CCL 1, 2, 3, 4
Optionally left
with right Oedema stage
suspender belt
1 2 3
Compression
Principles of
Sand
Contraindications
Caramel
Caramel
Indications /
Black
AB AB1 BD BF BG
Standard colours
Aqua
CF CG DF DG EG medi Magenta
Treatment
procedure
Brown
Navy
Anthracite
Lower limbs
Standard models
Trend colours
Models Flat oblique at the thigh and perforated tape with all pantyhose Delivery period up to ten
variants working days
Gusset / Panty top Mens leotard: ATH, ATEH, FTH, ETH, CTH, BTH
non-compressive front panty top: ATU, ATEU, FTU, ETU, CTU, BTU Design elements
Upper limbs
Diamonds
Pearls
Accessories
Stripes
Elastane (EL) Polyamide (PA) The design elements can be
CCL 1 23 % 77 % standard and trend colours.
Solutions fitting
CCL 2 25 % 75 %
CCL 3 28 % 72 %
problems
CCL 4 32 % 68 %
F.A.Q.

The lymphatic
mediven
system
550 toecap
Maximum wall stability for oedema up to
stage 3.
Compression
Principles of
Indications
Contraindications
Product strengths
Toecap with Clima Fresh: reliably prevents
Indications /
odours and colonisation of bacteria

Unique top and bottom principle: seam moved
to the upper and lower surfaces of the toes in
the direction of lymph drainage
Treatment
procedure
Optional incorporation of medi lymphpads for

additional pressure for lymphoedema over the
dorsum of the foot
Fully integrated toecap:

Safer measurements (overlap no longer has to
be calculated)
Lower limbs

seams
Upper limbs
Single toecap
and easy donning and doffing
Accessories
Sewn on toecap:
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Closed
toecap
Toecap
closed,
Toecap
open
Toecap
open,
CCL 1, 2, 3
without without
small toe small toe
Oedema stage
Compression
Principles of
Standard models
Colours
Sand
Contraindications
Caramel
Indications /
CCL 1 23 % 77 %
CCL 2 25 % 75 % Black
CCL 3 28 % 72 %
Standard colours
Aqua
medi Magenta
Treatment
procedure
Brown
Navy
Anthracite
Lower limbs
Trend colours
working days
Design elements
Fully integrated toecap
Upper limbs
Diamonds
Pearls
Accessories
Single toecap Stripes

Solutions fitting
problems
Sewn on toecap
F.A.Q.

The lymphatic
mediven
system
mondi
Compression
Principles of
Indications
stages 1 and 2
Contraindications
Severe phlebological indications with

tendency to oedema
Indications /
Keloid care, e.g. after burns

oedema

connective tissue
Treatment
procedure
Product strengths
Available with silver segments:
- Y-C, Y-D, Y-G
- Antibacterial effect, for patients with
e.g. chronic wounds, atopic
dermatitis
- Segments allow for specific and
Lower limbs
cost-effective use
Supple knit
special accessories e.g. Y knitting mark
colours and five trend colours
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
AD AF AG AT / ATH / ATU ATE / ATEH
CCL 1, 2, 3
Optionally left
right
with Oedema stage
suspender
belt
1 2 3
Compression
Principles of
Sand
Contraindications
Caramel
Caramel
Indications /
Black
Standard models
Standard colours

with all pantyhose variants Aqua
Gusset / Panty top Men's leotard:

ATH, ATEH, FTH, ETH, CTH, BTH medi Magenta
Treatment
procedure
non-compressive front panty top:
ATU, ATEU, FTU, ETU, CTU, BTU
Brown
Available silver segments Y-C, Y-D, Y-G

Navy
Material composition mediven mondi

Anthracite
Lower limbs
Elastane (EL) Polyamide(PA)
CCL 1 22 % 78 % Trend colours
CCL 2 24 % 76 % Delivery period up to ten
working days
CCL 3 28 % 72 %
Material composition mediven mondi mit Silbergarn

Elastane (EL) Polyamide(PA) Silver cover
CCL 1 22 % 77 % 1%
Upper limbs
CCL 2 24 % 75 % 1%
CCL 3 28 % 71 % 1%
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
mediven mondi
system
toecap
Compression
Principles of
Indications
Contraindications
Product strengths
Toecap with Clima Fresh: reliably prevents
Indications /
odours and colonisation by bacteria

Unique top and bottom principle:
- Seam moved to the upper and lower surfaces
of the toes in the direction of lymph drainage
Treatment
procedure

More reliable measurements
(overlap no longer has to be calculated)
Lower limbs
seams
Single toecap
Upper limbs

and easy donning
Sewn on toecap
Accessories

Solutions fitting
problemsF.A.Q.

The lymphatic
system
Closed
toecap
Toecap
closed,
Toecap
open
Toecap
open,
CCL 1, 2
without without
small toe small toe
Oedema stage
Compression
Principles of
Standard models
Colours
Sand
Contraindications
Caramel
Indications /
CCL 1 22 % 78 %
CCL 2 24 % 76 % Black
Standard colours
Aqua
medi Magenta
Treatment
procedure
Brown
Navy
Anthracite
Lower limbs
Trend colours
working days
Fully integrated toecap
Upper limbs
Accessories
Single toecap
Solutions fitting
problems
Sewn on toecap
F.A.Q.

The lymphatic
mediven
system
sensoo
Supple and soft
Compression
Principles of
Indications
stage 1
Lipoedema stage 1
Contraindications

oedema, mild stages
Indications /
Caring for keloid

Recommended for normal connective
tissues
Product strengths
Soft, sheer knit
Treatment
procedure
Material that is easy to put on

Soft and smooth surface
Selected extras
Lower limbs
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
AD AG AT / ATH
CCL 2
Oedema stage
1 2 3
Compression
Principles of
Colours
Standard models
Border Flat oblique with all stocking variants Sand
Contraindications
with all pantyhose variants
Caramel
Gusset Men's gusset: ATH Caramel
Indications /
Black
CCL 2 25 % 75 %
Treatment
procedure
Lower limbs
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Basic guidelines on measuring techniques

system

A number of additional important tips Always mark the measuring points with
Compression
from medi can be found below a soft pencil (kohl pencil).

Principles of
Always measure foot lengths on the

Measure the toe areas accurately to the weight-bearing foot with the patient
nearest millimetre measurements to standing.
the nearest 5 millimetres are sufficient
BUFA guideline: measure length
for the legs.
Contraindications
vertically.
Never measure circumferences in skin
Indications /
creases otherwise there is a risk of

causing constriction.
Never take circumference
measurements under tension.
Measurement under tension depends
on the tissue structure, the indication l K1T l K2T Tips
and the respective measuring point (see Always document the skin and
Treatment
procedure
lH tension measurements to
Tips for measuring points). Please take
l K1 enable an objective
the individual patient's sensitivity to assessment of any changes
pain into account. lG l K2 that may occur.
Photographic documentation
Never measure toes under tension. lF is always helpful and is
In the case of oedema at the base of the increasingly required by
close to perpendicular health insurance companies.
toes and in the toes, always provide a lE
It will make processing these
the body
Lower limbs
toecap, which is to be worn separately lD generally complicated

under stockings, sewn onto a stocking garments a lot easier.
lC
or as the fully knitted variant. In the case of products with
l B1 little longitudinal stretch,
Measure circumferences and lengths medi recommends you
up to measuring point F with the lB measure the lengths close to
patient lying down. In case of very soft the body and with the patient
standing to lK1 along the
connective tissue, projecting forms and inside leg.
Upper limbs
overhanging tissue at the knee due to

oedema or obesity, only to measuring
point D.
medi sets new standards
Make sure you carry out the measuring
procedure quickly. Patients with At medi, it is standard practice to
oedema should only be required to produce all garments with an oblique
stand for as short a time as possible border at the foot and at the proximal
Accessories
without their hosiery. end (see Tips for measuring points).

If the shapes of the limbs differ from This prevents circular constriction!
standard anatomy, you can base your
measurements on the following: normal
height of the B measurement is approx.
Solutions fitting
8-12 cm.
problemsF.A.Q.

The lymphatic
system
Measuring point A according to BUFA guidelines
Measuring point A
Compression
Principles of
Foot fully Length (l ) A Tips on measuring point A
weight-bearing Straight border: distance from heel to
Always measure the foot length on the weight-bearing
-metatarsophalangeal joint of little
foot with the patient standing.
toe (Fig. 1)
For the oblique border, medi requires both the foot length
on the medial as well as the lateral side of the foot.
Particularly for the open variants, ensure that the inner
and outer foot length measurements are not too short.
Contraindications
You should always measure over the
metacarpophalangeal joint of the big and little toes as far
Indications /
Fig. 1 Source: BUFA as the beginning of the toes.
Length (l ) Z edia
l
lA m
Closed toe: distance from
heel to longest toe (Fig. 2)
lA
Treatment
procedure
Tips on length A
Fig. 2 Source: BUFA
If the second toe is longer than the big toe, add the Special
Request Sew the tip of the toe on round.
Length (l ) A / A1
Oblique border:
Lower limbs
Distance from the heel.
- Distance from heel to
metatarsophalangeal joint of little
toe (= outer length) & distance from
heel to metatarsophalangeal joint
of big toe (= inner length) including
joint (Fig.3)
Upper limbs
Fig. 3 Source: BUFA
cA (for straight and oblique border) Tips on measuring point A
With feet and / or hallux valgus that are sensitive to

pressure, do not measure too tightly. Often the option of
a long soft toe with a straight border is recommended,
which then begins, as an exception, behind the hallux
Accessories
Circumference (c) A valgus.

Apply tape measure around the When measuring feet with oedema over the dorsum of
Joint line metatarsophalangeal joints (first the foot, press the tape measure gently into the oedema
joints of toe) (Fig. 4) to build up compression. A pad is needed to achieve
Fig. 4 Source: BUFA
optimum pressure.
Measuring an Measuring a straight

Solutions fitting
oblique border border with the tape

with the tape
problems
Joint line
F.A.Q.

The lymphatic
system
Lower limbs Y, P1 / P2, B, B1 according to BUFA guidelines
Measuring point Y
Compression
Principles of
Tips on measuring point Y
Always measure measuring point Y in maximum

dorsiflexion.
Without exception, never measure cY under tension.
Circumference (c) Y A reduction in this circumference causes increased
Take the measurements over the heel pressure on the tendon area.
Contraindications
and arch in dorsal flexion with The standard comfort heel is adequate in many
tendons taut; take body cases. In addition, Y shaping can be added to reduce
Indications /
measurements without tension; take pressure on the flexor tendons over the ankle and to
soft tissue projections into account bridge joint folds (see page 52 Accessories).
(Fig. 5)
Fig. 5 Source: BUFA
Measuring point P1 / P2
Length ( l ) P1 / P2 Tips for pads
Additional measurement for profile Please simply mark the position where the pads (e.g.
stockings Levamed) are to be incorporated with a cross on our
Treatment
procedure
order form. The pads will be sewn in when the garment

We do not require these is being made ready to give the anatomically correct
dimensions! fit.
You can also send us a sketch or drawing.
Circumference (c) P1 / P2 For the individually made variants, mark the position
Dorsal circumference over the of where the pad is to be fitted and return the stocking
Achilles tendon from the middle of to us.
the lateral to the middle of the
medial malleolus (P1). Plantar
Lower limbs
circumference over the sole of the

foot from the middle of the lateral to
the middle of the medial malleolus
Fig. 6 Source: BUFA (P2) (Fig. 6)
Measuring point B Tips for measuring point B
Measure circumference cB at the narrowest point of

Length ( l ) B
the ankle.
From sole of foot to above (proximal)
Exception: if there is oedema in this area the
to the ankle (Fig. 7)
measuring point moves to where the oedema starts;
Upper limbs
never measure in the skin fold around the joint.

The compression pressure starts at cB. So, from here up
measure under tension depending on the indication
Circumference (c) B and the tissue structure. The higher the material's wall
Measure circumference depending stability, the more tension it requires and tolerates.
on indication, tightly if necessary In many case, it is difficult to define the individual
(Fig. 7) measuring points due to the patient's anatomy. In
order to guarantee the optimum fit and the optimum
Fig. 7 Source: BUFA pressure gradient, try to divide the lower leg into three
sections of equal size between measuring points
Accessories
Measuring point B1 B to D.
Circumference (l ) B1
From sole of foot to start of calf
(Fig. 8)
Solutions fitting
problems
Fig. 8 Source: BUFA

F.A.Q.

The lymphatic
system
Lower limbs C, D according to BUFA guidelines
Measuring point C
Compression
Principles of
Length ( l ) C
largest calf circumference (Fig. 9)
Contraindications
Circumference (c) C
Measure circumference depending
Indications /
on indication, tightly if necessary
(Fig. 9)
Fig. 9 Source: BUFA
Measuring point D
Tips on measuring point D
Length ( l ) D
From the sole of foot to the head medi garments are manufactured with the flat
of the fibula* (approx. two fingers'- oblique top border as standard.
Treatment
procedure
width below kneecap) (Fig. 10) Due to the oblique border (larger distance = more
volume) and depending on the indication and the
tissue structure, we recommend you measure
measuring point D under tension. The length of the
Circumference (c) D stocking (AD to the first resistance, AG and AT between
Measure circumference depending the first resistance and full tension) is decisive for the
on indication, tightly if necessary intensity of the measurement under tension.
Optional borders include a steep oblique and a
Exception straight border. Check the course of the fold at the
Lower limbs
AD stocking = Body dimension, with back of the knee. Measure lD along the inside leg too,
addition if necessary (Fig. 10) the oblique is calculated automatically (see Page 46).
Fig. 10 Source: BUFA The difference between lC and lD or lD and lE
should be at least 6 cm to allow for the manufacture of
* The head of the fibula is palpable on the outer aspect directly below the knee widely differing circumferences.
joint (but is not part of the knee joint).
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
system
Lower limbs E, F according to BUFA guidelines
Measuring point E
Compression
Principles of
Length ( l ) E Tips on measuring point E

From sole of foot to middle of With projecting shapes and voluminous knees the
kneecap connective tissue gives different circumferences
(Fig. 11) and lengths when the patient is standing as opposed
to lying down. It is recommended that these
measurements should be checked again close to the
Contraindications
body when standing and averaged out if necessary.

For those patients who mainly have a sedentary or
Indications /
kneeling occupation and for those in a wheelchair, an

Fig. 11 Source: BUFA ellipse form at E can be chosen as an accessory to
relieve pressure on the back of the knee
(see page 52 Accessories). In this case, please give
the extra measurement Long back of knee on the
measurement sheet.
Circumference (c) E
Circumference (c) E is generally not
measured tightly; with the leg bent
(angle 30 45), take the
Treatment
procedure
circumference measurement one

fingerbreadth proximal to the back of
the knee and two fingerbreadths
proximal to the kneecap. Do not place
tape in the back of the knee or folds
of skin (Fig. 12)
Lower limbs
Length back of knee

Measuring point F
Length ( l ) F Tip on measuring point F
For large projecting shapes and deep skin folds it is
middle of the thigh (Fig. 13)
advisable to determine this circumference and length
measurement (as always close to the body) while the
patient is standing (cf. p. 36).
Upper limbs
Circumference (c) F
The circumference is generally
measured fairly tightly, depending on
the indication (Fig. 13)

Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Lower limbs G, K according to BUFA guidelines
Measuring point G
Compression
Principles of
Length ( l ) G Tips on measuring point G
AG stocking dimension: The length lK2 (= length of the back of the leg) is an
Sole of the foot to the widest part important leg length (see P. 42): it forms the basis for
(medial) below the transverse gluteal AG stockings and all pantyhose variants. Nevertheless,
fold (incl. non-slip topband) (Fig. 14) do not neglect length lG.
For AG stockings with a topband a circumference
Contraindications
check measurement should be taken. This should
roughly follow the desired position of the topband
Indications /
(see Fig. A). Measure this dimension tightly.
Circumference (c) G
Depending on the indication, the
circumference is generally measured
fairly tightly
Warning: measure AG stockings with
a non-slip topband under tension,
Treatment
procedure
but avoid constriction! (Fig. 15)
Fig. A
Lower limbs
Measuring point K (=K1)
Length ( l ) K Tips on measuring point K
From the sole of the foot to front of
medi always needs the circumference measurement cK
crotch (Fig. 16)
for all pantyhose variants. Measure this in a circle
(depending on the manufacturer) around both thighs below the buttock fold under
tension (Fig. B). The intensity of the tension should be
Upper limbs
proportional to the reduction of circumference cG, so
that the legs and the panty top match perfectly when
Circumference (c) K the garment is made ready.
Length dimensions only required Length lK1 is only needed for the accessory high
front. Start this measurement in the groin at the level
Obligatory measurement for medi! of the lower border of the pubic bone and measure
close to the body along the inside leg down to the sole
Fig. 16 Source: BUFA of the foot (see Fig. C).
The high front is calculated from the difference
between lK2 and lK1. Maximum high front AG: 8 cm.
Accessories
Maximum high front for pantyhose: 5 cm.

Solutions fitting
Pubic
bone
problems
Fig. B Fig. C
F.A.Q.

The lymphatic
system
Lower limbs K2, H according to BUFA guidelines
Measuring point K2
Compression
Principles of
Length ( l ) K2 Tips on measuring point K2

From sole of foot to transverse Important length for medi
gluteal fold (Fig. 17) Please always measure lK2 close to the body at the
(depending on the manufacturer) back of the leg, slightly medially, from the transverse
gluteal fold to the sole of the foot. The optimum
starting point here is where the groin area joins the
Contraindications
transverse buttock fold (see Fig. D).

Circumference (c) K2 If the AG garment is too short, it will slip down and
Indications /
Only the length dimensions are may chafe the skin over the inside of the thigh. If the
required AG garment is too long, the topband folds over or the
surplus material slips down into the hollow of the
knee.
Treatment
procedure
Fig. D
Lower limbs
Measuring point H
Length ( l ) H Tips on measuring point H
From the sole of the foot up to the l H is the only length measured down the outside of
widest part of the pelvis (Fig. 18) the leg.
If possible, select the compression class for the panty
top so that it is at most only one compression class
Upper limbs
below the compression class for the legs.
Circumference (c) H
Accessories
Circumference of pelvis at the widest

point, measure tightly depending on
indication (Fig. 19)
Solutions fitting

problemsF.A.Q.

