Lymphedema is a debilitating progressive condition with long-term physical and psycho-social consequences for the patient. The underlying problem is a dysfunction of the lymphatic system, which results in an abnormal accumulation of water and protein molecules in the body's soft tissues. Primary lymphedema is caused by a hereditary abnormality of the lymphatic system, resulting in an impairment of the lymphatic system's functionality. Secondary lymphedema can be caused by surgery, radiation or inflammation involving the lymphatic system. Lymphedema presents as a swelling that may involve the extremities, head and neck, abdomen, external genitalia or trunk.
Treatment Options for Lymphedema
There is no known cure to reverse the damage to the lymphatic system. The goal of any therapy is to reduce the swelling associated with lymphedema and to maintain the reduction so patients can continue with activities of daily living. Treatment should be initiated as early as possible in order to prevent secondary complications, such as infections and hardening of soft tissues, which are common in long-standing lymphedema.
Complete Decongestive Therapy
Complete decongestive therapy (CDT), sometimes referred to as combined physical therapy, is a non-invasive and highly effective conservative treatment technique. CDT consists of a combination of manual lymph drainage, compression therapy, skin care and decongestive exercises. Manual lymph drainage (MLD), a gentle manual technique, is designed to stimulate lymph vessels and to reroute stagnated lymph fluid around blocked areas. Specialized bandages are applied to the affected area following the MLD treatments and provide an external counterforce, which prevents the return of evacuated lymph fluid back into the tissues. The application of customized exercises contributes to the effectiveness of this therapy, which is performed by therapists.
Compression Garments
Compression garments are available as compression sleeves, gauntlets, stockings and compression brassieres or vests. They are made of materials which apply a controlled pressure on the affected body part. The elastic fibers in the soft tissues are damaged in lymphedema. Therefore, external support of the affected body part is an essential component in the treatment of lymphedema in order to prevent reaccumulation of lymph fluid. Because compression garments are not designed to reduce swelling, they should not be worn on an untreated, swollen extremity. Patients with lymphedema are measured for a compression garment by the therapist following successful decongestion of the affected body part and should be worn during the day.
Skin Care
Areas affected by lymphedema are saturated with protein-rich fluid, which serves as a breeding ground for bacteria. This increases the susceptibility to infections of the skin and nails, making skin care an essential component in the treatment of lymphedema. Under normal conditions, skin is impermeable to bacteria and other pathogens. Skin affected by lymphedema tends to be dry and scaly, increasing the risk of cracks and fissures, which could be an entry site for pathogens or infectious agents. Proper cleansing and moisturizing techniques, using anti-bacterial soaps and lotions or ointments formulated for sensitive skin, maintain the health and integrity of the skin.
Pneumatic Compression
These devices consist of multi-chambered sleeves that wrap around the affected body parts. The sleeves are connected to an air compression pump, which moves compressed air into the sleeve. The air chambers of the sleeve are filled sequentially, starting with the lowest, most distal chamber and gradually moving to the nearest, most proximal chamber. This creates a wave-like movement on the affected body part, which helps to evacuate the water from the area affected by lymphedema. Pneumatic compression devices are ineffective in the removal of the protein content in lymphedema and may only be used in conjunction with complete decongestive therapy.
Surgical Approaches
Surgery is rarely used in the treatment of lymphedema. Surgical approaches for this condition are not curative and generally limited to reduce the weight of the affected body part and to improve the cosmetic appearance following successful conservative lymphedema therapy. According to the National Lymphedema Network, the potential benefits of surgery need to be weighed against the significant risks associated with these procedures, the individual medical needs of the patient, and the expertise of the surgical team.
Pharmaceutical Options
The use of drugs in the treatment of lymphedema is limited to antibiotics, which are used to prevent and treat infections associated with lymphedema. The use of diuretics is ineffective and may lead to the worsening of symptoms associated with this condition.
