Procedures
Conservative management of lymphedema with complex decongestive therapy (CDT) remains the first-line treatment for chronic lymphedema. Surgical intervention may be of benefit to a few, well-selected individuals who do not respond to conservative management. [29]
Therapy
For moderate/severe limb lymphedema, the standard of care for management is complex decongestive therapy (CDT), a two-stage treatment program applied by lymphedema specialists. Intensive CDT is used during the initial treatment phase and is composed of compression therapy, manual lymphatic drainage (MLD), exercise and skin/nail care.
Self-care
Manual Treatment Techniques. In Europe, the best available nonsurgical therapy is manual lymphatic drainage according to the Vodder and/or Leduc techniques. Compression garments are essential between treatments. Similarly, other authors advocate manual massage of the affected extremity; this recruits collateral vessels,...
Nutrition
The goal of lymphedema therapy is to restore function, reduce physical and psychologic suffering, and prevent the development of infection. Initiate therapy for lymphedema as early as possible before extensive, irreversible fibrosclerotic changes occur in the interstitium.
What is the first-line treatment for chronic lymphedema?
How is Complex decongestive therapy (CDT) used to treat lymphedema?
What is the best non-surgical treatment for lymphedema?
What is the goal of lymphedema therapy?
What is the most common treatment for lymphedema?
Treating lymphoedema These include wearing compression garments, taking good care of your skin, moving and exercising regularly, having a healthy diet and lifestyle, and using specialised massage techniques. Read more about treating lymphoedema and preventing lymphoedema.
Which modalities can be used for the treatment of lymphedema?
Consequently, the mainstay of lymphedema management today largely consists of conservative modalities including manual lymphatic drainage, exercise, pneumatic pumps, and compression bandage therapy.
What is the gold standard for lymphedema treatment?
Complex decongestive therapy (CDT) remains the gold standard in the therapy of lymphedema.
What is one of the four main strategies for providing lymphedema care?
There's no cure for lymphedema. Treatment focuses on reducing the swelling and preventing complications....Examples include:Exercises. ... Manual lymph drainage. ... Compression bandages. ... Compression garments. ... Sequential pneumatic compression.
What is compression therapy for lymphoedema?
Compression treatment reduces swelling caused by a build up of lymph fluid (lymphoedema). It puts pressure on the area of swelling. The pressure needs to be even but firm on the tissues in the area.
What is the Charles procedure?
The Charles procedure offers radical excision of lymphedematous tissue followed by skin grafting. This procedure is rarely offered because of the potential for complications, but it may provide excellent outcomes in improving quality of life.
What is the best compression for lymphedema?
Generally, more severe cases of lymphedema require a class 3 or 4 sleeves, whereas milder cases require class 1 or 2 sleeves. Some manufacturers also offer compression sleeves that exert as little as 15 mmHg to 20 mmHg for very mild cases of lymphedema.
What is decongestive therapy for lipedema?
Complete Decongestive Therapy (CDT)is a common conservative intervention involving stimulation of the lymphatic system, use of compression, skin care and exercise. The use of graded negative pressure in conjunction with CDT is another conservative therapy intervention used to help clear the lymphatic congestion.
How effective is CDT?
In a relevant study conducted by Yamamoto, CDT was applied in 82 women for a median duration of six and 10 days for upper or lower limb lymphedema. Results showed a 58.9% edema reduction for the upper limb and 73.4% for the lower limb [25]. Morgan et al.
What is complete decongestive therapy for lymphedema?
Complete decongestive therapy (CDT) is a noninvasive treatment for lymphedema. The therapy includes a variety of techniques, including manual lymphatic drainage, compression, exercise and skin care.
How is upper extremity lymphedema treated?
In recent times, physiologic operations for treatment of lymphedema have emerged as the gold standard for improving the drainage of fluid from the affected extremity. The lymphaticovenular anastomosis (LVA) and the vascularized lymph node transfer (VLNT) are the 2 most effective options currently available.
How do you treat lymphedema in the legs?
Avoid extremes of temperature that can dry your skin – including hot, cold or windy weather. Don't wear tight clothing or jewellery. Avoid sitting or standing for long periods of time if you have leg swelling. Don't have injections, blood taken, or your blood pressure checked on the affected arm.
What is lymphedema in the lymphatic system?
Lymphedema: Diagnosis and treatment. Lymphedema is an abnormal accumulation of protein-rich fluid due to mechanical insufficiency of the lymphatic system. The veins and lymph vessels are both charged with removing liquid and solid debris from tissue. The veins remove most of the fluid, from 90 to 95 percent, and some small protein molecules such as ...
What is stage 2 lymphedema?
Stage 2 (irreversible lymphedema): Fibrosis — the deposition of loose, disorganized collagen tissue — has occurred. Without intervention, no matter how long the patient elevates or compresses the affected body part, it will not return to baseline contour and volume.
What is CDT treatment?