The lymphatic
system
Lower limbs T according to BUFA guidelines
Measuring point T
Compression
Principles of
Length ( l ) T Tips on measuring point T
From sole of foot to upper border of This measurement is only required for AG stockings
pantyhose (patient-specific) (Fig. 20) with a suspender belt.
Contraindications
Indications /
Length (c) T
Circumference of trunk, moderately
tightly if necessary (Fig. 21)
Treatment
procedure
Lower limbs
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
system
Measuring points for the front (l K1T) and back (l K2T) panty
top according to the BUFA guidelines
Compression
Front (l K1T) and back (l K2T) panty top

Principles of
Tips on measuring points l K1T and l K2T

Length ( l ) TK1
Front length TK1 (Fig. 22): The panty top has a therapeutic effect and also keeps
the garment from slipping down. In order to satisfy
Measure vertically next to body at
Contraindications
these criteria as well as possible, the panty top must

the level of the inguinal fold from the extend at least as high as the waist = lowest
crotch to the top border anatomical support. The more pronounced the
Indications /
abdomen, the higher the panty top must be measured,

up to just below the bust if necessary.
Measure the front panty section length from
measuring point K1 up to the optimum border
(s. Fig. E) = front anatomical suspender.
Measure the back panty section length from
Fig. 22 Source: BUFA measuring point K2 up to the optimum border
(s. Fig. F) = rear anatomical suspender.
Length (l ) TK2 Since the border fits the waist differently during
movement (e.g. when sitting down), consider the width
Rear length TK2 (Fig. 23):
Treatment
procedure
of the top border when measuring lK2T to ensure that

Measure vertically close to the body, the panty top fits properly (e.g. lK2T = 30 cm + 4 cm
from the transverse gluteal fold to waistband).
the top border. For patients with soft connective tissues, refer to the
Note: for soft connective tissue, the BUFA note on panty top lengths. medi offers
lengths should be measured under individually made up braces for additional
tension. The measurement for the attachment. Measure the length for this as shown in
panty section, where circumferences Figs. G + H.
are large, should never be too short
Lower limbs
and should be ordered with an

adjustable pull-through elastic band,
possibly with additional security Waist =
aids. anatomical
Fig. 23 Source: BUFA suspender
Pubic
bone
Upper limbs
Fig. E Fig. F
Accessories
Fig. G Fig. H
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Measuring positions for a pouch
Compression
Principles of
Measuring for a pouch
Measure the length as shown
in Fig. 1
Begin at the root of the penis and
Contraindications
measure down to the base of the
scrotum over the highest point of the
Indications /
Length oedema.
Width
Fig. I
Measure the width from groin to
Treatment
procedure
groin, also over the highest point of
the oedema (Fig. J).
Ideally, take the measurements over

the lymphological compression
Width
dressing.
Lower limbs
h Measurements can be taken over
ngt
Le underwear.
Fig. J
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
system
Lower limbs A, A1, toes 1 4

Measuring point A
Compression
Principles of
Length ( l ) A1 Tips on measuring point A

Lateral length: from the
Reduce measurement cA if oedematous. Press the
metatarsophalangeal joint of the
measuring tape gently into the oedema to prevent
small toe to the root of the instep
excessive pressure on the lateral borders of the feet.
(roughness of the 5 th metatarsal
Incorporation of a medi lymph pad gives the best
bone).
pressure distribution (see page 54).
Contraindications
Medial length: from the Measure the medial and lateral length of the toe cap
metatarsophalangeal joint of the big as the anatomical situation allows. Remember the
Indications /
toe to the end (Fig. 24) shorter the toe cap in this area, the greater the risk
that it will migrate forwards.
The difference between the medial and lateral
lengths should be at least 1.5 to 2.5 cm for optimum
manufacture of the toe piece.
Please also note our option of either having the toe
cap sewn directly onto the stocking or a fully knitted
stocking and toe cap.
Measuring point A1
Treatment
procedure
Circumference (c) A
Pass the tape measure around the
metatarsophalangeal joints (first
joints of toe) (Fig. 25)
Circumference (c) A1
Measure straight across middle of
Lower limbs
foot (final length)

Circumference (c) Tips on measuring the toes
Generally measure dimensions X and Never measure toes under tension!
Upper limbs
Please ensure a loose skin measurement at cX and a

tension. The X measurement must skin measurement accurate to 1 mm at cZ. For these
not be smaller than the Z very small extremities we recommend our medi finger
measurement and must be adjusted and toe measuring tape (Art.20.226).
to the Z measurement if necessary
(Fig. 26).
Accessories

Solutions fitting
problemsF.A.Q.

The lymphatic
system
Lower limbs toes 1 4
Compression
Principles of
Length Tips on measuring the toes
Shortest length from web (X) to
medi recommends measuring the lengths too long
middle of nail (Z) (Fig. 27)
rather than too short:
1. Toes that are too long can be marked when trying
Exception:
on and returned to us for shortening.
for closed toes, measure to end of
2. If the toe length is measured too short the patient
Contraindications
toes.
will be walking on the edge of the border, which is
very painful and can lead to ulceration.
Indications /
T he variant without little toe is generally made with
an anatomical opening (see Fig. K).
Variations for measuring on the top of the toes:

F or this variant try to straighten these generally short
Fig. 27 Source: BUFA and bent toes slightly and to separate the adjacent
toes laterally as far as possible so that the webs are
clearly visible (see Fig. L / M).
N ow mark the beginning on the imaginary line
Treatment
between the webs in the middle of the toe (see Fig. M).
procedure
Measure the length from this beginning to the end of
the toe (see Fig. N).
Lower limbs
Fig. K Fig. L
Upper limbs
Fig. M Fig. N
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Possible toe cap versions

system
Measuring technique toe cap
In addition to the variants where the toe cap is worn under the hosiery,
you can offer your patient a fully integrated toe cap or one sewn to the
Compression
Principles of
hosiery.
Ordering a fully knitted toe cap

Measure the toe circumferences cX and
cZ, their lengths and the circumference
Contraindications
cA across the metatarsophalangeal joints

as usual.
Indications /
Enter the dimensions in the measuring

A lAi chart Toe garments and mark Fully
integrated stocking and toe cap with a
cross for the model.
lA
The length of the foot is equivalent to

the measurements for an open oblique
Treatment
procedure
Fig. O Possible with mediven mondi and foot. Measure lAi and lA from where the
mediven 550 toe cap heel meets the ground to just distal to
the balls of the big and small toes (Fig. O).
Mark Toe cap with a cross in the Foot
field on the measuring chart.
Note
Lower limbs
The fully knitted variant is available for AD and AG

stockings.
Fully knitted stocking and toe cap

Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Compression
Principles of
Ordering a toe cap sewn to the hosiery
Based on the existing anatomy, mark the
best position for the seam. Measure the
Contraindications
inner and outer lengths for the toe cap
up to the mark. Order the garments, onto
Indications /
which the toe cap is to be sewn post-
A1
manufacture, with a straight border and
A
foot length lA up to the mark (Fig. P).
Enter Toe cap sewn to hosiery in
lA
hos
iery the Model field in the Toe garments
A1 measuring chart.
lA - ap
ec
To Mark the field Toe cap with a cross in
Treatment
procedure
Fig. P Possible with mediven mondi and the Leg garments measuring chart.
mediven 550 toe cap
Tip
The incorporation of a lymph pad helps achieve

optimum pressure distribution over an
oedematous dorsum of the foot.
Lower limbs
A1
A
Se
am
lA
iery
hos
A1
lA - cap
T oe
Toe cap sewn on
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Lower limbs
system
Leg accessories
3D panty top Benefit

Compression
Principles of
Anatomically shaped panty The perfect fit on the abdomen and

top bottom shaping of the abdomen and
The shape of the 3D panty top is bottom.
obtained from the determined
circumferential measurement
and length in the panty area
Contraindications
Indications /

Anatomically correct border due to circular borders basic
Standard for all mediven flat requirement for a garment that is
knit garments. Knitted fabric appropriate to the indication.
Treatment
procedure
for outer leg longer by x cm
Steep oblique Optimum anatomical fit, also for large

Anatomically correct border local accumulation of tissue, particularly
Knitted fabric for outer leg in cases of lipoedema that show the
longer by x cm classical saddlebag syndrome, no risk of
stasis due to circular borders.
Lower limbs
Anterior thigh longer Benefit
Accurate pressure gradient Optimum anatomical fit due to individual

up to groin adaptation to the course of the groin,
Upper limbs
Anterior thigh longer particularly in cases of local accumulation

of tissue in the region of the front of the
thigh.
Anterior view Lateral view

Accessories
Comfort heel = standard heel Benefit
Individual angle at the heel Better fit due to reduced wrinkling in this
The individual angle is often difficult area. Even the standard
calculated from the heel takes the individual requirements of
Solutions fitting
measurements you supply each patient into account. The number

cY= Standard and angle of the knitting marks are
calculated individually.
problemsF.A.Q.

The lymphatic
system
Compression
Principles of
Contraindications
Indications /
Tips Field: Standard border c.f. Fax Order
medi always produces flat knit products with an oblique border at the The flat oblique is standard 3 + 4
proximal end, i.e. the lateral side of the garment is x cm longer. for all mediven garments.
The level of the oblique depends on the circumference of the border (cD for You do not need to make a at the top of
knee-length garments and cG for thigh-length garments and pantyhose). selection. fold-out page 104
Treatment
procedure
The standard is flat oblique = approx. 5 % of the circumference. Field: Optional border
A steep oblique = approx. 10 % of the circumference can be selected
as an option. Cross steep oblique!
The obliques optimise the fit they compensate for the longer distances
caused by the accumulation of tissue (e.g. jodhpur syndrome).
Please consider the patient's anatomy when choosing the oblique.

Incorporation of a longer knit also means a higher volume.
Lower limbs
You must also consider the course of the gluteal fold. With gluteal folds that
are straight or dip downwards laterally, the topband may fold over.
c.f. Fax Order
Tips Field: Accessories 5
The high front optimises the fit. Voluminous thighs caused by tissue Give lK1 and cross high front at the top of
accumulation at the front of the thigh make this distance longer. This can be fold-out page 104
compensated for with the high front.
Upper limbs
The high front is calculated from the difference between the front leg length
lK1 and the back leg length lK2. Please note here the maximum lengths:
pantyhose = 5 cm AGs = 8 cm.
The lK1 measurement is only needed for measuring the high front!
When choosing the high front, please consider the patient's anatomy and the
garment style. Incorporation of a longer knit also means a higher volume.
Accessories
Tips
In many cases, you can already achieve an optimum fit in this area simply
with our standard heel (= comfort heel). The standard heel is particularly
suitable for slim, non-oedematous feet or for feet with a high arch.
Solutions fitting
problems
F.A.Q.

The lymphatic
Lower limbs
system
Leg accessories
Ellipse form at E Benefit

Compression
Principles of
Knitting marks in the knee To reduce excessive pressure on the veins

area at the back of the knee and the major
lymphatic trunks.
For patients who only sit Also reduces wrinkles forming when
(e.g. people in wheelchairs) sitting.
Contraindications
Indications /
Y knitting marks = 90 heel Benefit
Additional Y knitting marks in Reduces pressure on the instep and to

heel and arch areas bridge skin creases.
Treatment
procedure
Oblique forefoot Benefit

Lower limbs
Oblique line of compressive Optimum pressure gradient as far as the

knitted fabric joints at the base of toes due to the
Standard for all mediven flat anatomical gradient, no circular
knit garments constriction in the forefoot area.
Upper limbs
Long sole Benefit
Extension of the compressive Optimises the fit in the forefoot, relieves

knit along the sole of the foot pressure on the toes with closed
garments.
Accessories
Soft toe Benefit
Particularly soft and elastic More comfortable to wear for particularly

Solutions fitting
knitted fabric for the toe area sensitive toes in diabetics and with severe
hallux valgus.
mediven 550 leg only
problemsF.A.Q.

The lymphatic
system
Compression
Principles of
The ellipse makes the garments more comfortable to wear for people who Mark Ellipse form with a 5
spend most of their time sitting down or kneeling. It compensates for the cross. Please also show the
longer distance at the knee when sitting and thus reduces increased pressure height of the back of the knee at the top of
on the patella and wrinkling in the back of the knee. separately. fold-out page 104
Always give the measurement l back of the knee. Measure this close to Standard = 4 cm
the body from the fold in the back of the knee to the heel with the patient Minimum = 2 cm
standing. Note that lE must be at least 1 cm longer than l back of the knee.
Contraindications
Maximum = 8 cm
Attention! In patients with voluminous knees (lipoedema) or a large cE
measurement, the incorporation of ellipses increases wrinkling in the knee Give any deviation from
Indications /
region. Wrinkles may also form below the patella. standard in cm in the field
Do not use ellipses here. Special Requests.

The incorporation of Y knitting marks at the ankle holds the foot in about Mark Y knitting mark with a 5
90 flexion. This increases the volume at the ankle. Use the Y knitting mark cross.
specifically for patients who need a different foot position to lower pressure at the top of
and reduce wrinkle formation. Reasons for this could be: foot architecture, fold-out page 104
oedema or the accumulation of tissue as well as pronounced tissue folds at
Treatment
procedure
the ankle (e.g. due to lipoedema). In case of oedema around the malleoli, the
Y knitting mark in conjunction with pads (e.g. Levamed) ensures optimum
pressure distribution. Never reduce cY because this increases the pressure on
the flexor tendons of the foot.
medi produces all flat knit garments with an oblique foot border. Mark open or closed with a 1
Lower limbs
This guarantees the best possible fit to follow the anatomical line of the cross.
metatarsophalangeal joints. It also prevents constriction of the forefoot. at the top of
The oblique border is standard for both open and closed toes. The oblique Please also give fold-out page 104
border of the compressive knit is calculated from the difference between the lZ (overall measurement)
inner length of the foot lAi and the outer foot length lA. The maximum lAi (inner length)
possible oblique is 4 cm. lA (outer length).
Upper limbs
The long sole optimises the fit in the forefoot region in the case of foot Mark Long sole field with a 5
deformities such as hallux valgus or hammer toe. cross.
Knitting the compressive knit along the sole of the foot gives the stocking at the top of
a circular grip at the metatarsophalangeal joints. fold-out page 104
This stops the foot section slipping back towards the heel.
The length of the long sole depends on cA and is produced automatically.
Accessories
Tipps Field: foot c.f. Fax Order

Do not choose the length of the foot longer than necessary for this variant Mark Soft toe with a cross. 1
- a maximum of 5 cm tricot length is usually sufficient.
Solutions fitting
Exceptions: inflamed hallux valgus - in this case, the soft toe also includes at the top of
this pressure-sensitive region. fold-out page 104
problems
F.A.Q.

The lymphatic
Lower limbs
system
Leg accessories

Compression
Principles of
Incorporation of medi lymph Compensate for concave areas (curving

pads, pre-formed silicone inwards) to achieve the best possible
pads (Levamed) and padding pressure distribution (e.g. malleoli)
materials Better pressure distribution over the
back of the hands and feet
Loosen fibrosis
Specific pressure increase over the
Contraindications
oedematous region
Indications /

Incorporation of medi lymph Local relief of pressure over sensitive
pads regions or around joints such as the back
of the knee or anterior (subtalar) ankle
Treatment
procedure
joint.

Lower limbs
Lining with soft smooth The skin in particularly sensitive areas,

material (texture similar to irritated skin areas (e.g. after psoriasis,
that of microfibre) ulcer, or burns) is not subject to additional
irritation and calms down.
Unpleasant itching is avoided.
Upper limbs

- Topband
Most common method of Circular support, simple handling

Accessories
securing stockings (AG, AF

and AD) without circular
constriction with oblique
borders

Solutions fitting
- Suspender belt
Support of AG stockings at Alternative fastening, e.g. if topband is
problems
the waist not tolerated, or for men with very hairy

legs.
F.A.Q.

The lymphatic
system
Compression
Principles of
If additional local compression is necessary or if support is required for Please state choice and 8
dispersing fibrosis, we recommend using only the mediven 550 models. document the position, shape
When ordering pads that are made up individually, we recommend you send etc. medi will then make these at the top of
the pads back to us for alteration after the trial fitting. according to your individual fold-out page 104
For this, mark the exact shape and position of the pads with our medi textile instructions (Special
pencil (Art. 25.460). Requests).
Levamed pads and medi lymph pads that are positioned on the basis of
Contraindications
For this, please give the exact size and positioning points.
Indications /
Please always write the original sizes on the sketch because the scale can
change when faxing or mailing.
Field: Other accessories c.f. Fax Order
Please state choice and 8

document the position, shape
Treatment
procedure
Requests)
Lower limbs
Please always give us the exact size and positioning of the lining material. Please state choice and 8
Lining material can also be added retrospectively. document the position, shape
Requests).
Tips Attachment field c.f. Fax Order Upper limbs

For each quality and each topband type, medi uses the appropriate Please select the required 7
circumference conversion, i.e. the table measurement for the topband is topband and give any
based on years of experience and numerous tests. possible non-standard at the top of
Accessories
If, in exceptional cases, it is necessary to fit a tighter or looser topband than topband circumference fold-out page 104
usual, please show the respective circumference in cm after the variant. measurements.

Solutions fitting
medi needs the overall length lT for making up AG stockings with a waist Cross Waist attachment 7 + 8
attachment! If the fabric over the inner thigh tends to roll down, and the positions on the left /
problems
we recommend our skin adhesive medi fix (Art. 1023105). right and write lT in the field at the top of
Alternatively, the medi waist attachment can also be combined with Special Requests fold-out page 104
a topband border.
F.A.Q.

The lymphatic
Lower limbs
system
Leg accessories

Compression
Principles of
- Topband stoppers
Additional support for leg Additional security of fit for voluminous

garments. thighs.
Only possible along the panty
form, longitudinally above
the patella or longitudinally
on the back of the thigh.
Contraindications
Indications /
Open crotch Benefit
Pantyhose without gusset Solution for patients with incontinence

Treatment
procedure
issues or frequent fungal infections,

quicker and easier handling of garments
for this additional indication.
Lower limbs
Maternity pantyhose Benefit
Compression pantyhose with Gentle care also during pregnancy,

front of panty top in knitted precisely when it is particularly needed.
material (no compressive
fibres in the knitted fabric)
Upper limbs
Incorporation of zips / Velcro Benefit

fasteners

optimum therapeutic outcome, enables
donning and doffing for
Unusual shapes
Fresh scars (following burns)
Accessories
rheumatism)

compression
Solutions fitting
Compression weft fibres in Ease of handling of compression garment

every other row in the area without the risk of congestion, correct
problems
that overlaps with the pressure gradient at the overlapping

optimum border junction with multi-part garments.
F.A.Q.

The lymphatic
system
Compression
Principles of
Additional attachments for the thigh may be necessary due to large Please specify the type of 6
circumferences, lax connective tissue, deep skin and joint folds as well as topband stopper.
conical and cylindrical limbs. Have the topband stoppers sewn on later, Pay attention to the at the top of
always use these specifically and position them only if necessary in a region standard here. fold-out page 104
where additional grip is required, e.g.:
Topband stopper along the oblique for jodhpur syndrome
Topband stopper at the back on the seam for deep folds in the back
Contraindications
of the knee
Topband stopper above the knee for voluminous thighs.
Indications /
However, please note that additional sewn in topband stoppers reduce the
stretch of the compression knit.
No extra topband stoppers are fitted on the medial surface of the thigh (the
inside of the thigh) as more lymph ducts run across this area and there is an
added risk of chafing.
Two-part garments (AD+ CT, AG + FT) can also make donning and doffing the Please specify the open 8
garment easier for patients. mediven 550 and mediven mondi models are to crotch request separately.
Treatment
procedure
be particularly recommended for those who suffer from frequent fungal at the top of
infections because of the use of antibacterial yarn (prevents colonisation by fold-out page 104
bacteria and micro-organisms).
Lower limbs
Tips Field: Variants c.f. Fax Order
During pregnancy the circumference measurements of the legs hardly Mark the variant ATU with a 2
change at all if appropriate and optimum treatment is continued. cross.
In the abdominal area, however, sizes often change very rapidly. at the top of
Here again, two-part garments can be used economically to accommodate fold-out page 104
the change in circumference
The pleasant side effect for the mother-to-be is the ease of donning and
doffing of the cycling shorts (in combination with AC stockings) compared
with AT.
Upper limbs
Zips are a compromise solution and should only be used in individual Please specify the type of 8
cases. For AD stockings the incorporation of a zip on the inside of the leg is fastener (fine or coarse zip,
recommended - this zip is similar to the zip on a boot. Velcro fastener), its position at the top of
No zip should be sewn on the inside of the thigh of AF-AG garments. The (drawing) and length. fold-out page 104
problem of donning and doffing pantyhose may be improved by using zip in
the following positions:
Centre front of panty top
Accessories
In the side seam on the right (for right-handed patients) or left (left-handed
patients)
In the side seam on the right and left
A zip can be incorporated into the seam at any time at a later stage.

