Lymphedema
What is Lymphedema?
Lymphedema is an abnormal swelling of a body part due to an accumulation of lymph fluid. Lymph is a colorless fluid which collects and removes waste products from the tissue spaces. This fluid is absorbed into the lymph vessels and transported to lymph nodes for filtering before returning to the bloodstream. Lymph nodes exist in clusters throughout the body; tonsils are a familiar lymph node. Unlike the circulatory system for the blood, the lymphatics have no pumping system. Lymph fluid is moved through the body by muscular activity, by movement of the diaphragm during breathing, and by gravity.
What causes lymphedema?
Lymphedema generally involves an impairment of the lymphatic system resulting in poor circulation of lymph.
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Primary lymphedema, by definition, arises from unknown causes, and is some instances in congenital.
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Secondary lymphedema arises as the result of damage to components of the lymphatic system, for example through radiation, surgery, trauma, or infection. Common causes are Breast Cancer with mastectomy or lumpectomy and venous insufficiencies.
Symptoms
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The primary symptom of lymphedema is swelling caused by the accumulation of fluid and protien in tissue.
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As lymphedema progresses the skin becomes fibrotic and darkened. This is due to the accumulation of proteins and other elements that would normally be removed by the lymphatic system.
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With lymphedema, there is an increased risk of infection. This is because the condition of reduced fluid flow that occors in lymphedema creates an environment favorable to bacteria growth.
TREATMENT COURSE AND DURATION OF TREATMENT
The treatment for lymphedema is completed in 2 phases:
Phase 1 (Treatment Phase)
This is the intensive phase of treatment, patients will receive the treatment 3 to 5 times for a duration of 2 to 5 weeks. Upper extremity treatment is usually less than lower extremity treatment. This treatment consists of:
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Manual lymph drainage
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Compression bandaging of the extremity
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Remedial exercises
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Skin care education and instruction
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Self care - including self bandaging and skin care
This phase is completed once the limb or afffected area has reached close to or at the unaffected limb size or no further reduction is achieved. Once this phase is completed the patient will enter Phase 2 which must bemaintained throught the lifetime of the patient.
Phase 2 of MLD-CDP
In this phase the patient will be fit with a compression garment and instructed on care of the affected area. Patient education is done. The patient may continue for a short time a high frequency of therapy and then decrease to to follow up visits as needed.
