Common Options for Custom Upper Extremity Garments
On a sleeve which is open at the wrist, zippers are generally placed to open at the wrist. This allows the patient to get the hand through the smallest part of the sleeve. A sleeve which would be attached to a glove or gauntlet would open at the top of the sleeve. Many patients do not require a zipper on a sleeve. A patient with good hand and finger strength on the opposite side usually does not need a zipper unless the extremity presents too much pain and difficulty. We strongly recommend against a zipper for a sleeve to be used in lymphedema management of the upper extremity. Most lymphedema patients will be more comfortable with an expansion panel.
It is best to avoid placing a zipper over the front (radial) or back (ulnar) of the elbow, although there may be occasions where this may be unavoidable. Specify a “dorsal zipper” for most patients. A dorsal sleeve zipper would run dorsally from the wrist, mid-way between the ulnus and the radius, to laterally between the antecubital fossa and the elbow and then to the lateral upper arm opposite the axilla.
For some patients, bunching of fabric in the antecubital fossa (the front of the elbow) can be uncomfortable. An “anterior (radial) elbow insert” made with our stretchy soft Insert Material will help prevent that. Inserts over the back of the elbow (ulnar) are sometimes requested for patients with skin breakdown. See below for the procedure for incorporating a ‘contracture dart’ into an elbow insert.
An expansion panel is made of the same soft and stretchy fabric we use to make the inserts described above. A panel of this fabric along the ulnar side of the arm (the back of the elbow) allows for minor fluctuations in patient measurements and growth in small children. The expansion panel is designed into the garment in such a way as to ensure that the required pressure is not compromised.
It is possible to line an entire garment with our Lining Material, but for many patients this would be uncomfortably bulky. When considering a lining on any garment always keep in mind that the lining means two layers of material and doubly thick seams. For many patients it may be more effective to make the whole garment out of a light fabric, such as our Soft Material.
Elbow linings are the most common lining option on an upper extremity garment. This would consist of a fully circumferential layer of lining fabric wide enough to include the whole elbow and the antecubital fossa.
Many patients experience difficulty in keeping their sleeve from slipping down the arm. In some cases the patient may have had a decrease in measurements, but in many cases the patient’s form will prevent a sleeve from staying up unaided. Look at your sleeve measurements, if the top one or two measurements are bigger than the next measurements, the sleeve may slide down. We suggest lining the top elastic band of a sleeve with Silon-TEX. Silon-TEX is resistive to the skin and acts as a very good mechanism to prevent the sleeve from falling. Indicate, “Silon top band” on the measurement chart on the “Lining” option. In some cases the standard 1 inch wide band may not provide sufficient support to hold up a sleeve, even with Silon-TEX lining. You may wish to request a 1 1/2 or 2 inch wide band instead. If this is not feasible due to involvement in the upperarm, scapular, or clavicular region, then a shoulder flap is required.
The distal opening of a sleeve normally does not end with an elastic band. A few patients find this uncomfortable. You may request a distal band on your sleeve order. Write “add distal band” in the “Additional Instructions.”
The fabrics described below are Nylon® Lycra® or Dorlastan® spandex and contain no latex. All pressure ranges are available in all fabric types, however, each fabric has its own stretch properties. A soft fabric with high stretch will “give” more as the patient moves, and may, therefore, be less suitable for large circumferences or very active patients. A heavier stretch-resistant fabric will tend to maintain a more consistent pressure, but may be irritating to sensitive skin. Be sure to indicate the diagnosis on the Order Form.
Default material for adults and children 11 years or older (except head and neck and hand garments, see below). This is a heavy open weave, with a maximum stretch resistance. Regular Material is available in all 30 Bio-Concepts garment colors.
Close Knit Material
Default material for children 10 and under and for elderly patients 75 and older. Also the default fabric for face masks, chin straps, and hand garments. This fabric is very similar to the Regular Matierial, however, the threads are much finer and the weave is slightly more open. Close Knit Material is available in all 30 Bio-Concepts colors.
Our new LuxFab™ is a wonderful fabric for the vascular patient. It has great three-way stretch and durability. Many patients will benefit from a LuxFab garment in their lymphedema management program.
Patients with extremely sensitive areas of skin may not be ready for Regular Material or even Close Knit fabric. The skin side of our Soft Material is very smooth and the fabric is very light as well. We often construct whole garments of Soft Material for small children and the very elderly. Soft Material is available in all 30 Bio-Concepts colors.
We normally use Lining Material to line the inside of the garment over particularly sensitive areas, such as elbows, axillae, and knees. We can line entire garments as well. The lining material is very soft. Lining Material is available in all 30 Bio-Concepts colors.
Insert Material stretches well in every direction and conforms extremely well to irregular surfaces. Elbows, knees, chins, tops of heads, heels, abdomens, and other sites are good places for inserts. Because Insert Material conforms so well, we also use it to cover stumps and to end a mitten. Insert Material is available in all 30 Bio-Concepts colors.
A revolutionary new material that we incorporate directly into the garment. Silon-TEX is a medical-grade silicone elastomer sheet bonded to a Lycra Spandex fabric. Silon-TEX may be sewn into the garment in virtually any configuration needed to treat troublesome hypertrophic and keloid scars. Typically, Silon-TEX is used as a lining, sewn into the inside of the material of the rest of the garment. Silon-TEX is available only in white.