Do not have the entire overlap area made porous. Please specify the length of 5
Solutions fitting
This will not give a stabilising transition and the material will slip upwards. the porous rows
at the top of
fold-out page 104
problems
F.A.Q.

58 Upper limbs medi Lymphology Care Guide

Upper limbs
The lymphatic
Versions available
system
for a lot of individual hosiery possibilities
You can choose between the following hand part variants both for the individual and for the two-part garment:
Compression
Principles of
AC1-glove
AC1
Contraindications
Indications /
H
and part without Hand part without H
and part with short H
and part with long H
and part with
fingers, with thumb fingers, with base of fingers and base of fingers and base of closed fingers
opening thumb thumb thumb
AD- and AE- AF- and AG- CG-sleeve

glove sleeve
AD AE AF AG CG
Treatment
procedure
Lower limbs
Single garment Single garment Single garment
A s a double garment C ombined with glove
combined with a (two-pieces
sleeve garment)
Upper limbs
Note
medi produces all flat knit

sleeve variants with standard
oblique borders at the
proximal end.
The AC1 glove is an exception
to this. This is made with a
2cm porous border as
Accessories
standard.
Solutions fitting
problems
F.A.Q.
medi Lymphology Care Guide Upper limbs 59

The lymphatic
Possible
system
combinations
of the versions
Compression
Principles of
A lymphological compression garment does not

always consist of only a sleeve or only a sleeve
with a hand part!
Multi-part garments and double

Contraindications
Indications /

always be assessed individually.
The type of garment depends on the localisation and
the stage of the oedema. Secondary disorders,
impaired mobility and handling in everyday living are
also decisive.
Treatment
procedure
Thus it is often an advantage to divide a one piece

sleeve (AG) into a combination of CG + AC1 to enable
CG + AC1
the patient to take the hand part off for a short time if
necessary for hygienic reasons.
However, depending on the stage, the demands on

the stability of the garments may also be higher in
Lower limbs
lymphoedema of the arm. In such cases the wall

stability of a single layer is no longer sufficient local
double compression garments are then necessary.
In such cases e.g., a long hand part AD / AE can be
worn in combination with a CG sleeve.
The continuous pressure gradient must be assured to

Upper limbs
guarantee optimum lymphatic return and avoid

pooling and constriction. It is particularly important
to make sure that no constriction (tourniquet)
develops around the wrist.
With AC1 hand parts always order the whole overlap

zone as porous, only take the skin measurements
Accessories
here for cC and cC1.

Do not select a length for the short cuff of the hand
part that is too long, otherwise this will slip towards
the wrist and could cause wrinkles.
Solutions fitting
problemsF.A.Q.

The lymphatic
In the case of double compression garments with long
system
hand parts patients are recommended to wear these
under the sleeve. This gives a smoother transition to
the wrist. Depending on the site of the oedema please
choose a broad porous border as the standard
border (=2 cm porous) for the CG sleeve worn on top
Compression
to avoid constriction.
Principles of
Make sure of optimum axial positioning (anatomical
suspender) of the long hand part to avoid it slipping
towards the wrist. Do not select the cuff too short!
It is best if this overlaps the muscles of the forearm.
Contraindications
Indications /
measurement and the stronger stretch measurement
(exception cC only skin measurement here).

remember not to add together the compression
classes but rather the pressures they represent.
Treatment
procedure
Example:
AE hand part
CCL 1 = 18 21 mmHg (RAL-GZ-387)
If two CCL 1 garments are worn on top of each
other the mean pressure amounts to
2 x 20 mm HG = 40 mm HG = CCL 3.
Lower limbs
Upper limbs
Accessories
Solutions fitting

AE hand part + CG sleeve
problems
F.A.Q.

The lymphatic

system

Compression
Principles of
Lipoedema arm Variant A Variant B

Contraindications
Indications /
CG sleeve with
topband and steep
oblique accessory
Secondary lymphoedema Variant A Variant B

Treatment
procedure
One-pieces garment Two-pieces garment

Lower limbs
AG sleeve with CG sleeve with AC1 glove with lymph pad

topband and flat topband and flat and long open fingers
oblique with oblique
lymph pad and long
open fingers
Upper limbs

of the forearm with One piece garment with more wall Two-pieces garment
fibrosis over the forearm
Accessories
CG sleeve with AE glove with long

topband and steep cuff and oblique
oblique accessory border, lymph pad
Solutions fitting
and long open

fingers
problemsF.A.Q.

The lymphatic
system
Upper limbs
Compression
Principles of
Indication Diagnosis Cardinal symptom mediven mediven
550 Arm esprit *
for con- for con-
nective nective
tissue tissue
that is: that is:
soft
normal normal
Contraindications
firm firm
Lipoedema Stage 1 Orange peel skin with a finely nodular surface
Indications /
AG CG CCL 1 CCL 1
Stage 2 Mattress skin, coarse, nodular skin surface with

larger dimples
AG CG CCL 2 CCL 2

AG CG CCL 3
Treatment
procedure
Lymphoedema Stage 1 Spontaneously reversible, soft and doughy swel-
ling, pitting on pressure, no skin changes CCL 1
AG CG CCL 1
CCL 2
Stage 2 Not spontaneously reversible, early fibrosis,

pitting hardly possible, sometimes skin changes
AG CG CCL 2 CCL 2
Lower limbs
Stage 3 Pronounced form, elephantiasis, fibrosis, typical
chronic skin changes CCL 2
AG CG
CCL 3
Attention
Upper limbs
mediven 550 in compression class I is
indicated for the following comorbidities
or accompanying conditions:

For paralysis
After a stroke
For joint problems
Accessories

Explanation
* Please remember that mediven esprit is a

garment for mild indications.
Solutions fitting
It does not have sufficient wall stability to

problems
connective tissue.
They creep into skin creases, which leads to
constrictions.
F.A.Q.

The lymphatic
mediven 550
system
arm
variety - for oedema up to stage 3.
Compression
Principles of
Indications
stages 1, 2 and 3
Contraindications

oedema
Indications /
Keloid treatment, e.g. after burns

connective tissue
Product strengths
Treatment
procedure

special extras
Numerous variants, e.g. arm cuffs for
double and multi-part garments
colours, seven trend colours and three
Lower limbs
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
Available versions Compression
system
AD
Long glove
AE
Long glove
AF
Arm sleeve
AG
Arm sleeve
CCL 1, 2, 3
to D to E with hand with hand
to F to G
Oedema Stage
1 2 3
Compression
Principles of
CD CE CF CG
Colours
Arm sleeve Arm sleeve Arm sleeve Arm sleeve
without without without without
hand to D hand to E hand to F hand to G
Sand
Contraindications
Caramel
Caramel
Indications /
DF DG EG FG
Black
Arm cuff Arm cuff Arm cuff Arm cuff
Standard colours
Aqua
Attachment
Topband Shoulder cap Shoulder cap
options medi Magenta
Treatment
procedure
with shoulder with bra
strap (HK) attachment
at G (H) at G
Navy
Anthracite
Hand parts AC1

Moss-green
Lower limbs
Finger stall Hand part Hand part Hand part with
without fingers, without fingers, short fingers
with thumb with base of with base of
opening thumb thumb Cherry-red
Hand part with Hand part
long Fingers, with closed
with base fingers Cashmere
of thumb
Trend colours
Standard models working days
Upper limbs
Proximal border Flat oblique for all variants apart from AC1
Porous straight border: AC1 Design elements
Distal border Porous straight border: CD, CE, CF, CG

Fingers Without fingers with base of thumb, open / closed fingers
with base of thumb: AE, AF,
Finger stall Open or closed Live Laugh Love
Accessories
CCL 1 12 % 88 % Timeless
CCL 2 16 % 84 %
CCL 3 26 % 74 %
Solutions fitting
Note Sportive
problems
The trend colours and the The design elements can be

design elements are available freely combined with both
at no extra charge. standard and trend colours
F.A.Q.

The lymphatic
mediven esprit
system
Comfortable and effective for

oedema up to stage 2.
Indications
Compression
Principles of

stages 1 and 2
oedema
Contraindications

Indications /

connective tissue
Product strengths
Supple knit
special extras
Treatment
procedure
Numerous variants for double and

multi-part garments
colours, seven trend colours and three
Lower limbs
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
Available versions Compression
system
AD AE AF AG
CCL 1, 2, 3
Long glove Long glove Arm sleeve Arm sleeve
to F to G Oedma Stage
1 2 3
Compression
Principles of
CD CE CF CG Colours
Sand
Contraindications
Caramel
Indications /
Attachment
options Topband Shoulder cap Shoulder cap
Black
at G (H) at G Standard colours
Aqua
Hand parts AC1 medi Magenta
Treatment
procedure
Hand part Hand part Hand part with Hand part with Hand part
without fingers, without fingers, short fingers, long fingers, with closed
with thumb with base with base with base fingers Navy
opening of thumb of thumb of thumb
Anthracite
Standard models
Moss-green
Lower limbs
Porous straight border: AC1
Cherry-red
with base of thumb: AE, AF, AG, AC1, AD
Cashmere
Trend colours
Elastane (EL) Polyamide (PA) Delivery period up to ten
working days
Upper limbs
CCL 1 12 % 88 %
CCL 2 16 % 84 % Design elements
CCL 3 26 % 74 %
Note
The trend colours and the Live Laugh Love

design elements are available
at no extra charge.
Accessories
Timeless
Solutions fitting
Sportive
problems

freely combined with both
standard and trend colours
F.A.Q.

The lymphatic
Basic guidelines for measuring techniques

system

Tips
A number of additional important tips medi sets new standards
Always document the skin and
Compression
from medi can be found below:

Principles of
tension measurements to
All garments from medi are supplied enable objective assessment
Measure the finger areas accurately to with an oblique border. of any changes.
the nearest millimetre measurement This prevents circular constriction. Photographic documentation
is always helpful and is
to the nearest 5 millimetres is sufficient increasingly required by
for the arms. A flat oblique is provided as standard insurance companies.
Contraindications
at the requested cuff end at D, E or F for It will make processing these

generally complicated
Never measure circumferences in skin the proximal (upper) border of the long
Indications /
garments a lot easier.

creases otherwise there is a risk of glove.
causing constriction. When making the appoint-
ment to take the measure-
An oblique flat oblique border is ments for the arm / hand
Never take circumference defined as standard for the proximal garment, remind the patient
measurements under tension and never (upper) border of the sleeve. to wear suitable clothing a
loose bra and top will protect
constrict the limb. Measurement under the patients modesty.
tension depends on the tissue structure,
the indication, and the respective
Treatment
procedure
measuring point (see Tips for measuring

points). Never measure fingers under
tension.
Where the back of the hand is severely

oedematous a compression pad
Lower limbs
covering the wrist (page 78) should

always be incorporated. A glove with a
long cuff should be used if the tissues
on the forearm are fibrosed.
Gloves should only be made up without

fingers in exceptional cases.
Upper limbs
Do not measure the finger lengths too

short. The fingers should extend to the
base of the nail bed for the optimum fit
and therapeutic efficacy.
Take all length measurements with the

patients arm straight check the total
Accessories
length on the loosely hanging arm.
Discuss any accessory requirements

with the patient when you are taking
the history.
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Upper limbs - C, C1 , D, E - according to BUFA guidelines
Measuring point C
Compression
Principles of
Usually distal (second) wrist fold Circumference (c) C Tips on measuring point C
(styloid process) depending on the Measure without tension; for small Never measure in a skin fold or a fold around the joint.
extent of the oedema circumferences (approx. < 18), make a A sleeve that is too tight would otherwise lead to
dimensional allowance, if necessary additional congestion.
Caution: If C dimension is too small, When ordering a single sleeve the garment is finished
oedema may develop in the back of at C as standard with 2 cm porous knitted fabric - if
Contraindications
the hand (Fig. 28) this measurement needs to be different, please note
under Other accessories.
Indications /
Caution: due to the change to the new RAL for arms
since 1.10.2009, it is no longer necessary to add a few
centimetres to the circumference.
Measuring point C1
Treatment
procedure
Located in the first third between Length (l ) C1 Tips on measuring point C1 , D, E
C and E, approx. 7 cm above (not required by all manufacturers) In many cases it is difficult to define the individual
(proximal to) the C measurement measuring points due to the patients anatomy. In
Obligatory measurement for medi! order to guarantee the optimum fit and the correct
pressure gradient, we recommend you try to divide
the forearm into three sections of equal length
Circumference (c) C1
from measuring point C to E.
Measure without tension (Fig. 29)
Due to the new RAL for arms C1 may also be measured
Lower limbs
under tension if the indication requires.
Measure all lengths close to the body and on the exten-
Fig. 29 Source: BUFA ded arm.
Measuring point D
Located in the middle third Length ( l ) D
Upper limbs
between C and E, largest Measure on the flexor side (inside) of
circumference of the forearm the extended arm, specify the length
from C to D
Circumference (c) D
Usually measured under tension,
depends on the oedema (Fig. 30)
Accessories

Solutions fitting
problems
F.A.Q.

The lymphatic
system
Upper limbs E, F - according to BUFA guidelines
Measuring point E
Compression
Principles of
Over elbow and flexion crease Length ( l ) E Tips on measuring point E

Select the measuring point at the If patients have oedema at the elbow or lax tissues in
bent elbow as illustrated and this area you are recommended to take this into
determine the length from C to E on account when measuring. Press the tape measure
the extended arm gently into the area in order to reduce the
Contraindications
circumference and avoid wrinkles at the bend of the

elbow.
Circumference (c) E The knitting marks at E (standard 160) prevent
Indications /
With the elbow slightly bent (approx. wrinkles forming in the flexion area when the elbow is
45), measure without tension and bent. For patients with a sedentary occupation - and
not into the flexion crease. Measure therefore with frequently flexed arms - you can order
slightly above the elbow if other more flexed variants.
Fig. 31 Source: BUFA necessary,(Fig. 31) For particularly sensitive elbow creases the
incorporation of lining material provides additional
protection for this area. For this, please note the area
or the position where the lining should be incorporated
in the Other accessories field. This accessory can also
be incorporated later at any time.
Treatment
procedure
Standard 160 150

Lower limbs
135
Measuring point F
Middle of upper arm (midpoint Tips on measuring point F
Length (l ) F
Upper limbs
between E and G) Measure length from C to F on the Here too, measure all lengths close to the body.
extended arm In normal cases, cF should be cE.
Circumference (c ) F
Usually measured tightly, depending
on the oedema (Fig. 32)

Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Upper limbs G, G1 - according to BUFA guidelines
Measuring point G
Compression
Principles of
Armpit, use measuring aids Length (l ) G Tips on measuring point G
(Fig. 34) Measure length from C to G on the For sleeves with a short upper arm (depending on the
inside of the extended arm anatomy and height) and a wide topband, please note
that there should be sufficient space between
circumferences cF and cG, as the topband already
Contraindications
takes up a width of 5 cm - if necessary, move
Circumference (c ) G measuring point F slightly towards the elbow.
Indications /
As a rule, measure without tension, It is important that the sleeve is long enough! It should
depends on oedema, measure at 90 ideally end in the axilla region. Make sure that the
to the axis of the arm (Figs. 33 / 35) border does not fold over. A non-slip topband gives the
most secure fit and border.
Due to the oblique border the measurement here
may be made under slight tension depending on the
Fig. 33 Source: BUFA oedema -generally to the first resistance of the tissue.
In normal cases, cG should be cF.
Treatment
procedure
Measuring point G1
Length (l ) G1 Tips on measuring point G1
Lateral extension of approx
3 - 6 cm above G Oblique border: state distance from medi does not need the extra measurement G1 for this
G - G1 medi generally manufactures sleeves with the flat
medi does not need this oblique border. A steep oblique can be chosen
measurement here as an option (see P. 76 Accessories). The obliques
depend on the borders circumference and are
Circumference (c ) G1
Lower limbs
calculated automatically.
No circumference dimension medi offers a standard and an anatomical shoulder
Fig. 34 required cap. The anatomical shoulder cap offers a better fit.
medi does not need this For this, measure the distance from the anterior to the
measurement posterior axillary fold (Fig. A). A shoulder cap can be
chosen optionally with a bra attachment or a shoulder
Attachment options strap.
1. Topband (only with lateral In the Attachment field, choose between the 2.5 cm
extension). See options offered by and the 5.0 cm strap width.
manufacturer
Upper limbs
2. Skin adhesive (check skin
tolerability)
3. Shoulder strap
Fig. 35 4. Bra attachment
H (1. shoulder strap)

Measure from G on the outer aspect
as far as the shoulder (acromion)
Accessories
Measure strap length from shoulder

level (acromion) over torso and back
to height of shoulder (Fig. 36)
H (2. bra attachment)

Measure from G to the lateral side of
the bra strap
Solutions fitting
Fig. 36 State bra strap width (> 3 cm) (Fig. 35) Fig. A
problems
Source: BUFA
F.A.Q.

The lymphatic
system
Upper Limbs - A, B - according to BUFA guidelines
Measuring point A
Compression
Principles of
Tips on measuring point A

Line joining the Length (l ) A
metacarpophalangeal joints of Starting point for further length Take circumference measurements with the back of the
the little and index measurements is halfway along this hand facing upwards. Place the palm firmly on a hard
fingers line (Fig. 37) surface, such as a table. The fingers are in the functional
position, i.e. are slightly splayed.
Measure lengths along the inside of the hand.
Contraindications
Measuring point A is located slightly below the fold of

Circumference (c) A the joint at the base of the middle finger (Fig. B). The
Indications /
Pass the tape measure around the intermediate area is of no importance except for gloves
joints at the base of the fingers with without fingers.
the hand placed firmly on a hard
surface such as a table (Fig. 38)
A
Treatment
procedure
Measuring point B Fig. B
Tip on measuring point B

(Line from the web of the thumb Length (l ) B
at right angles to the axis of the Measure A to B on the extended In normal cases cB should be cA
hand) palm; experience shows that in 80 %
of cases this is approx. 3 cm in adults;
Lower limbs
this does not apply for gloves without

fingers (Fig. 37)
Circumference (c) B
Measure straight line over middle of
hand with palm placed firmly on a
hard surface such as a table (Fig. 38)
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Upper limbs - C, C1 - according to BUFA guidelines
Measuring point C
Compression
Principles of
Tips on measuring point C
Usually distal (second) Length (l ) C
wrist fold (styloid Measure A C on the inside of the Due to the new RAL for sleeves, the addition of a few
process) depending extended hand (Fig. 39) centimetres to the circumference is no longer
on the extent necessary.
of the oedema If there is oedema over the back of the hand and / or a
Circumference (c) C
Contraindications
skin fold at C, please always order with a lymph pad.
Measure without tension, for small
circumferences (approx. < 18 cm), add
Indications /
to measurement if necessary.
Caution: If C dimension is too small,
oedema may develop over the back of
the hand. Avoid increased pressure in
Fig. 39 Source: BUFA the area of the overlap
Treatment
procedure
Measuring point C1
Located at least in Length (l ) C1 Tips on measuring point C1
the first third Measure A-C1 on the volar aspect of Measure C1 individually for the hand part, do not use
between C and E the extended hand (Fig. 40) the measuring point for the sleeve.
Position C1 so that there is an adequate overlap zone
Lower limbs
(5-7 cm), but such that the cuff cannot slip down into
the wrist area.
For two-pieces garments, medi manufactures the
Circumference (c) C1 glove cuff C-C1 in porous material. For a glove cuff
Measure as border dimension with full compression, please mark C-C1 non-
without tension, otherwise as sleeve porous in the Special Requests field.
When ordering an individual glove, the ends of the cuff
have a band of 2 cm porous fabric as standard.
Fig. 40 Source: BUFA If you require more porous fabric, please enter the
different length in cm in the Other accessories field.
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Measuring technique
system
Upper limbs - D, E - according to BUFA guidelines
Measuring point D
Compression
Principles of
(Long glove) generally to E Length (l ) D Tips on measuring point D

Measure A D on volar aspect (inner)
Oedema often requires higher wall stability. This is
aspect of the extended wrist (Fig. 41)
achieved by a combination of a long hand part that is
usually worn under the sleeve.
The reduction in the circumferences of the garment
worn on top depends on the indication, the thickness
Contraindications
of the oedema and the patients individual response.

Circumference (c) D It varies between skin measurements and strong
Indications /
See sleeve measurements under tension.

The long hand part should always enclose the
complete fibrotic area - but must end a maximum
of 1 - 2 cm before the flexed elbow. Bear in mind the
anatomical support.
The border of the long glove cuff is made with the flat
oblique border as standard.
Treatment
procedure
A A
l AC1 l AC1
Measuring point E C1 C1
Long glove up to 2 cm below E Length (l ) E cC

Measure A - E on volar aspect (inside) cC
of the extended wrist

Lower limbs
c C1 c C1
D cD D
E
cE
Long glove cuff to D Long glove cuff to E

Circumference (c) E
Ensure that the border dimension is
Upper limbs
not measured too tightly

Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Upper limbs - Fingers - according to BUFA guidelines
Finger lengths
Compression
Principles of
X proximal dimension Length (l ) Tips on taking the finger measurements
Z / W distal dimension Shortest length from web (X) to the m edi recommends you choose the lengths too long
nail bed (Z / W). rather than too short: fingers that are too long can be
Exception: If the fingers are closed, marked at the trial fitting and sent in for alteration.
measure to the end of the finger Variant 1: Mark the required length of the finger of the
(Fig. 43) glove on the inside of the hand (Fig. C - e.g. the nail
Contraindications
bed) and measure the length required from the
bottom skin fold on each finger on the inside of the
Indications /
hand.
Variant 2: Mark the middle of the imaginary line
connecting the webs and measure from there to the
required end of the finger (here to the nail bed -
Fig. 43 Source: BUFA Fig. D / E).
Never measure fingers tightly. Please ensure a loose
skin measurement at cX and cZ.
For these very small extremities we recommend our
Finger circumferences medi finger and toe measuring tape (Art.20.226).

Do not pull this too tight.
Treatment
When measuring circumference cX, it should be placed
procedure
(X - proximal measurement Circumference (c) over the finger joint like a ring.
Z / W - distal measurement) Generally measure dimensions X and
tension.
The X dimension may not be smaller

than the Z dimension; if necessary,
adjust to the Z dimension (Fig 44)
Lower limbs
Fig. C - Finger Fig. D - Inside of hand
(side view) (palm)
Upper limbs
Fig. E - Back of hand

Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Upper limbs
system
Arm accessories

Compression
Principles of

Anatomically correct border due to circular borders - basic require-
at G1 ment for a garment that is suitable for the
indication.
Standard in all mediven flat knit
garments.
Contraindications
Steep oblique Optimum anatomical fit, also for larger

Indications /
Anatomically correct border circumferences, no danger of congestion

at G1 - basic requirement for a garment
suitable for the indication.
Outside of arm knitted x cm
longer.
Treatment
procedure
Angle at E Benefit
Knitting marks in elbow area To reduce excessive pressure on the elbow

flexure and prevent wrinkles on
medi produces all arm movement.
garments with the standard
angle of 160 at E.
Lower limbs

compression
Upper limbs
Compression weft threads Ease of handling of compression garment

only in every third row without the risk of congestion, correct
pressure gradient for multi-part
2 cm standard border in CG garments, optimum transition from
sleeves and AC1 hand parts. compressed to uncompressed areas.
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Tips Field: Variable border c.f. Fax Order
Compression
Principles of
medi produces all flat knit products with an oblique border at the proximal Please mark the steep 1
end, i.e. the lateral side of the garment is x cm longer. oblique field with a cross.
The level of the oblique depends on the circumference of the border at the bottom of
(cD, cE, cF with long hand parts and CG with sleeves). fold-out page 104
The standard is flat oblique = approx. 5 % of the circumference.

A steep oblique = approx. 10 % of the circumference can be selected as an
Contraindications
option.
Indications /
Please consider the patients anatomy when choosing the oblique.
Incorporation of a steep oblique also means a higher volume. This can lead
to the formation of bags on the upper arm.
Treatment
procedure
Tips Field: Knitting marks c.f. Fax Order
In most cases the standard 160 bend is adequate. Please cross desired angle. 5
For patients who hold their arms in a flexed position for long periods during
the day (e.g. when using a computer), an additional garment with a 150 at the bottom of
angle is recommended. fold-out page 104
For patients with, for example, paralysis (after a stroke) who constantly hold
their arm close to the body in a flexed position, the sleeve may be ordered
with an angle of 135.
Lower limbs
Upper limbs
If you order a CG sleeve + AC1 hand part together on one measurement sheet, Please state x cm porous 2
the overlap zone of the glove will automatically be made porous from C - C1.
With individual or follow-up orders you must give the desired porous cm at the bottom of
separately. fold-out page 104
A combination of oblique border and porous rows is not possible. An
exception to this is the proximal border on a sleeve without a topband. In this
case, the standard is knitted with 2 cm porous. Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Upper limbs
system
Arm accessories
Compression pads: Benefit

Compression
Principles of
incorporation of individual
cushions / lymph pads
Additional compression E ven pressure distribution over the back
I ncorporation of medi lymph of the hand
pads, pre-formed silicone pads Loosen fibrosis
(Epicomed) and padding S pecific pressure increase over the
material oedematous region
Contraindications
Indications /
Padding out Benefit

Treatment
procedure
Reduction of wrinkles Local reduction in pressure over sensitive

Incorporation of medi lymph regions or around joints, e.g. bend of the
pads elbow.

Lower limbs
Lining with soft, smooth The skin in particularly sensitive areas,

material such as in the bend of the elbow, or in
irritated skin areas (e.g. status post
psoriasis, post ulcer, burns) is not subject
to additional irritation and calms down.
Unpleasant itching is avoided, more
comfortable to wear.
Upper limbs
Securing / attachments - Benefit

topband
Most common method of Ease of handling for optimum comfort in

securing sleeves, with no wear.
constriction due to oblique Topband does not roll over, but gives an
borders attractive border without causing
constriction.
Accessories

topband stoppers
Additional security of fit in Optimum security of fit for voluminous

the area of the oblique border upper arms, easy handling for optimum
comfort in wear, treatment compliance
Solutions fitting
and maximum success. It provides for

better adhesion to extreme shapes.
problemsF.A.Q.

The lymphatic
system
Compression
Principles of
We recommend that only the mediven 550 models are used if additional Please mark the appropriate 2
local compression is necessary or if support is required for dispersing fibrosis. selection. Show the desired
position / area as well as the at the bottom of
If pads are made up individually, we recommend you send the goods back to length and width. fold-out page 104
us to be incorporated in the garment after the trial fitting. For this, mark the
exact shape and position of the pads with our medi textile pencil
(Art. 25.460).
Contraindications
Epicomed pads and medi lymphpads that are positioned on the basis of
Indications /
For this, please give the exact size and the positioning points.
Please always give us the exact size and positioning of the lining material.
Lining material can also be sewn in later.
Treatment
procedure
Lower limbs
Please always give us the exact size and positioning of the lining material. Please mark the appropriate 2
selection. Show the desired
Lining material can also be sewn in later. position / area as well as the at the bottom of
length and width. fold-out page 104
Upper limbs
For each model and each topband type medi uses the suitable circumference Mark the required variant 3
conversion, i.e. the table measurements for the topband are based on with a cross.
years of experience and numerous tests. at the bottom of
If, in exceptional cases, it is necessary to fit a tighter or looser topband than fold-out page 104
usual, please show the appropriate circumference in cm after the variant.
Accessories
This topband stopper can be incorporated as the only support or as an Mark the required variant 2
additional support and can be incorporated later at any time. This is the ideal with a cross.
support for patients who cannot have the topband at G1, (particularly on at the bottom of
the inside of the upper arm),. fold-out page 104
Solutions fitting
problems
F.A.Q.

The lymphatic
Upper limbs
system
Arm accessories
Attachments / support Benefit

Compression
Principles of
devices shoulder cap /

anatomical shoulder cap
Alternative attachment in Optimum security of fit for patients
case of intolerance of the who do not tolerate silicone
topband
Possible variants:
Contraindications
S houlder cap with bra

Standard Anatomical shoulder cap attachment
Indications /
shoulder cap S houlder cap with shoulder

strap
The shoulder cap is also

available in two different
versions:
Standard
Anatomical
Treatment
procedure
Addition of zips / hook and Benefit

loop fasteners
Easy to put on and take off. Suitable for:

Large differences in circumference
Recent scars (after burns)
rheumatism)
Lower limbs

optimum therapeutic outcome.
Oblique border hand part Benefit
Anatomically correct border Optimum anatomical fit, no risk of stasis

Upper limbs
for long hand part (AD and AE) due to circular borders - basic
requirement for a garment that is
Standard in all mediven flat knit appropriate to the indication.
garments. The hand part is
knitted longer at the proximal
seam edge.
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Compression
Principles of
We recommend the anatomical variant because of the better fit, the Mark the required variant 3
attractive appearance, and reduced wrinkling when moving the arm. with a cross.
at the bottom of
The variant with bra attachment is not suitable for very small appliances
fold-out page 104
(the low weight cannot hold the sleeve) or where the breasts are very large
(too much weight encourages the formation of oedema in the shoulder / arm)
- alternatives are a topband and / or shoulder cap with a shoulder strap.
Contraindications
Indications /
Treatment
procedure
The incorporation of a short zip on the outside of the arm is recommended Mark the required variant 4
for voluminous upper arms that have a smaller circumference at G than at with a cross.
F. A zip can be sewn into the seam later at any time at the bottom of
fold-out page 104
Lower limbs
Tips
Use oblique borders to avoid circular constriction if you are treating fibrosed
lower arms with a long glove cuff
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Functions of medi lymph pads

system
For many garments medi lymph pads are the optimum addition as padding
material.
The characteristics and requirements of each specific form of oedema can be

Compression
Principles of
catered for more individually with the aid of the three different surface structures.
Lymph pad fine-nubbed Lymph pad Lymph pad ribbed Properties to Ko Tex Standard
coarse- nubbed Breathable
Contraindications
Permanently dimensionally
stable
Indications /
Washable up to 40
Free from CFC, PCP, nitrosamines,
azo dyes and fillers
Prescribable
Can be cut to size individually
with scissors.
This provides gentle drainage The coarse-nubbed medi The ribbed surface of this medi
in combination with the lymph pad is usually used lymph pad also works with the
compression garment. under bandaging - here again compression garment to
Treatment
procedure
The fine-nubbed surface deposits are loosened. provide gentle drainage.

stimulates the The ribs running in the
microcirculation in the tissues. direction of the lymph ducts
Fibrosis can be loosened in this assist with lymph drainage.
way and deposits can be
transported away, particularly
in lymphoedema.
Areas of use
Lower limbs
Pad for back of hand (if there Thigh, e.g. for lipoedema Pad on the back of the hand
is a risk of wrinkling at C, extending over the wrist
always extend over the wrist) (here the longitudinal ribs
Hand palm pad also resist wrinkling at the
Dorsum of the foot wrist)
Compression pad for fibrotic Hand palm pad
areas (possibly also as an Dorsum of the foot
alternative to the ribbed pad) Compression pad for fibrotic
areas (possibly also as an
Upper limbs
alternative to the finely

ribbed pad)
Compression pad in the area
of the malleolus - length
often to C or D
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
Examples of medi lymph pads in use
system
Lymph pad on back of hand Lymph pad over the palm of Lymph pad on top of forearm Tips
- extending over wrist the hand
We recommend the models
mediven 550 arm or leg for
patients who need lymph pads.
Compression
Principles of
The mediven mondi and mediven
esprit models are no longer
adequate for such cases.
It is not possible to incorporate

medi lymph pads in the mediven
Lymph pad ribbed Lymph pad ribbed Lymph pad ribbed sensoo models.
Contraindications
Lymph pad fine-nubbed Lymph pad fine-nubbed Lymph pad fine-nubbed
For padding and compression For padding and compression To loosen fibrosis in the When ordering the compression
garment lymph pads
Indications /
enhancement in oedema of the enhancement in oedema of the forearm
back of the hand hand (additional to the back of I ndicate the position or area
hand pad if required) the measurements of the length
and width are also essential
Lymph pad on underside of F or complicated pad shapes
forearm: please fax or mail sketch, photo
etc. (export@medi.de)
As a later addition to the

compression garment
T he patient should try the
Treatment
procedure
garment on (if necessary, it
should also be worn for several
days and the fit OK obtained
from the patient). Indicate the
Lymph pad ribbed
position of the pad(s)
Lymph pad fine-nubbed
F or complicated pad shapes
To loosen fibrosis in the please fax or mail sketch, photo
forearm etc. (export@medi.de)
Lymph pad over dorsum of Compression pad for medial Longer pressure pad for
Lower limbs
the foot: and lateral malleolus medial and lateral malleolus
Upper limbs
In the toe cap In the leg garment In the leg garment
In the AD stocking with closed Made of silicone (Levamed Lymph pad ribbed
toe pad)
Lymph pad ribbed Lymph pad ribbed
For additional compression for For additional compression in For additional compression in
oedema over the dorsum of the the oedematous malleolar the oedematous malleolar
foot area area and to assist lymph
drainage along the lymph
ducts
Accessories
Individual pads
Solutions fitting
problems
Lymph pad ribbed

For additional compression in the oedematous
malleolar area and to loosen fibrotic tissue in the
lower leg (usually stipulated and marked by the
lymphologist)
F.A.Q.
medi Lymphology Care Guide Accessories 83

The lymphatic
Topband variants
system
mediven flat knit
Topband Variants Description Comment

Compression
Principles of
Silicone topband, Nubbed silicone coating Can be used for all

narrow types of connective
Secure holding of the garment
tissue
Contraindications
2.5 cm wide
Indications /
Silicone topband Nubbed silicone coating Can be used for all

Secure holding of the garment types of connective
5.0 cm wide tissue
Silicone topband Nubbed silicone coating Optimum security of fit

with motif Secure holding of the garment of the garment due to
nubbed structure, even
Treatment
procedure
Outer surface with floral motif

5.0 cm wide for soft connective
tissue
Profile topband Rhomboid silicone coating over wide area Large area silicone
Secure holding of the garment coating for comfort in
5.0 cm wide wear and an extremely
secure fit
Lower limbs
Sensitive topband Honeycomb silicone coating Solution for patients who

Better air permeability due to the lace cannot cope with profile,
5.0 cm wide topband nubbed or silicone topband
Soft material for high wearing comfort with motif
Upper limbs
Overview of variants
Lower limbs
Mens leotard
Accessories
Variants Perforated topband Waistband (not adjustable Knitted border (not

(adjustable) + adjustable) adjustable)
Closed gusset
(front section knitted in 2 parts)
Horizontal fly (front section knitted

Solutions fitting
in 3 parts)
Zip, continuous, with hooks and eyes

problems
underneath (front section knitted in 2 parts)

Zip, not continuous without hooks and eyes
(Zip ends under perforated (Zip continuous to border) (Zip continuous to border)
border)
F.A.Q.
84 Accessories medi Lymphology Care Guide

The lymphatic
system
Upper limbs Lower limbs
All arm Glove with Arm As topband AD with cD AD with very AG As topband
Compression
garments long cuff* garments stopper* larger than large cD stopper*
Principles of
to G* for very cC circumference
voluminous
upper arms *
Contraindications
Indications /

Treatment
procedure

Lower limbs

*
Please note: these are only recommendations. The topbands are available for all sleeve lengths
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.
medi Lymphology Care Guide Overview of variants 85


Upper limbs
The lymphatic
Versions available
system
From glove to sleeve
You can choose between the following hand part variants both for the individual and for the two-part garment:
Compression
Principles of
AC1-glove
AC1
Contraindications
Indications /
Hand part without Hand part without H
and part with short H
and part with long H
and part with
fingers, with thumb fingers, with base of fingers and base of fingers and base of closed fingers
opening thumb thumb thumb
AD- and AE- AF- and AG- CG-sleeve

glove sleeve
AD AE AF AG CG
Treatment
procedure
Lower limbs
Single garment Single garment Single garment
A s a double garment C ombined with glove
combined with a (two-piece garment)
sleeve
Upper limbs
Note
medi produces all flat knit

sleeve variants with standard
oblique borders at the
proximal end.
The AC1 glove is an exception
to this. This is made with a
2cm porous border as
Accessories
standard.
Solutions fitting
problems
F.A.Q.

The lymphatic
Possible
system
combinations
of the variants
Compression
Principles of
A lymphological compression garment does not

always consist of only a sleeve or only a sleeve
with a hand part!
Multi-part garments and double

Contraindications
Indications /

always be assessed individually.
The type of garment depends on the localisation and
the stage of the oedema. Secondary disorders,
impaired mobility and handling in everyday living are
also decisive.
Treatment
procedure
Thus it is often an advantage to divide a one piece

sleeve (AG) into a combination of CG + AC1 to enable
CG + AC1
the patient to take the hand part off for a short time if
necessary for hygienic reasons.
However, depending on the stage, the demands on

the stability of the garments may also be higher in
Lower limbs
lymphoedema of the arm. In such cases the wall

stability of a single layer is no longer sufficient local
double compression garments are then necessary.
In such cases e.g., a long hand part AD / AE can be
worn in combination with a CG sleeve.
The continuous pressure gradient must be assured to

Upper limbs
guarantee optimum lymphatic return and avoid

pooling and constriction. It is particularly important
to make sure that no constriction (tourniquet)
develops around the wrist.
With AC1 hand parts always order the whole overlap

zone as porous, only take the skin measurements
Accessories
here for cC and cC1.

Do not select a length for the short cuff of the hand
part that is too long, otherwise this will slip towards
the wrist and could cause wrinkles.
Solutions fitting
problemsF.A.Q.

The lymphatic
In the case of double compression garments with long
system
hand parts patients are recommended to wear these
under the sleeve. This gives a smoother transition to
the wrist. Depending on the site of the oedema please
choose a broad porous border as the standard
border (=2 cm porous) for the CG sleeve worn on top
Compression
to avoid constriction.
Principles of
Make sure of optimum axial positioning (anatomical
suspender) of the long hand part to avoid it slipping
towards the wrist. Do not select the cuff too short!
It is best if this overlaps the muscles of the forearm.
Contraindications
Indications /
measurement and the stronger stretch measurement
(exception cC only skin measurement here).

remember not to add together the compression
classes but rather the pressures they represent.
Treatment
procedure
Example:
AE hand part
CCL 1 = 18 21 mmHg (RAL-GZ-387)
If two CCL 1 garments are worn on top of each
other the mean pressure amounts to
2 x 20 mm HG = 40 mm HG = CCL 3.
Lower limbs
Upper limbs
Accessories
Solutions fitting

AE hand part + CG sleeve
problems
F.A.Q.

The lymphatic

system

Compression
Principles of
Lipoedema arm Variant A Variant B

Contraindications
Indications /
CG sleeve with
topband and steep
oblique accessory

Treatment
procedure
One-piece garment Two-piece garment

Lower limbs
AG sleeve with CG sleeve with AC1 glove with lymph pad

topband and flat topband and flat and long open fingers
oblique with oblique
lymph pad and long
open fingers
Upper limbs

of the forearm with One piece garment with more wall Two-piece garment
fibrosis over the forearm
Accessories
CG sleeve with AE glove with long

topband and steep cuff and oblique
oblique accessory border, lymph pad
Solutions fitting
and long open

fingers
problemsF.A.Q.

The lymphatic
system
Upper limbs
Compression
Principles of
Indication Diagnosis Cardinal symptom mediven mediven
550 Arm esprit *
for con- for con-
nective nective
tissue tissue
that is: that is:
soft
normal normal
Contraindications
firm firm
Lipoedema Stage 1 Orange peel skin with a finely nodular surface
Indications /
AG CG CCL 1 CCL 1
Stage 2 Mattress skin, coarse, nodular skin surface with

larger dimples
AG CG CCL 2 CCL 2

AG CG CCL 3
Treatment
procedure
Lymphoedema Stage 1 Spontaneously reversible, soft and doughy swel-
ling, pitting on pressure, no skin changes CCL 1
AG CG CCL 1
CCL 2
Stage 2 Not spontaneously reversible, early fibrosis,

pitting hardly possible, sometimes skin changes
AG CG CCL 2 CCL 2
Lower limbs
Stage 3 Pronounced form, elephantiasis, fibrosis, typical
chronic skin changes CCL 2
AG CG
CCL 3
Attention
Upper limbs
mediven 550 in compression class I is
indicated for the following comorbidities
or accompanying conditions:

For paralysis
After a stroke
For joint problems
Accessories

Explanation
* Please remember that mediven esprit is a

garment for mild indications.
Solutions fitting
It does not have sufficient wall stability to

problems
connective tissue.
They creep into skin creases, which leads to
constrictions.
F.A.Q.

The lymphatic
mediven 550
system
arm
variety - for oedema up to stage 3.
Compression
Principles of
Indications
stages 1, 2 and 3
Contraindications

oedema
Indications /

connective tissue
Product strengths
Treatment
procedure

special extras
Numerous variants, e.g. arm cuffs for
double and multi-part garments
Lower limbs
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
Available variants Compression
system
AD
Long glove
AE
Long glove
AF
Arm sleeve
AG
Arm sleeve
CCL 1, 2, 3
to F to G
Oedma Stage
1 2 3
Compression
Principles of
CD CE CF CG
Colours
Sand
Contraindications
Caramel
Caramel
Indications /
DF DG EG FG
Black
Arm cuff Arm cuff Arm cuff Arm cuff
Standard colours
Aqua
Attachment
Topband Shoulder cap Shoulder cap
options medi Magenta
Treatment
procedure
at G (H) at G
Brown
Navy
Hand parts AC1

Anthracite
Lower limbs
Finger stall Hand part Hand part Hand part with
without fingers, without fingers, short fingers
with thumb with base of with base of
opening thumb thumb Trend colours
Delivery time up to 10 days
Hand part with Hand part
long Fingers, with closed
with base fingers
of thumb Design elements
Standard models
Upper limbs
Porous straight border: AC1 Live Laugh Love
with base of thumb: AE, AF,
Finger stall Open or closed
Timeless
Accessories
CCL 1 12 % 88 % Sportive
CCL 2 16 % 84 %
CCL 3 26 % 74 % freely combined with both
Solutions fitting

problems
Note
The trend colours and the

at no extra charge.
F.A.Q.

The lymphatic
mediven esprit
system
Comfortable and effective for

oedema up to stage 2.
Indications
Compression
Principles of

stages 1 and 2
oedema
Contraindications

Indications /

connective tissue
Product strengths
Supple knit
special extras
Treatment
procedure
Numerous variants for double and

multi-part garments
Lower limbs
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
Available variants Compression
system
AD AE AF AG
CCL 1, 2, 3
Long glove Long glove Arm sleeve Arm sleeve
to F to G Oedma Stage
1 2 3
Compression
Principles of
CD CE CF CG Colours
Sand
Contraindications
Caramel
Indications /
Attachment
options Topband Shoulder cap Shoulder cap
Black
at G (H) at G Standard colours
Aqua
Hand parts AC1 medi Magenta
Treatment
procedure
Hand part Hand part Hand part with Hand part with Hand part
without fingers, without fingers, short fingers, long fingers, with closed
with thumb with base with base with base fingers Brown
opening of thumb of thumb of thumb
Navy
Standard models
Anthracite
Lower limbs
Porous straight border: AC1
Trend colours
Fingers Without fingers with base of thumb, open / closed fingers Delivery time up to 10 days
with base of thumb: AE, AF, AG, AC1, AD
Design elements
Upper limbs
CCL 1 12 % 88 %
CCL 2 16 % 84 %
Live Laugh Love
CCL 3 26 % 74 %
Timeless
Accessories
Sportive

freely combined with both
Solutions fitting

problems
Note
The trend colours and the

at no extra charge.
F.A.Q.

The lymphatic
Basic guidelines for measuring techniques

system

Tips
A number of additional important tips medi sets new standards
Always document the skin and
Compression
from medi can be found below:

Principles of
tension measurements to
All garments from medi are supplied enable objective assessment
Measure the finger areas accurately to with an oblique border. of any changes.
the nearest millimetre measurement This prevents circular constriction. Photographic documentation
is always helpful and is
to the nearest 5 millimetres is sufficient increasingly required by
for the arms. A flat oblique is provided as standard insurance companies.
Contraindications
at the requested cuff end at D, E or F for It will make processing these

generally complicated
Never measure circumferences in skin the proximal (upper) border of the long
Indications /
garments a lot easier.

creases otherwise there is a risk of glove.
causing constriction. When making the appoint-
ment to take the measure-
An oblique flat oblique border is ments for the arm / hand
Never take circumference defined as standard for the proximal garment, remind the patient
measurements under tension and never (upper) border of the sleeve. to wear suitable clothing a
loose bra and top will protect
constrict the limb. Measurement under the patients modesty.
tension depends on the tissue structure,
the indication, and the respective
Treatment
procedure
measuring point (see Tips for measuring

points). Never measure fingers under
tension.
Where the back of the hand is severely

oedematous a compression pad
Lower limbs
covering the wrist (page 78) should

always be incorporated. A glove with a
long cuff should be used if the tissues
on the forearm are fibrosed.
Gloves should only be made up without

fingers in exceptional cases.
Upper limbs
Do not measure the finger lengths too

short. The fingers should extend to the
base of the nail bed for the optimum fit
and therapeutic efficacy.
Take all length measurements with the

patients arm straight check the total
Accessories
length on the loosely hanging arm.
Discuss any accessory requirements

with the patient when you are taking
the history.
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Upper limbs - C, C1, D, E - according to BUFA guidelines
Measuring point C
Compression
Principles of
Usually distal (second) wrist fold Circumference (c) C Tips on measuring point C
(styloid process) depending on the Measure without tension; for small Never measure in a skin fold or a fold around the joint.
extent of the oedema circumferences (approx. < 18), make a A sleeve that is too tight would otherwise lead to
dimensional allowance, if necessary additional congestion.
Caution: If C dimension is too small, When ordering a single sleeve the garment is finished
oedema may develop in the back of at C as standard with 2 cm porous knitted fabric - if
Contraindications
the hand (Fig. 28) this measurement needs to be different, please note
under Other accessories.
Indications /
Caution: due to the change to the new RAL for arms
since 1.10.2009, it is no longer necessary to add a few
centimetres to the circumference.
Measuring point C1
Treatment
procedure
Located in the first third between Length (l ) C1 Tips on measuring point C1, D, E
C and E, approx. 7 cm above (not required by all manufacturers) In many cases it is difficult to define the individual
(proximal to) the C measurement measuring points due to the patients anatomy. In
Obligatory measurement for medi! order to guarantee the optimum fit and the correct
pressure gradient, we recommend you try to divide
the forearm into three sections of equal length
Circumference (c) C1
from measuring point C to E.
Measure without tension (Fig. 29)
Due to the new RAL for arms C1 may also be measured
Lower limbs
under tension if the indication requires.
Measure all lengths close to the body and on the exten-
Fig. 29 Source: BUFA ded arm.
Measuring point D
Located in the middle third Length ( l ) D
Upper limbs
between C and E, largest Measure on the flexor side (inside) of
circumference of the forearm the extended arm, specify the length
from C to D
Circumference (c) D
Usually measured under tension,
depends on the oedema (Fig. 30)
Accessories

Solutions fitting
problems
F.A.Q.

The lymphatic
system
Upper limbs E, F - according to BUFA guidelines
Measuring point E
Compression
Principles of
Over elbow and flexion crease Length ( l ) E Tips on measuring point E

Select the measuring point at the If patients have oedema at the elbow or lax tissues in
bent elbow as illustrated and this area you are recommended to take this into
determine the length from C to E on account when measuring. Press the tape measure
the extended arm gently into the area in order to reduce the
Contraindications
circumference and avoid wrinkles at the bend of the

elbow.
Circumference (c) E The knitting marks at E (standard 160) prevent
Indications /
With the elbow slightly bent (approx. wrinkles forming in the flexion area when the elbow is
45), measure without tension and bent. For patients with a sedentary occupation - and
not into the flexion crease. Measure therefore with frequently flexed arms - you can order
slightly above the elbow if other more flexed variants.
Fig. 31 Source: BUFA necessary,(Fig. 31) For particularly sensitive elbow creases the
incorporation of lining material provides additional
protection for this area. For this, please note the area
or the position where the lining should be incorporated
in the Other accessories field. This accessory can also
be incorporated later at any time.
Treatment
procedure
Standard 160 150

Lower limbs
135
Measuring point F
Middle of upper arm (midpoint Tips on measuring point F
Length (l ) F
Upper limbs
between E and G) Measure length from C to F on the Here too, measure all lengths close to the body.
extended arm In normal cases, cF should be cE.
Circumference (c ) F
Usually measured tightly, depending
on the oedema (Fig. 32)

Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Upper limbs G, G1 - according to BUFA guidelines
Measuring point G
Compression
Principles of
Armpit, use measuring aids Length (l ) G Tips on measuring point G
(Fig. 34) Measure length from C to G on the For sleeves with a short upper arm (depending on the
inside of the extended arm anatomy and height) and a wide topband, please note
that there should be sufficient space between
circumferences cF and cG, as the topband already
Contraindications
takes up a width of 5 cm - if necessary, move
Circumference (c ) G measuring point F slightly towards the elbow.
Indications /
As a rule, measure without tension, It is important that the sleeve is long enough! It should
depends on oedema, measure at 90 ideally end in the axilla region. Make sure that the
to the axis of the arm (Figs. 33 / 35) border does not fold over. A non-slip topband gives the
most secure fit and border.
Due to the oblique border the measurement here
may be made under slight tension depending on the
Fig. 33 Source: BUFA oedema -generally to the first resistance of the tissue.
In normal cases, cG should be cF.
Treatment
procedure
Measuring point G1
Length (l ) G1 Tips on measuring point G1
Lateral extension of approx
3 - 6 cm above G Oblique border: state distance from medi does not need the extra measurement G1 for this
G - G1 medi generally manufactures sleeves with the flat
medi does not need this oblique border. A steep oblique can be chosen
measurement here as an option (see P. 76 Accessories). The obliques
depend on the borders circumference and are
Circumference (c ) G1
Lower limbs
calculated automatically.
No circumference dimension medi offers a standard and an anatomical shoulder
Fig. 34 required cap. The anatomical shoulder cap offers a better fit.
medi does not need this For this, measure the distance from the anterior to the
measurement posterior axillary fold (Fig. A). A shoulder cap can be
chosen optionally with a bra attachment or a shoulder
Attachment options strap.
1. Topband (only with lateral In the Attachment field, choose between the 2.5 cm
extension). See options offered by and the 5.0 cm strap width.
manufacturer
Upper limbs
2. Skin adhesive (check skin
tolerability)
3. Shoulder strap
Fig. 35 4. Bra attachment
H (1. shoulder strap)

Measure from G on the outer aspect
as far as the shoulder (acromion)
Accessories
Measure strap length from shoulder

level (acromion) over torso and back
to height of shoulder (Fig. 36)
H (2. bra attachment)

Measure from G to the lateral side of
the bra strap
Solutions fitting
Fig. 36 State bra strap width (> 3 cm) (Fig. 35) Fig. A
problems
Source: BUFA
F.A.Q.

The lymphatic
system
Upper Limbs - A, B - according to BUFA guidelines
Measuring point A
Compression
Principles of
Tips on measuring point A

Line joining the Length (l ) A
metacarpophalangeal joints of Starting point for further length Take circumference measurements with the back of the
the little and index measurements is halfway along this hand facing upwards. Place the palm firmly on a hard
fingers line (Fig. 37) surface, such as a table. The fingers are in the functional
position, i.e. are slightly splayed.
Measure lengths along the inside of the hand.
Contraindications
Measuring point A is located slightly below the fold of

Circumference (c) A the joint at the base of the middle finger (Fig. B). The
Indications /
Pass the tape measure around the intermediate area is of no importance except for gloves
joints at the base of the fingers with without fingers.
the hand placed firmly on a hard
surface such as a table (Fig. 38)
A
Treatment
procedure
Measuring point B Fig. B
Tip on measuring point B

(Line from the web of the thumb Length (l ) B
at right angles to the axis of the Measure A to B on the extended In normal cases cB should be cA
hand) palm; experience shows that in 80 %
of cases this is approx. 3 cm in adults;
Lower limbs
this does not apply for gloves without

fingers (Fig. 37)
Circumference (c) B
Measure straight line over middle of
hand with palm placed firmly on a
hard surface such as a table (Fig. 38)
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Upper limbs - C, C1 - according to BUFA guidelines
Measuring point C
Compression
Principles of
Tips on measuring point C
Usually distal (second) Length (l ) C
wrist fold (styloid Measure A C on the inside of the Due to the new RAL for sleeves, the addition of a few
process) depending extended hand (Fig. 39) centimetres to the circumference is no longer
on the extent necessary.
of the oedema If there is oedema over the back of the hand and / or a
Circumference (c) C
Contraindications
skin fold at C, please always order with a lymph pad.
Measure without tension, for small
circumferences (approx. < 18 cm), add
Indications /
to measurement if necessary.
Caution: If C dimension is too small,
oedema may develop over the back of
the hand. Avoid increased pressure in
Fig. 39 Source: BUFA the area of the overlap
Treatment
procedure
Measuring point C1
Located at least in Length (l ) C1 Tips on measuring point C1
the first third Measure A-C1 on the volar aspect of Measure C1 individually for the hand part, do not use
between C and E the extended hand (Fig. 40) the measuring point for the sleeve.
Position C1 so that there is an adequate overlap zone
Lower limbs
(5-7 cm), but such that the cuff cannot slip down into
the wrist area.
For two-piece garments, medi manufactures the glove
Circumference (c) C1 cuff C-C1 in porous material. For a glove cuff with
Measure as border dimension full compression, please mark C-C1 non-porous in
without tension, otherwise as sleeve the Special Requests field.
When ordering an individual glove, the ends of the cuff
have a band of 2 cm porous fabric as standard.
Fig. 40 Source: BUFA If you require more porous fabric, please enter the
different length in cm in the Other accessories field.
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Measuring technique
system
Upper limbs - D, E - according to BUFA guidelines
Measuring point D
Compression
Principles of
(Long glove) generally to E Length (l ) D Tips on measuring point D

Measure A D on volar aspect (inner)
Oedema often requires higher wall stability. This is
aspect of the extended wrist (Fig. 41)
achieved by a combination of a long hand part that is
usually worn under the sleeve.
The reduction in the circumferences of the garment
worn on top depends on the indication, the thickness
Contraindications
of the oedema and the patients individual response.

Circumference (c) D It varies between skin measurements and strong
Indications /
See sleeve measurements under tension.

The long hand part should always enclose the
complete fibrotic area - but must end a maximum
of 1 - 2 cm before the flexed elbow. Bear in mind the
anatomical support.
The border of the long glove cuff is made with the flat
oblique border as standard.
Treatment
procedure
A A
l AC1 l AC1
Measuring point E C1 C1
Long glove up to 2 cm below E Length (l ) E cC

Measure A - E on volar aspect (inside) cC
of the extended wrist

Lower limbs
c C1 c C1
D cD D
E
cE
Long glove cuff to D Long glove cuff to E

Circumference (c) E
Ensure that the border dimension is
Upper limbs
not measured too tightly

Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Upper limbs - Fingers - according to BUFA guidelines
Finger lengths
Compression
Principles of
X proximal dimension Length (l ) Tips on taking the finger measurements
Z / W distal dimension Shortest length from web (X) to the m edi recommends you choose the lengths too long
nail bed (Z / W). rather than too short: fingers that are too long can be
Exception: If the fingers are closed, marked at the trial fitting and sent in for alteration.
measure to the end of the finger Variant 1: Mark the required length of the finger of the
(Fig. 43) glove on the inside of the hand (Fig. C - e.g. the nail
Contraindications
bed) and measure the length required from the
bottom skin fold on each finger on the inside of the
Indications /
hand.
Variant 2: Mark the middle of the imaginary line
connecting the webs and measure from there to the
required end of the finger (here to the nail bed -
Fig. 43 Source: BUFA Fig. D / E).
Never measure fingers tightly. Please ensure a loose
skin measurement at cX and cZ.
For these very small extremities we recommend our
Finger circumferences medi finger and toe measuring tape (Art.20.226).

Do not pull this too tight.
Treatment
When measuring circumference cX, it should be placed
procedure
(X - proximal measurement Circumference (c) over the finger joint like a ring.
Z / W - distal measurement) Generally measure dimensions X and
tension.
The X dimension may not be smaller

than the Z dimension; if necessary,
adjust to the Z dimension (Fig 44)
Lower limbs
Fig. C - Finger Fig. D - Inside of hand
(side view) (palm)
Upper limbs
Fig. E - Back of hand

Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Upper limbs
system
Arm accessories

Compression
Principles of

Anatomically correct border due to circular borders - basic require-
at G1 ment for a garment that is suitable for the
indication.
Standard in all mediven flat knit
garments.
Contraindications
Steep oblique Optimum anatomical fit, also for larger

Indications /
Anatomically correct border circumferences, no danger of congestion

at G1 - basic requirement for a garment
suitable for the indication.
Outside of arm knitted x cm
longer.
Treatment
procedure
Angle at E Benefit
Knitting marks in elbow area To reduce excessive pressure on the elbow

flexure and prevent wrinkles on
medi produces all arm movement.
garments with the standard
angle of 160 at E.
Lower limbs

compression
Upper limbs
Compression weft threads Ease of handling of compression garment

only in every third row without the risk of congestion, correct
pressure gradient for multi-part
2 cm standard border in CG garments, optimum transition from
sleeves and AC1 hand parts. compressed to uncompressed areas.
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Tips Field: Variable border c.f. Fax Order
Compression
Principles of
medi produces all flat knit products with an oblique border at the proximal Please mark the steep 1
end, i.e. the lateral side of the garment is x cm longer. oblique field with a cross.
The level of the oblique depends on the circumference of the border at the bottom of
(cD, cE, cF with long hand parts and CG with sleeves). fold-out page 104
The standard is flat oblique = approx. 5 % of the circumference.

A steep oblique = approx. 10 % of the circumference can be selected as an
Contraindications
option.
Indications /
Please consider the patients anatomy when choosing the oblique.
Incorporation of a steep oblique also means a higher volume. This can lead
to the formation of bags on the upper arm.
Treatment
procedure
Tips Field: Knitting marks c.f. Fax Order
In most cases the standard 160 bend is adequate. Please cross desired angle. 5
For patients who hold their arms in a flexed position for long periods during
the day (e.g. when using a computer), an additional garment with a 150 at the bottom of
angle is recommended. fold-out page 104
For patients with, for example, paralysis (after a stroke) who constantly hold
their arm close to the body in a flexed position, the sleeve may be ordered
with an angle of 135.
Lower limbs
Upper limbs
If you order a CG sleeve + AC1 hand part together on one measurement Please state x cm porous 2
sheet, the overlap zone of the glove will automatically be made porous
from C - C1. With individual or follow-up orders you must give the desired at the bottom of
porous cm separately. fold-out page 104
A combination of oblique border and porous rows is not possible. An
exception to this is the proximal border on a sleeve without a topband. In this
case, the standard is knitted with 2 cm porous. Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Upper limbs
system
Arm accessories
Compression pads: Benefit

Compression
Principles of
incorporation of individual
cushions / lymph pads
Additional compression E ven pressure distribution over the back
I ncorporation of medi lymph of the hand
pads, pre-formed silicone pads Loosen fibrosis
(Epicomed) and padding S pecific pressure increase over the
material oedematous region
Contraindications
Indications /
Padding out Benefit

Treatment
procedure
Reduction of wrinkles Local reduction in pressure over sensitive

Incorporation of medi lymph regions or around joints, e.g. bend of the
pads elbow.

Lower limbs
Lining with soft, smooth The skin in particularly sensitive areas,

material such as in the bend of the elbow, or in
irritated skin areas (e.g. status post
psoriasis, post ulcer, burns) is not subject
to additional irritation and calms down.
Unpleasant itching is avoided, more
comfortable to wear.
Upper limbs

topband
Most common method of Ease of handling for optimum comfort in

securing sleeves, with no wear.
constriction due to oblique Topband does not roll over, but gives an
borders attractive border without causing
constriction.
Accessories

topband stoppers
Additional security of fit in Optimum security of fit for voluminous

the area of the oblique border upper arms, easy handling for optimum
comfort in wear, treatment compliance
Solutions fitting
and maximum success. It provides for

better adhesion to extreme shapes.
problemsF.A.Q.

The lymphatic
system
Compression
Principles of
We recommend that only the mediven 550 models are used if additional Please mark the appropriate 2
local compression is necessary or if support is required for dispersing fibrosis. selection. Show the desired
position / area as well as the at the bottom of
If pads are made up individually, we recommend you send the goods back to length and width. fold-out page 104
us to be incorporated in the garment after the trial fitting. For this, mark the
exact shape and position of the pads with our medi textile pencil
(Art. 25.460).
Contraindications
Epicomed pads and medi lymphpads that are positioned on the basis of
Indications /
For this, please give the exact size and the positioning points.
Please always give us the exact size and positioning of the lining material.
Lining material can also be sewn in later.
Treatment
procedure
Lower limbs
Please always give us the exact size and positioning of the lining material. Please mark the appropriate 2
selection. Show the desired
Lining material can also be sewn in later. position / area as well as the at the bottom of
length and width. fold-out page 104
Upper limbs
For each model and each topband type medi uses the suitable circumference Mark the required variant 3
conversion, i.e. the table measurements for the topband are based on with a cross.
years of experience and numerous tests. at the bottom of
If, in exceptional cases, it is necessary to fit a tighter or looser topband than fold-out page 104
usual, please show the appropriate circumference in cm after the variant.
Accessories
This topband stopper can be incorporated as the only support or as an Mark the required variant 2
additional support and can be incorporated later at any time. This is the ideal with a cross.
support for patients who cannot have the topband at G1, (particularly on at the bottom of
the inside of the upper arm),. fold-out page 104
Solutions fitting
problems
F.A.Q.

The lymphatic
Upper limbs
system
Arm accessories
Attachments / support Benefit

Compression
Principles of
devices shoulder cap /

anatomical shoulder cap
Alternative attachment in Optimum security of fit for patients
case of intolerance of the who do not tolerate silicone
topband
Possible variants:
Contraindications
S houlder cap with bra

Standard Anatomical shoulder cap attachment
Indications /
shoulder cap S houlder cap with shoulder

strap
The shoulder cap is also

available in two different
versions:
Standard
Anatomical
Treatment
procedure
Addition of zips / hook and Benefit

loop fasteners
Easy to put on and take off. Suitable for:

Large differences in circumference
Recent scars (after burns)
rheumatism)
Lower limbs

optimum therapeutic outcome.
Oblique border hand part Benefit
Anatomically correct border Optimum anatomical fit, no risk of stasis

Upper limbs
for long hand part (AD and AE) due to circular borders - basic
requirement for a garment that is
Standard in all mediven flat knit appropriate to the indication.
garments. The hand part is
knitted longer at the proximal
seam edge.
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Compression
Principles of
We recommend the anatomical variant because of the better fit, the Mark the required variant 3
attractive appearance, and reduced wrinkling when moving the arm. with a cross.
at the bottom of
The variant with bra attachment is not suitable for very small appliances
fold-out page 104
(the low weight cannot hold the sleeve) or where the breasts are very large
(too much weight encourages the formation of oedema in the shoulder / arm)
- alternatives are a topband and / or shoulder cap with a shoulder strap.
Contraindications
Indications /
Treatment
procedure
The incorporation of a short zip on the outside of the arm is recommended Mark the required variant 4
for voluminous upper arms that have a smaller circumference at G than at with a cross.
F. A zip can be sewn into the seam later at any time at the bottom of
fold-out page 104
Lower limbs
Tips
Use oblique borders to avoid circular constriction if you are treating fibrosed
lower arms with a long glove cuff
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Functions of medi lymph pads

system
For many garments medi lymph pads are the optimum addition as padding
material.
The characteristics and requirements of each specific form of oedema can be

Compression
Principles of
catered for more individually with the aid of the three different surface structures.
Lymph pad fine-nubbed Lymph pad Lymph pad ribbed Properties to Ko Tex Standard
coarse- nubbed Breathable
Contraindications
Permanently dimensionally
stable
Indications /
Washable up to 40
Free from CFC, PCP, nitrosamines,
azo dyes and fillers
Prescribable
Can be cut to size individually
with scissors.
This provides gentle drainage The coarse-nubbed medi The ribbed surface of this medi
in combination with the lymph pad is usually used lymph pad also works with the
compression garment. under bandaging - here again compression garment to
Treatment
procedure
The fine-nubbed surface deposits are loosened. provide gentle drainage.

stimulates the The ribs running in the
microcirculation in the tissues. direction of the lymph ducts
Fibrosis can be loosened in this assist with lymph drainage.
way and deposits can be
transported away, particularly
in lymphoedema.
Areas of use
Lower limbs
Pad for back of hand (if there Thigh, e.g. for lipoedema Pad on the back of the hand
is a risk of wrinkling at C, extending over the wrist
always extend over the wrist) (here the longitudinal ribs
Hand palm pad also resist wrinkling at the
Dorsum of the foot wrist)
Compression pad for fibrotic Hand palm pad
areas (possibly also as an Dorsum of the foot
alternative to the ribbed pad) Compression pad for fibrotic
areas (possibly also as an
Upper limbs
alternative to the finely

ribbed pad)
Compression pad in the area
of the malleolus - length
often to C or D
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
Examples of medi lymph pads in use
system
Lymph pad on back of hand Lymph pad over the palm of Lymph pad on top of forearm Tips
- extending over wrist the hand
We recommend the models
mediven 550 arm or leg for
patients who need lymph pads.
Compression
Principles of
The mediven mondi and mediven
esprit models are no longer
adequate for such cases.
It is not possible to incorporate

medi lymph pads in the mediven
Lymph pad ribbed Lymph pad ribbed Lymph pad ribbed sensoo models.
Contraindications
Lymph pad fine-nubbed Lymph pad fine-nubbed Lymph pad fine-nubbed
For padding and compression For padding and compression To loosen fibrosis in the When ordering the compression
garment lymph pads
Indications /
enhancement in oedema of the enhancement in oedema of the forearm
back of the hand hand (additional to the back of I ndicate the position or area
hand pad if required) the measurements of the length
and width are also essential
Lymph pad on underside of F or complicated pad shapes
forearm: please fax or mail sketch, photo
etc. (export@medi.de)
As a later addition to the

compression garment
T he patient should try the
Treatment
procedure
garment on (if necessary, it
should also be worn for several
days and the fit OK obtained
from the patient). Indicate the
Lymph pad ribbed
position of the pad(s)
Lymph pad fine-nubbed
F or complicated pad shapes
To loosen fibrosis in the please fax or mail sketch, photo
forearm etc. (export@medi.de)
Lymph pad over dorsum of Compression pad for medial Longer pressure pad for
Lower limbs
the foot: and lateral malleolus medial and lateral malleolus
Upper limbs
In the toe cap In the leg garment In the leg garment
In the AD stocking with closed Made of silicone (Levamed Lymph pad ribbed
toe pad)
Lymph pad ribbed Lymph pad ribbed
For additional compression for For additional compression in For additional compression in
oedema over the dorsum of the the oedematous malleolar the oedematous malleolar
foot area area and to assist lymph
drainage along the lymph
ducts
Accessories
Individual pads
Solutions fitting
problems
Lymph pad ribbed

For additional compression in the oedematous
malleolar area and to loosen fibrotic tissue in the
lower leg (usually stipulated and marked by the
lymphologist)
F.A.Q.
medi Lymphology Care Guide Accessories 83

The lymphatic
Topband variants
system
mediven flat knit
Topband Variants Description Comment

Compression
Principles of
Silicone topband, Nubbed silicone coating Can be used for all

narrow types of connective
Secure holding of the garment
tissue
Contraindications
2.5 cm wide
Indications /
Silicone topband Nubbed silicone coating Can be used for all

Secure holding of the garment types of connective
5.0 cm wide tissue
Silicone topband Nubbed silicone coating Optimum security of fit

with motif Secure holding of the garment of the garment due to
nubbed structure, even
Treatment
procedure
Outer surface with floral motif

5.0 cm wide for soft connective
tissue
Profile topband Rhomboid silicone coating over wide area Large area silicone
Secure holding of the garment coating for comfort in
5.0 cm wide wear and an extremely
secure fit
Lower limbs
Sensitive topband Honeycomb silicone coating Solution for patients who

Better air permeability due to the lace cannot cope with profile,
5.0 cm wide topband nubbed or silicone topband
Soft material for high wearing comfort with motif
Upper limbs
Overview of variants
Lower limbs
Mens leotard
Accessories
Variants Perforated topband Waistband (not adjustable Knitted border (not

(adjustable) + adjustable) adjustable)
Closed gusset
(front section knitted in 2 parts)
Horizontal fly (front section knitted

Solutions fitting
in 3 parts)
Zip, continuous, with hooks and eyes

problems

Zip, not continuous without hooks and eyes
(Zip ends under perforated (Zip continuous to border) (Zip continuous to border)
border)
F.A.Q.
84 Accessories medi Lymphology Care Guide

The lymphatic
system
Upper limbs Lower limbs
All arm Glove with Arm As topband AD with cD AD with very AG As topband
Compression
garments long cuff* garments stopper* larger than large cD stopper*
Principles of
to G* for very cC circumference
voluminous
upper arms *
Contraindications
Indications /

Treatment
procedure

Lower limbs

*
Please note: these are only recommendations. The topbands are available for all sleeve lengths
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.
medi Lymphology Care Guide Overview of variants 85

The lymphatic
Possible causes of
system
fitting problems
The stocking slips down
Compression
Principles of
Putting the garment on Care Measuring

Not pulled up far enough Stocking not washed Too little tension used when taking
Overstretched when pulled up Fabric softener or detergent with measurements, possibly only measured
Borders not correctly positioned bleaching agent used for phlebology
(connective tissue bulge) Washed or dried at high temperature Measured too short or too long,
Skin care products containing grease or anatomical suspenders were not taken
Contraindications
ointment used into account

Accessories required (e.g. long thigh,
topband stopper)
Indications /
The anatomy Other causes Psychological components

(see page 88 Fitting Problems) Weight loss Dissatisfied with the situation
Conical legs Low oedema volume
Voluminous thighs Cold > vessels constrict > circumference
Pronounced paunch changes
Extreme difference in circumference
between leg and thigh
Soft connective tissue
Treatment
procedure
The stocking cuts into the skin, develops wrinkles, etc.

Garment cuts in The stocking forms wrinkles in the hollow The stocking cuts into the skin of the
of the knee hollow of the knee and chafes
Borders measured too tightly Stocking is too wide - possibly only See stocking wrinkles in the hollow of the
Lower limbs
Stocking too long measured for phlebology knee

Hosiery measured too tightly Stocking is too long - excess material Circumference cE measured too tightly,
Measured in the fold collects in the hollow of the knee measured directly in the hollow of the
Reduction in elasticity due to sewing in Large difference in circumferences distal knee, knee not bent, measured under
topband pieces and proximal to a joint (lipoedema) tension
The stocking wrinkles over the arch The stocking cuts into the skin over the Stocking exerts too little compression
ankle - skin irritation
Stocking was measured too wide from cB, Stocking too long and / or too wide - Too little tension during measuring
possibly only measured for phlebology material collects over the joint Circumference changed due to:
Upper limbs
- excess material collects over the joint cY measured too tightly - poss. under a. Weight loss
Foot is too short tension b. Changes in oedema volume (e.g. by
Y knitting mark necessary Y knitting mark necessary lymphatic drainage)
Stocking too long and / or too wide - Foot too long / short Subjective perception
material collects over the joint No topband in A-D stocking in spite of Material too elastic (working pressure
No topband in A-D stocking in spite of conical leg shape - stocking slips too low)
conical leg shape - stocking slips Compression class too low
Double wall effect may be necessary
Oedema worsening (caused by garment) Topband rolls over Panty section slips / rolls over
Accessories
Wrong material chosen Stocking is not pulled up properly - Panty section measured too short / long
Constriction caused by excess material topband ends on a tissue bulge - anatomical support not taken into
Joint area measured too tightly Tissues on the inner side of the thigh not account
Poor compliance packed into the stocking Too little tension used when taking
Diet Topband or cG too tight measurements, possibly only measured
Weight gain Steep oblique chosen - does not follow for phlebology
No lymphatic drainage the course of the gluteal fold Border measured too tightly - poss.
Solutions fitting
Is not bandaged after MLD Stocking too long measured in the fold
Emotional problems Legs measured too short - tension is so
Stress strong that the panty top is pulled down
problemsF.A.Q.
86 Solutions fitting problems medi Lymphology Care Guide

The lymphatic
Solving fitting problems
system
Care for patients with oedema is 3. Care
very individual, so fitting problems medi compression stockings are
can arise at any time. With first-time generally considered to be very easy to
provision in particular, problems care for. However, the Care Instructions
Compression
Principles of
often first occur in everyday use after (see Instructions for Users or Care
wearing and washing the garments Instructions document in the garment
several times. guide CD) must be followed exactly to
make sure they fit properly in the long
However, problems can occasionally term. If medical compression stockings
Contraindications
occur when a new garment is supplied, are washed with products containing
even for experienced patients who have bleach or fabric softeners the structure
Indications /
been treated for several years. This may of the material will change. The
be due to a variety of causes. elasticity changes and the stocking will
have a Teflon-like coating - it will slip!
1. Measuring
Oedema patients frequently have 4. Therapy
unusual body shapes which must be Oedema changes! If a garment is fitted
taken into account when measuring. In to an extremity before decongestion
view of the low elasticity of flat knit the stocking can slip after a short time
Treatment
procedure
materials, measurements for garments because compression and
made from this material must always micromassage stimulate lymph
be taken without tension or, as the drainage and the circumference is
case may be, with a tension that is reduced. However, the opposite may
appropriate to the dimension of the also be the case. If you supply a
circumference, the tissue structure, garment for lymphoedema stage II or
and the indication. Ensure that the III that has been inadequately treated
Lower limbs
lengths are measured accurately - we and shows definite fibrosis, this can
recommend that you always measure lead to worsening of the oedema. Not
these close to the body. only will problems with fit occur, the
entire situation can worsen
2. Putting the garment on dramatically!
Following the correct procedure when
putting on a garment is crucial for a 5. General condition of the patient
Upper limbs
perfect fit and comfort in wear. Stress, psychological stress, illness,
Compression stocking or sleeve fabric hormonal influences, medication, diet,
must be spread correctly over the leg weight gain, nutrition and temperature
or arm, starting from the distal area changes etc. all affect an oedema
and working towards the proximal patients condition. It is vital to take
area and not overstretched. Make sure these factors into account in the event
that all joint areas of the garment and of a complaint regarding fit.
Accessories
any borders are correctly positioned.

Solutions fitting
problems
F.A.Q.
medi Lymphology Care Guide Solutions fitting problems 87

The lymphatic
Solutions for fitting problems

system
What do I do about deep skin folds and When do I use a long thigh? Massive connective tissue bulge
soft connective tissue? above the patella (kneecap)
Compression
Principles of
Contraindications
Deep skin folds Very large thighs Tissue overhang above the kneecap
Always select the mediven 550 model The longer thigh gives the
Indications /
as you must have sufficient wall connective tissue space, precisely in

stability. the area where the patient requires
optimum shaping.
Never measure in skin folds - otherwise
even flat knit material will constrict. In Do not use the longer thigh option for
this case, you should also include the any pantyhose models - the exception
abdominal / hip area that is also affected. to this are patients with very large
thighs, particularly at the front. Measure cE
Multi-part garments are beneficial for
simplifying the donning procedure and When fitting patients with A-G When determining the usual
circumferences (over the top edge
Treatment
procedure
guaranteeing a good fit of the garments. stockings we always recommend a

longer thigh. of the patella), this does not take
CT + AD A
n AD garment alone will not the volume in the area above the
treat the bulges on the thigh. AT If possible, avoid a longer kneecap into account.
thigh If there is an overhang, the tissues
FT + AG An AG garment alone will roll AD+CT AD with flat oblique border cannot be correctly packed in and
down if the connective tissue is CT without longer thigh and the material forms massive folds at
very soft. with steep oblique border the front of the knee area.
AG+FT AG with steep oblique
Lower limbs
and with long thigh - for In this case, measure the circumference
very large increases in cE with the patient standing (the
circumference from F to garment will fit better because
G, an AG garment alone will voluminous thigh measurements are
not stay in place. Therefore more accurate if taken with the patient
always include the affected standing - the patient is also usually
abdominal / hip area in standing when donning stockings for
the garment: FT without a treating this area).
long thigh and with steep
oblique border. Include this connective tissue in the
Upper limbs
measurements as indicated. Dimension

cE is then usually measured under
tension.
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Where to measure? How do I care for an area where Correct measuring in case of missing
tissue is missing? limbs / deformed extremities
Compression
Principles of
Missing tissue Back of hand
Contraindications
Front view to E
1. P
repare an individual cushion with
Indications /
padding material e.g. similar to the
padding material for orthopaedic
corsets) to replace the missing tissue
or to even it out.
2. Measure the circumference with the

pad in place.
Front view to G Palm of hand
3. If the pad that is simply put in place
Depending on the anatomical slips when the garment is put on, Measure these extremities as
circumstances (as with phlebology), usual - intermediate measurements
Treatment
procedure
mark the exact position of the pad
the area to be reshaped is divided into after the stocking has been put on cannot be recorded by the measuring
sections (lymphologically). using a textile pencil and send us technique, but sometimes help in
the garment with the following note assessing the feasibility of a garment.
Red markings - based on the anatomical Incorporate pocket as marked.
circumstances (phlebology). In this case, You are also welcome to send the However, photographs are even
an exact picture of the limb to be treated garment in with your own individual clearer - take a photograph of the
is made - with all its lumps and bumps. pad. areas affected from a number of
angles (in this example: the back of
Lower limbs
Green markings - uniform distribution the hand and palm) and send these to
of measuring points in the lower leg us with the measurement sheet.
and thigh areas gives the garment a You can also send the photos by email
harmonious shaping and moulding (export@medi.de).
effect. The aim of every lymphological
garment is to reshape the leg towards A s in this example, you can also take
the form of a healthy leg. a photocopy of the hand - possibly
placing a tape measure next to it so
that the proportions can be more
easily assessed.
Upper limbs
Since, as in this example, an individual
calculation must be carried out by
the Technical Department for special
garments, feasibility must first be
established.
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic

system
The narrow topband on the sleeve Massive lipoedema of the upper arm Massive lipoedema on the upper arm
rolls down. - measuring point cE - border at G1
Compression
Principles of
zip short
g
lon
cE zip
cE
cE
Contraindications
Narrow topband rolls down Measure cE Without sleeve
Wide silicone topband and / or In comparable situations measure

Indications /
An additional topband stopper circumference cE with the arm

(5 x 5 cm) in the long upper arm, or flexed, including the connective tissue
zip short
Anatomical shoulder cap and topband directly above E. lon
g
stopper 5 x 5 in the oblique Order the garment with the standard zip
cE
cG too tight 160 knitting marks only - more
l CG too long - shorten overall length, knitting marks give the tissue too
use steep oblique much space and the sleeve puffs out
at the elbow. With compression garment
Always order with wide silicone

topband border.
Treatment
procedure
A topband stopper (5 x 5 cm or
5 x 10 cm) can provide a more secure
fit in the oblique border area.
Sewing a zip in can make dressing and
undressing easier for arms with these
proportions:
Short zip (from F to G1)
Long zip from C1 or D1 to G1.
Lower limbs
Patients with this kind of massive

lipoedema in the arm will normally
require a second person to assist in
shaping a sleeve perfectly.
Upper limbs
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Garment cuts into the wrist Oedema only in the fingers after Very large abdomen, pantyhose
surgery and stiffening of the hand presses on back of knee, scar over
lateral side of right lower leg
Compression
Principles of
Contraindications
Constriction Oedema of the fingers Severe ulcers in the calf
Indications /
Case report Case report
The patient was supplied with a two-part The patient was supplied with a glove
garment in which the sleeve was far too although only one finger was swollen.
long at the forearm therefore causing it to Due to the deformity of the hand she
slip back. The glove ended at measuring could not put on the garment alone or
point D, exactly on the belly of the muscle, without pain.
which also caused the garment to slip. The
wrinkling at the wrist leads to constriction. Treatment option
The patient was successfully fitted Large skin flaps at the knee
Treatment option 1 with a finger stall. There were no
Treatment option
Treatment
procedure
CG1 with 4 cm porous border at C changes in the hand / arm area in the
Glove is worn over the sleeve; to C1 or to D. long term. In view of the severe ulcerations in
Glove contains a long pad to at least C1 the lower leg mediven mondi AD CCL
2 with topband, Y knitting mark, and
Treatment option 2 oblique closed foot was selected.
1-part AG This was covered by mediven 550 CG
leg pieces CCL 1 or 2 with a topband,
long thigh and flat oblique starting
at C, porous and 6 cm wide.
Lower limbs
mediven 550 CCL 1 FT with 6 cm
porous at F can be added to stop any
possible rolling over of the topband
due to soft connective tissues.
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic

system
Very large circumferences in the area Very soft connective tissue with Very large abdomen, pantyhose
of the panty top with relatively small slight wrinkling and overhangs in presses on back of knee, scar over
leg circumferences area over E lateral side of right lower leg
Compression
Principles of
Contraindications
Very large circumferences Wrinkling ... Very large abdomen

Indications /
Treatment option
mediven 550 CCL 2 AG with topband
and topband stoppers in the oblique
border, over measuring point E and
on the seam, longer thigh with oblique
foot.
In addition, mediven 550 CCL 2 ET
with perforated topband, flat oblique,
without a longer thigh - 6 cm porous ... and overhangs Treatment example
material from E - panty top extending
Treatment
procedure
to under the breast if possible. Treatment option Case report

Consider the possibility of braces if the mediven 550 CCL 2 AD silicone AD too long and too wide, no Y
lower abdomen is very large. topband flat oblique, Y knitting knitting marks, no topband, therefore
marks and open oblique toe constrictions at the back of the knee, CT
Where there are differences in length of mediven 550 CCL 2 CG leg pieces, is not accurately fitted - the abdomen
more than 15 cm in the panty section silicone topband, steep oblique with is pendulous and it is impossible to put
(l K1T to l K2T), please consult your medi longer thigh - topband stopper added the garment on correctly.
Lymph Service before ordering. at back on seam
A larger difference is possible depending mediven 550 CCL 1 ET from E 6 cm Treatment option
Lower limbs
on the circumferences and lengths. porous, perforated topband. Measure Abdomen should preferably be
panty top as high as possible to supported by a corset. Too much
give a very secure fit over the lower weight for knitted fabric - consider
abdomen. the possibility of braces.
mediven 550 CCL 2 or 3 AD with
oblique open toe, silicone topband,
flat oblique border and Y knitting
marks, soft foam pad placed on the
scar on the right-hand side with
extended transitions.
Upper limbs
O ver this, 550 CCL 2 CG leg piece on

right, BG leg piece on left, silicone
topband, longer thigh and topband
stopper added to the oblique border
and at back on seam - 6 cm porous
fabric at C and B.
Accessories
Solutions fitting
problemsF.A.Q.

The lymphatic
system
Very severe wrinkling at E and Y Slim waist with large K and H Constrictions at ankle and skin
with relatively normal shapes and a circumference irritation over dorsum of the foot
slight angle
Compression
Principles of
Contraindications
Severe wrinkling Large K and H circumference Constrictions
Indications /
Case report Abdomen must be measured in its Case report
Stocking is much too wide - only anatomical form. AD too long and too wide - no Y
phlebologically measured, material Make sure that the tissue at cK and knitting marks. The measurement at Y
already gathers in the back of the knee cH is adequately compressed. It is was taken without maximum flexion of
after only a short time, it has no Y important here to exert enough the foot; no topband in spite of conical
knitting marks, foot too small. tension when measuring in order to shape.
build up the necessary extensive grip In addition, large reduction in oedema
Treatment option and avoid sagging. after fitting stocking, stocking slipped
mediven 550, AG CCL 2 or 3, topband and wrinkled.
and Y knitting marks, open oblique foot,
Treatment
procedure
flat oblique border and longer thigh Treatment option
Initially continue to bandage toes.
mediven 550 CCL 2, knee stocking with
open oblique toe, Y knitting marks, flat
oblique border and wide topband.
O ver this, mediven 550 CCL 1 CG leg
piece, silicone topband, flat oblique
border; 6 cm porous at C.
Lower limbs
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
The optimum complaints procedure

system
We would like to inform you that all complaints 2. Putting the garment on
about the fit must be subjected to the latest The reason for a problem with the fit frequently lies
technical tests to rule out incorrect handling or a in the incorrect method of putting the garment on.
production defect. Get the patients to put on the compression
Compression
Principles of
garment themselves and watch for possible errors

However, even with experienced patients treated for in how they do it - assist if necessary, and give them
several years, problems can occasionally occur when tips on the correct procedure. Only a garment that
a new garment is supplied. This may be due to a has been put on correctly from the outset will
variety of causes. provide the best comfort in wear and guarantee
Contraindications
optimum therapeutic benefit!

1. T
he complaints investigation
Indications /
Not only should the problem of the actual fit itself 3. C

hecking the fit when the garment
be investigated as accurately as possible, other is being worn
factors should also be considered. For example, the Once the garment has been put on correctly please
care and handling of the garments, changes in check the exact fit of the compression garment
everyday circumstances, the patients activities, from distal to proximal. Check that it fits correctly
stress, illness, diet, weight changes and treatment at the foot, the heel, the knee, the borders and the
can all have a possible influence on the accuracy of longitudinal and transverse seams.
the fit. A detailed inspection of the knitted rows and lifting
Treatment
procedure
the material away from the tissue will enable you to

Information such as. observe any possible overstretching or excess
What exactly is wrong? material in the individual segments of the garment.
When did the problem occur?
How severe was it or how severely does it affect 4. C
hecking the model
you? Accessories such as soft toes, Y knitting marks,
How long as the fit been poor? knitting marks at E, longer thighs, steep oblique or
Lower limbs
Have the problems occurred daily? topband stoppers optimise the fit in some very
How do you deal with this? pronounced anatomical forms, but not every
How do you look after your stockings? accessory is desirable in every case.
How often do you wash your stockings? Therefore check whether the style of the garment is
Do you use creams or ointments containing grease? the most suitable for your client.
What activities do you carry out when wearing the
garment? 5. Marking the part that fits incorrectly
Upper limbs
Have you been ill? The more detail you give about the reason for the
Have you recently been under severe stress? complaint, the better medi can investigate its
Do you have to take medication? cause. You can provide additional assistance for our
Have you had hormonal changes? investigation by marking the regions that do not fit
Are you regularly having lymph drainage? correctly. You can also mark, for example, wrinkles
Are you bandaged after lymphatic drainage? or incorrectly positioned knitted marks.
Accessories
.. is enormously important in allowing us to obtain

a clearer picture of the problem.
Tip
The medi textile pencil

Solutions fitting
(Art. 25.460) is perfect for marking

flat knit garments.
problemsF.A.Q.

The lymphatic
6. Photographic documentation
system
If the garment does not fit properly please always
send us pictures of the garments from four angles
(front, back, right side and left side), with and
without the garment(s). It is important that these
pictures show the whole of the garment and not
Compression
only the area where the problems have been
Principles of
marked.
Contraindications
Indications /
Treatment
procedure
Without garment front Left side Right side Back
Lower limbs
Upper limbs
With garment front Left side Right side Back
Accessories
7. Checking measurements
In any case, after examining the fit, check the skin and
length dimensions in order to rule out a change - if
necessary, take completely new measurements for
the garment.
Solutions fitting
8. S
ending in the complaint
Please send us the marked goods with a detailed
problems
letter of complaint, photos and, if appropriate, new

measurements. The letter should describe in detail
the exact reason for the complaint and the changes
you require.
F.A.Q.

The lymphatic
Frequently asked questions

system
Can compression pads also be sewn into A compression garment shows damage
round knit garments? to the fabric, the seams or the topband.
Can I repair this myself?
No, incorporation of compression
Compression
Principles of
cushions or lymph pads into compression Technically correct repairs to pulled

garments by means of a pocket or of threads, ladders etc. are best carried out
lining material is only possible with flat by medi in Bayreuth. The 6-month
knit garments. guarantee period normally becomes null
and void if you carry out your own
Contraindications
repairs.
After a successful decongestion phase Repairs during the guarantee period are,
Indications /
the patient still has large folds of skin of course, free of charge.
on the thighs and on the inside of the
knees. Measuring in this area is very
difficult. A patient uses a wheelchair because of
How can I simplify this process paraplegia. He wears flat knit
and avoid excessive reductions in compression stockings to treat his
circumference? inactivity oedema. What can we do
about wrinkles forming at the back of
Treatment
procedure
After successful treatment and / or large the knee?

weight reductions skin folds can develop
on both the arms and legs as well as on In a case of this kind it is recommended
the trunk. to incorporate an 8 cm elliptical shape.
You can consider gentle fixation with Since the angle is approximately 90, no
wide long-stretch bandages or fitting a further wrinkles will form in the
TG tube dressing over the area to simplify compression garment.
Lower limbs
the measuring process and to achieve

appropriate reshaping. In less extreme
cases you can also measure over the old
compression garment.
It is essential that you instruct the

patient regarding skin care. Inflammation
Upper limbs
and other diseases can develop very

quickly in the folds underneath the
sagging skin.
Accessories
Solutions fitting
problemsF.A.Q.
96 F.A.Q. medi Lymphology Care Guide

The lymphatic
What is a pouch? How do I best explain the difference
system
between the individual compression
A pouch is the name for a pronounced classes?
individually fitted fly area for men with
genital oedema. Compare the pressure of the
Special additional measurements are compression stockings with the
Compression
Principles of
required for this (Page 45). hydrostatic pressure when a patient
is in the bath or swimming pool. For a
patient with a height of approx. 1.75m,
When do I use non-standard elbow the pressure of compression class 1
angles for an arm garment? garments on the ankle is approximately
equivalent to a water depth of 37 cm. The
Contraindications
The standard angle (160) generally picture clearly illustrates further data for
offers good everyday function. compression classes 2, 3 and 4:
Indications /
A 150 angle is recommended if the
patient has problems in the elbow
area, incipient osteoarthritis or minor CCL 1 37 cm CCL 2 47 cm CCL 3 58 cm CCL 4 76 cm
paralysis. A 135 angle should be
considered for patients whose arm is
almost permanently flexed, in paralysis
and osteoarthritis.
Treatment
procedure
We are always being asked what the
difference is between round knit and
flat knit garments.
How can I explain this difference
briefly?
Lower limbs
18 21 mmHg 23 32 mmHg 34 46 mmHg > 49 mmHg
Round knit compression garments
The pressure exerted by each compression class corresponds to the given
are knitted on machines on a round water column in cm. The mean values given are for a person 1.75 m tall and for
needle bed. The bed always has the same B = 12 cm.
circumference and the same number of
needles (similar to French knitting).
Different body circumferences are
Upper limbs
produced by regulating the size of the
stitches.
Flat knit compression garments

by contrast, are produced on a
longitudinal (flat) needle bed.
The change in circumference is achieved
by increasing and decreasing the number
Accessories
of stitches (similarly to when knitting a

normal garment).
Finally, the garment is formed by sewing
it up with a seam. Almost all body shapes
can be produced by this method.
Solutions fitting
problems
F.A.Q.
medi Lymphology Care Guide F.A.Q. 97

The lymphatic

system
What care instructions must I pass on A patient has been prescribed a knee
when advising my clients? stocking (AD) with a legging pantyhose
(BT), both in compression class 1.
In order to maintain the functionality Does this mean that the pressure of a
Compression
Principles of
of your medi compression garment the compression class 2 garment is being

garment should be washed every day in applied in the overlap area?
the evening after taking it off.
The RAL Quality Mark leaves
We recommend medi clean, a special manufacturers a wide discretionary
Contraindications
hand wash liquid for gentle care or a leeway for some of the compression
detergent for delicates for the machine classes.
Indications /
wash (delicates cycle at 40) without

optical brighteners or fabric softeners. In order to define the pressure exerted
The use of a laundry net protects the do not add together the compression
garments from damage by zips etc. classes you chose, but add the respective
pressures together.
Please do not leave the damp stocking The flat knit compression stockings by
in a wet towel. Please pull flat knit medi are traditionally in the upper range
garments into shape after washing. of the compression class. Therefore, in
Treatment
procedure
Do not, under any circumstances, the case described (CCL1 over CCL1),
dry your stocking in the sun or on the there would be a pressure of just under
radiator, dry it in the delicates cycle of 40 mmHg at the origin of the overlap
your tumble drier or simply allow it to dry area (measuring point B).
in the air. Please pull flat knit garments This corresponds roughly to compression
back into shape after washing. class 3.
Lower limbs
CCL 1 CCL 2 CCL 3 CCL 4

2.4 to 2.8 kPa 3.1 to 4.3 kPa 4.5 to 6.1 kPa 6.5 and bigger
or or or or
18 21 mmHg 23 32 mmHg 34 46 mmHg >49 mmHg
Can compression garments go in the
tumble dryer?
All compression garments from medi are

Upper limbs
suitable for machine washing and tumble

drying (delicates cycle).
What materials does medi use in its flat

knit compression garments?
Accessories
medi uses exclusively materials made of

Elastane (polyurethane) and Polyamide.
Solutions fitting
problemsF.A.Q.

The lymphatic
Why do flat knit compression garments Can you sew a topband onto the inside
system
not bear a CE mark? of the garment?
Flat knit compression stockings are It is possible to have topband stoppers

made to measure or specially produced sewn into the garment at various places.
garments. For these products, there is no Topband stoppers on the inside of the leg
Compression
Principles of
obligatory marking within the European or around the inside of the compression
Union. stocking are fundamentally ruled out for
therapeutic reasons.
Is rubber or latex used in the stockings?

What does the Clima Fresh concept
Contraindications
Medical compression garments involve?
from medi do not contain any rubber
Indications /
(Elastodien) or latex. Clima Fresh is the name used to describe
the antibacterial effect of almost all medi
compression stockings.
A patient suffers from severe allergies. During the spinning process silver
How can I find the right stocking? ions are sprayed onto the yarn by this
patented technology. This prevents
You will find a compression stocking colonisation of the knitted fabric
Treatment
procedure
finder at www.medi.de/en. by bacteria and fungi and constant
Here you can enter the materials that reinfection. The antibacterial effect
are not tolerated, the indication, and is permanent and does not have to be
the compression class to find the right renewed.
compression stocking. You can also use
the compression stocking finder in the
opposite direction. Does your patient What is medi LymphVis?
Lower limbs
show signs of intolerance while wearing a
compression stocking? medi LymphVis is a computer-assisted
Under the product description you programme for visualising treatment
can find all substances that a product success and documenting the best time
contains. In this way a doctor can more for fitting a stocking.
easily filter out the relevant intolerances Ask your medi representative or your
and modify the treatment. medi Lymph Service.
Upper limbs
Does compression therapy have any What is the difference between resting
side effects? and working pressure?
Apart from dry skin, no side effects are to Resting pressure is the permanent
be expected. external pressure exerted on tissues and
vessels when the muscles are relaxed
Accessories
and resting. Working pressure, on the

other hand, is the pressure at which the
contracting muscles work against the
compression garment from the inside.
Solutions fitting
problems
F.A.Q.

The lymphatic

system
What does porous mean? What is the RAL Quality Mark? What material does
medi use to make the
The fabric is described as porous when The RAL (Reichsausschuss fr medi lymph pads?
the knit only has a compressive thread Lieferbedingungen [National Committee
Compression
Principles of
in alternate rows. This achieves a 50 % for Conditions of Supply], now known The medi lymph pads are
reduction in compression. Porous rows as: Ausschuss fr Lieferbedingungen made of 100 % styrene-
are used in overlapping areas when und Gtesicherung beim Deutschen butadiene copolymer
two stockings are fitted, or to create Normenausschuss e.V. [Committee and are latex-free.
a homogeneous transition, e.g. for CG for Conditions of Supply and Quality
Contraindications
sleeves. Assurance of the German Standards

Committee e.V.]) sets out fundamental
Indications /
guidelines for the manufacture of

A client would like a stocking without a medical compression stockings under No.
heel. Is this possible? RAL-GZ 387 / 1 and RAL-GZ 387 / 2.
The RAL Quality Mark is also the
This is not possible. The quality and test basis for the allocation of a Medical
regulations for medical compression Device Number and therefore for
stockings (RAL-GZ 387 / 1) state the reimbursement of the cost of the
following on the subject of heels: The garment by the statutory health
Treatment
procedure
stockings must have a closed flexible insurance scheme.

elastic heel manufactured by knitting
technology and appropriate to the
anatomical conditions. In lymphological What do the abbreviations LY1, LY2 and
indications there is also the risk that LY3 mean?
oedema will develop in the area not
covered by the stocking. The abbreviations LY1, LY2 and LY3 are
Lower limbs
terms from the German Index of Medical

Procedures and describe the treatment
Is the pressure the same in all areas of units reimbursable by the statutory
the compression stocking? health insurance schemes.
The RAL Quality Mark stipulates a

particular pressure gradient for medical What material does medi use for linings
Upper limbs
compression stockings. and pad pockets?
The very fine lining and pocket material

consists of 79 % polyamide and 21 %
Elastane.
Accessories
Pressure approx. 40 % 50 % 70 % 100 %

Solutions fitting
problems
G F E D C B B
Correct degressive pressure gradient

F.A.Q.

The lymphatic
Why do my stockings with topbands slip
system
down? What can I do about it?
Silicone coated non-slip topbands have

become ever more popular in the last few
years as an alternative way of keeping
Compression
Principles of
stockings up.
The best way to prevent garments
slipping is to ensure that the skin is as
hairless as possible, that there is little
or no skin moisture (perspiration), that
only our range of care products that are
Contraindications
compatible with compression therapy is
used for sin care, muscular legs, normal
Indications /
leg proportions, washing the garments
daily inside out (e.g. with our special
washing liquid medi clean). When
washing by hand, the topband should
also be cleaned with detergent suds to
remove all soap residues completely in
order to restore full adhesion. Our profile
Treatment
procedure
topband provides for the most secure fit.
Lower limbs
Any more questions?
medi Lymph Service is looking forward to
your call or an email!
Telephone: +49 921 912-0

E-Mail: export@medi.de
Upper limbs
Accessories
Solutions fitting
problems
F.A.Q.

The lymphatic
Care in the treatment of oedema - an important building block.

system
medi products for skin, feet and stockings.
Skin care
Intensive skin care is particularly important in the treatment of oedema.

Compression
Products that are exactly matched to compression treatment are most

Principles of
suitable for this. For instance, the very popular medi soft cream foam
provides extra moisture for lymph patients. The daytime care gel (medi
day) and the light night-time gel (medi night) have also proved very
successful. On hot summer days, the cooling spray medi fresh ensures a
pleasant refreshing kick for when youre out and about.
Contraindications
Recommend the skin care products from medi. A tip that patients will
thank you for. medi soft - the gentle cream
Indications /
foam with extra moisture
Foot care
The feet should receive extra care and attention during compression
treatment. No matter whether its the relaxing foot soak medi novee, the
gentle peeling medi smooth, or the rich intensive cream medi blando -
medi foot care keeps the feet fit and beautiful.
Treatment
procedure
Caring for the compression stockings
The right care is enormously important to keep the stockings functioning

as long as possible. Please recommend these medi products to your medi novee - the feel-good foot
customers to help them care for their compression stockings. soak
Lower limbs
These are specially matched to the needs of a compression garment and

also prolong the useful life of the material, e.g. the spot removal stick medi
spot ex, or the detergent medi clean (gentle hand wash liquid).
Upper limbs
medi Butler - for easy donning of hosiery

The donning and doffing aids from medi are suitable for all compression
garments, are robust, and are extremely easy to use. Make daily donning of medi spot ex - the clever spot
removal stick
stockings easier for your customers, for example, with one of the medi
Butlers.
Accessories
These prestretch the knit making it much easier to insert the feet. medi
Butlers are available in many different models, for instance, medis
long-handled Butler.
The practical donning and doffing aid medi 2in1 is also ideal for flat knit
patients. The smooth material lets the stocking glide over the leg quickly
Solutions fitting
and easily.
problems
If necessary, medis donning and doffing aids can be prescribed by a doctor

and are reimbursable (e.g. in obesity or limited mobility). medi long-handled Butler -
donning made easy
F.A.Q.
102 Further information medi Lymphology Care Guide

Further information Ordering pads for mediven compression garments
Leg accessories
Oblique borders
Anterior thigh longer
Info Fax order to medi Telefax +49 921 912-781
Estimate
A list of medi articles Order
Ellipse form at E
Art. No. For taking the most accurate measurements For more information Customer name _________________________________________________
Customer No. _______________________ Delivery address _____________
Y knitting marks = 90 heel
20.205 Flat measuring tape (non-stretch) regarding Lymphology: Commission ____________________________________________________ Stamp Long sole
Delivery date (client) __________________ Order date _________________ Signature _________________________________
Soft toe
20.212 Measuring tape, roll
export@medi.de Circumferences left
Circumferences left Circumferences rightCircumferences right Lengths Lengths
normal Tight tapenormal
measure Tight tape measure Tight tape measure Tight tape measure
normal normal left right left right
cT cT lK1T lK1T lK2T lK2T
20. 226 Finger measuring tape cH cH lH
cK lH
25.460 Tailors chalk cG
cK
cG cG
cG
lK1 lK1 lK2 lK2
cF cF lG
cF cF lG
mediven compression garments flat-knitted with seam

98L10 Measuring pad, arm cE cE
lF
lF
l Pit of knee
cE cE lE l Pit of knee
cD cD lE
99L09 Measuring pad, leg cD cD left right
cC cC lD Please specify left right
cC cC lDeliptical form under
lC Special request
Please specify
eliptical form under
cB1 cB1 lC Special request
98L11 Measuring pad, toe cB cB1

cB
cB cB1
cB
lB1
cY cY lB lB1
cA cY cA cY
98T61 Measuring pad, thorax cA cA
lB
Model Compression CCL 1 2 3 4 Colours/trend colours Quantity Foot

mediven sensoo Panty section
(CCL 2)
Left leg
Sand
Caramel
Navy
Brown
pair _______
pcs. ______
1
closed toe
open toe
l Z _______ cm (total)
l Ai _______ cm (inner)
mediven mondi
(CCL 1, 2, 3) Right leg Black Anthracite soft toe l A _______ cm (outer)
(only mediven 550)
mediven 550 medi Magenta Aqua
(CCL 1, 2, 3, 4)
Variants Standard border optional border Accessories Waist Gusset

below knee (AD)
2 slight oblique steep oblique
5
Extension to sole of foot perforated topband tricot
thigh-length (AG)
pantyhose (AT)
3
(proximal)
4
straight Y knitting mark
(90 heel)
waistband
knitted border
netting
compressive
elliptical form
mens leotard (ATH) orientation mark at D
(only mediven 550 (only for AG and AT)
maternity panty (ATU) and mediven mondi)
extra leg length
one-legged panty (ATE) (l K1 needed)
BT / CT / ET / FT ______cm porous
Other accessories design elements mediven 550 : Diamonds Stripes Pearls
_______ cm topband section along oblique (Standard 15 cm) 6 Special requests 8

_______ cm topband section above knee (Standard 8 cm)
_______ cm topband section at rear over seam (Standard 8 cm)

Silver Y to C Y to D Y to G
(only mediven mondi) left right
Lymphpad* Padding* Pocket*
left inside outside right inside outside
Attachment
7
profile topband (5 cm) Circumference:
silicone napped topband narrow 2.5 cm wide 5 cm left ________ cm
99L09 / 05.2014
silicone topband with motif (5 cm) right ______ cm
waist attachment left right l T_______cm

* Please specify/draw exact area.
Lower limbs, flat knit seamed, Art.No.: 99L09
Arm accessories
Estimate
Order Fax order to medi Telefax +49 921 912 781
Customer name __________________________________________________ Oblique borders

Angle at E
Commission ____________________________________________________ Stamp
Porous rows - half
compression
ARMSLEEVE HAND SECTION ARMSLEEVE HAND SECTION
Circumferences Lengths Circumferences Lengths Circumferences Lengths Circumferences Lengths
cZ cZ
lGH cZ lGH cZ
H cX H cX
cX cX
Sho Sho
uld uld
Size er st Skin Size Size er st Skin Size
mediven compression garments arm / hand flat-knitted

rap rap
Skin size stretched K size stretched cZ Skin size stretched
stretched K size stretched cZ
G1 cX G1 cX
cG cA cG cA
lG lAB lG lAB
cF cB cF cB
lF lF
cE cE
lE lE
cD lAC cD lAC
cC cC
lD lD
cC
1 cC
1
lC1 lAC1 lC1 lAC1

cC cC1 cC cC1
lAD lAD
cD cD
lAE lAE
cE cE
Model Compression CCL 1 2 3 Colour Quantity Options
mediven esprit Hand section Caramel Sand Black Left Right
mediven 550 arm Armsleeve Aqua Brown Navy pcs. Fingers open Fingers closed
medi Magenta Anthracite
Variants Standard border (proximal) Variable Border Other accessories 2

1
Handsection 5 x 5 cm topband piece in upper arm, oblique
AC1 straight (porous - 2 cm) flat oblique steep oblique cm porous in hand section (proximal standard 2 cm)
AD / AE flat oblique steep oblique straight porous in arm sleeve (distal standard 2 cm)
Armsleeve
CD / CE / CF / CG flat oblique steep oblique straight LymphpadPaddingPocket
AF / AG (1-part) flat oblique steep oblique straight (Please specify / draw position exactly!)
Attachment Design elements:Live Laugh LoveTimelessSportive

Silicone topband narrow2,5cmwide 5 cm Circumference
Silicone topband with motif (5 cm) Special requests
Profile topband (5 cm)
Sensitive topband (5 cm) cm
4
with shoulder strap K
strap width:2,5 cm5 cm.
with bra attachment
width of bra strap: cm.
3
shoulder cap standard
shoulder cap anatomical cm.
98L10 / 05.2014
Knitting marks elbow area
160 (Standard)150135
5
Further information medi Lymphology Care Guide 103 Upper limbs, flat knit seamed, Art.No.: 98L10 Further information medi Lymphology Care Guide 104
Further information Ordering pads for mediven compression garments
Leg accessories
Oblique borders
Anterior thigh longer
Info Fax order to medi Telefax +49 921 912-781
Estimate
A list of medi articles Order
Ellipse form at E
Art. No. For taking the most accurate measurements For more information Customer name _________________________________________________
Y knitting marks = 90 heel
20.205 Flat measuring tape (non-stretch) regarding Lymphology: Commission ____________________________________________________ Stamp Long sole
Soft toe
20.212 Measuring tape, roll
export@medi.de Circumferences left
Circumferences left Circumferences rightCircumferences right Lengths Lengths
normal Tight tapenormal
measure Tight tape measure Tight tape measure Tight tape measure
normal normal left right left right
cT cT lK1T lK1T lK2T lK2T
20. 226 Finger measuring tape cH cH lH
cK lH
25.460 Tailors chalk cG
cK
cG cG
cG
lK1 lK1 lK2 lK2
cF cF lG
cF cF lG
mediven compression garments flat-knitted with seam

98L10 Measuring pad, arm cE cE
lF
lF
l Pit of knee
cE cE lE l Pit of knee
cD cD lE
99L09 Measuring pad, leg cD cD left right
cC cC lD Please specify left right
cC cC lDeliptical form under
lC Special request
Please specify
eliptical form under
cB1 cB1 lC Special request
98L11 Measuring pad, toe cB cB1

cB
cB cB1
cB
lB1
cY cY lB lB1
cA cY cA cY
98T61 Measuring pad, thorax cA cA
lB
Model Compression CCL 1 2 3 4 Colours/trend colours Quantity Foot

mediven sensoo Panty section
(CCL 2)
Left leg
Sand
Caramel
Navy
Brown
pair _______
pcs. ______
1
closed toe
open toe
l Z _______ cm (total)
l Ai _______ cm (inner)
mediven mondi
(CCL 1, 2, 3) Right leg Black Anthracite soft toe l A _______ cm (outer)
(only mediven 550)
mediven 550 medi Magenta Aqua
(CCL 1, 2, 3, 4)
Variants Standard border optional border Accessories Waist Gusset

below knee (AD)
2 slight oblique steep oblique
5
Extension to sole of foot perforated topband tricot
thigh-length (AG)
pantyhose (AT)
3
(proximal)
4
straight Y knitting mark
(90 heel)
waistband
knitted border
netting
compressive
elliptical form
mens leotard (ATH) orientation mark at D
(only mediven 550 (only for AG and AT)
maternity panty (ATU) and mediven mondi)
extra leg length
one-legged panty (ATE) (l K1 needed)
BT / CT / ET / FT ______cm porous
Other accessories design elements mediven 550 : Diamonds Stripes Pearls
_______ cm topband section along oblique (Standard 15 cm) 6 Special requests 8

_______ cm topband section above knee (Standard 8 cm)
_______ cm topband section at rear over seam (Standard 8 cm)

Silver Y to C Y to D Y to G
(only mediven mondi) left right
Lymphpad* Padding* Pocket*
left inside outside right inside outside
Attachment
7
profile topband (5 cm) Circumference:
silicone napped topband narrow 2.5 cm wide 5 cm left ________ cm
99L09 / 05.2014
silicone topband with motif (5 cm) right ______ cm
waist attachment left right l T_______cm

* Please specify/draw exact area.
Lower limbs, flat knit seamed, Art.No.: 99L09
Arm accessories
Estimate
Order Fax order to medi Telefax +49 921 912 781
Customer name __________________________________________________ Oblique borders

Angle at E
Commission ____________________________________________________ Stamp
Porous rows - half
compression
ARMSLEEVE HAND SECTION ARMSLEEVE HAND SECTION
Circumferences Lengths Circumferences Lengths Circumferences Lengths Circumferences Lengths
cZ cZ
lGH cZ lGH cZ
H cX H cX
cX cX
Sho Sho
uld uld
Size er st Skin Size Size er st Skin Size
mediven compression garments arm / hand flat-knitted

rap rap
Skin size stretched K size stretched cZ Skin size stretched
stretched K size stretched cZ
G1 cX G1 cX
cG cA cG cA
lG lAB lG lAB
cF cB cF cB
lF lF
cE cE
lE lE
cD lAC cD lAC
cC cC
lD lD
cC
1 cC
1
lC1 lAC1 lC1 lAC1

cC cC1 cC cC1
lAD lAD
cD cD
lAE lAE
cE cE
Model Compression CCL 1 2 3 Colour Quantity Options
mediven esprit Hand section Caramel Sand Black Left Right
mediven 550 arm Armsleeve Aqua Brown Navy pcs. Fingers open Fingers closed
medi Magenta Anthracite
Variants Standard border (proximal) Variable Border Other accessories 2

1
Handsection 5 x 5 cm topband piece in upper arm, oblique
AC1 straight (porous - 2 cm) flat oblique steep oblique cm porous in hand section (proximal standard 2 cm)
AD / AE flat oblique steep oblique straight porous in arm sleeve (distal standard 2 cm)
Armsleeve
CD / CE / CF / CG flat oblique steep oblique straight LymphpadPaddingPocket
AF / AG (1-part) flat oblique steep oblique straight (Please specify / draw position exactly!)
Attachment Design elements:Live Laugh LoveTimelessSportive

Silicone topband narrow2,5cmwide 5 cm Circumference
Silicone topband with motif (5 cm) Special requests
Profile topband (5 cm)
Sensitive topband (5 cm) cm
4
with shoulder strap K
strap width:2,5 cm5 cm.
with bra attachment
width of bra strap: cm.
3
shoulder cap standard
shoulder cap anatomical cm.
98L10 / 05.2014
Knitting marks elbow area
160 (Standard)150135
5
Further information medi Lymphology Care Guide 103 Upper limbs, flat knit seamed, Art.No.: 98L10 Further information medi Lymphology Care Guide 104
The lymphatic
system
Compression
Principles of
4 58
The lymphatic system Upper limbs
Contraindications
6 Lymphoedema 59 Available variants
10 Lipoedema 60 Possible combinations of
Indications /
the variants
12 64 mediven models
Principles of compression 68 General notes on
69 Measuring techniques
illustrated
15
Treatment
procedure
76 Arm accessories
Indications /
Contraindications
16
Treatment procedure
Lower limbs
82
Accessories
Upper limbs
82 medi lymph pads
84 Topband variants
85 Gusset variants
18
Lower limbs 86
19 Available variants
Causes / Solutions
Accessories
20 Possible combinations of Fitting problems

the variants
24 mediven models 94
36 General notes on The optimum
Solutions fitting
complaints procedure Headquarters

37 Measuring techniques medi GmbH & Co. KG
illustrated Medicusstrae 1
problems
50 Leg accessories 96 95448 Bayreuth

Germany
98L05 / 05.2014
FAQ Treatment T +49 921 912-0
F +49 921 912-57
of oedema / flat knit lymphservice@medi.de
www.medi.de/en
F.A.Q.

Guide Lymphology

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Guide Lymphology

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medi. I feel better.

10 Lipoedema 60 Possible combinations of

20 Possible combinations of Fitting problems

complaints procedure Headquarters

50 Leg accessories 96 95448 Bayreuth

If you have suggestions or ideas for improving this guide,

medi Lymphology Care Guide 3

The remaining 10 %, interstitial fluid together with

protein, pathogens, cancer cells, dust and dyes, is

From here it enters the bloodstream, principally via

The section between two valves is known as a

respiration, which generates negative pressure in the

The lymph flows through numerous lymph nodes.

as B and T lymphocytes and macrophages, that

these. As the lymph flows very slowly, there is

4 The lymphatic system medi Lymphology Care Guide

Inguinal lymph nodes

infection. the thoracic duct behind the left nodes

by what are known as watersheds.

flows through the lymph trunk on the

medi Lymphology Care Guide The lymphatic system 5

What is Signs of lymphoedema Explanation

with a finger at the affected site

oedema, e.g. swelling of the eyelids,

Doctors with experience in lymphology

the surface of the body).

eventually results in an increase in

6 The lymphatic system medi Lymphology Care Guide

Stage 3 lymphostatic elephantiasis

medi Lymphology Care Guide The lymphatic system 7

CDT phase 1 Decongestion phase

5.  Healthy diet and, if necessary, weight reduction

CDT phase 2 Maintenance phase

8 The lymphatic system medi Lymphology Care Guide

Compression class CCL 1 is indicated*4 for the Explanation

Arterial circulatory disorders useful

In stroke patients For further information

medi Lymphology Care Guide The lymphatic system 9

Lipohypertrophy and lipoedema

and is not diet-related. lymphoedema may also develop. Lipohypertrophy is a

The swelling extends from the iliac crest

normal. lipoedema at any time. *1 P rogression means the

the buttocks or the lower leg may be

Stage 2: Mattress skin, coarse modular skin surface with considerable

10 The lymphatic system medi Lymphology Care Guide

Here the capillary structure of the

Phleboedema is a form of oedema caused

veins*7, deep vein thrombosis or Lip-Lymphoedema,

* 6 MLD = Manual lymphatic

medi Lymphology Care Guide The lymphatic system 11

There are few forms of treatment The physics of compression

treatment has no side effects. compression:

scientific studies and measurements. Eccentric compression is a local

individuals with diseases of the the padding) or smoothing out of

Why is the pressure in a glove greater

What is the difference between round bandage is proportional to the tension

non-elastic compression, which is C

Pressure units: develops over projections with a small Pressure: B > C

mmHg = millimetres of mercury ankles and shin (B).

12 Principles of compression medi Lymphology Care Guide

If the health insurance company has paid

medi Lymphology Care Guide Principles of compression 13

5. Healthy diet and, if necessary, weight reduction

normal. lipoedema at any time. *1 P rogression means the

* 6 MLD = Manual lymphatic

mmHg = millimetres of mercury ankles and shin (B).

or AG stocking In combination with an AD stocking as a two-part