CDT is still considered the international standard of care for lymphedema treatment and consists of two phases: reductive and maintenance. CDT strives to increase lymph drainage; to decrease swelling, discomfort, fibrosis and risk of cellulitis; and to improve functional status and quality of life. The reductive phase includes the use of a massage technique known as manual lymphatic draining (MLD), short stretch bandaging, exercises to create and augment an internal pumping mechanism, skin care and education in self-management. Skin care is necessary to prevent infection and includes controlling bacterial and fungal colonization, eliminating microbial overgrowth in skin crevices, and hydrating the skin to control dryness and fissuring.
What percentage of primary lymphedema is congenital?
Causes, natural history and stages. Primary lymphedema occurs in individuals who are born with impaired lymph vessel or node development. Only about 6.5 percent of primary lymphedema is congenital, and the condition generally presents later in life, principally among females.
What causes secondary lymphedema?
Other forms of injury to the lymphatic system, such as serial infections, can also cause secondary lymphedema. Identifying the accumulation of protein and cellular debris in the tissues as abnormal and potentially threatening, the body sends in neutrophils.
What is the function of the lymphatic system?
The lymphatic system moves some fluid, but its primary job is to remove solid macromolecular debris from the tissue — large molecules, including long-chain fatty acids and large proteins.
What is stage 3 of lymphostatic elephantiasis?
Stage 3 (lymphostatic elephantiasis): This stage is marked by the presence of dermal metaplasia. Some of the proteins present are pro-inflammatory and can lead to skin changes. Typically, these skin changes include dermal keratinization (thickening) and papilloma formation.
What is the goal of lymphedema treatment?
The goal is to maintain clean and well-moisturized skin to ward off infection.
What is primary lymphedema?
Primary lymphedema is lymphedema that happens on its own, not caused by another condition or injury. It can occur in children born with impaired or missing lymph nodes. Globally, a common cause of lymphedema is an infection by Wuchereria bancrofti roundworms. This is known as lymphatic filariasis.
What is lymphatic drainage?
Manual lymphatic drainage, which is targeted massage or manipulation of soft tissue, can aid in draining lymphatic fluid. Your CDT provider will likely massage you and also show you some techniques that you can perform on yourself to promote drainage.
What is the difference between primary and secondary lymphedema?
For example, up to 40 percent of those who undergo surgery for breast cancer will experience it, as this surgery usually involves a sentinel lymph node biopsy. This type of lymphedema is called secondary lymphedema. Primary lymphedema is lymphedema that happens on its own, not caused by another condition or injury.
How many people have lymphedema?
According to the World Health Organization. Trusted Source. , it’s responsible for causing lymphedema in over 15 million people worldwide. Lymphatic filariasis is one of the world’s leading causes of disability. Trusted Source. . No matter the origin, everyone with lymphedema experiences pain and discomfort.
How long do you have to wrap your body for lymphatic drainage?
Affected body parts usually need to stay wrapped up 24 hours a day — except during bathing.
How to improve drainage?
It’s important to stay as active as you can, as physical activity is one of the most effective ways to promote drainage. Your doctor will help you determine which types of exercises are right for you. Most will include stimulation of arm or leg muscles.
What is the first line of treatment for lymphedema?
The first-line treatment for lymphedema is complex physical therapy. [ 3] This treatment is aimed at improving lymphedema with manual lymphatic drainage, massage, and exercise. It advocates the use of compression stockings (at a minimum of 40 mm Hg), [ 68] multilayer bandaging, or pneumatic pumps. Leg elevation is essential.
What is the goal of lymphedema therapy?
The goal of lymphedema therapy is to restore function, reduce physical and psychologic suffering, and prevent the development of infection. Initiate therapy for lymphedema as early as possible before extensive, irreversible fibrosclerotic changes occur in the interstitium. Strict compliance with treatment techniques is essential, ...
What is lymphaticovenular anastomosis surgery?
Lymphaticovenular anastomosis surgery can be used to reduce lymphedema severity in selected patients. [ 81] . Combining a lymphaticovenular anastomosis operation with complex physical therapy during the same hospitalization may provide a good combination therapy for advanced lymphedema.
How to treat lymphedema at night?
Encourage patients to lose weight, avoid even minor trauma, and avoid constrictive clothing that might have a tourniquet effect. Encourage elevation of the affected extremity whenever possible, particularly at night . For lower extremity lymphedema, this may be accomplished by elevating the foot of the bed to an appropriate level.
How long before surgery can you do elevation?
Institute strict elevation and pneumatic compression, if available, 24-72 hours prior to surgery. This allows maximum excision to be performed. The extremity must also be free of infection at the time of surgery; a single dose of preoperative intravenous antibiotic is administered. Intraoperative details.
How to prevent sepsis?
At the earliest signs of infection, institute topical or systemic antifungal or antimicrobial therapy to prevent the development of sepsis. Sometimes long-term treatment with antifungal and antibacterial treatments can result in a remission of the recurrent cellulitis (75-85%).
What antibiotics are used for recurrent lymphangitis?
Long-term, prophylactic treatment with antimicrobial agents such as penicillin, cephalexin, or erythromycin may be required in 15-25% of patients experiencing recurrent lymphangitis or cellulitis. [ 72, 73] Filariasis. Filariasis has been treated with diethylcarbamazine and albendazole. [ 74] .
What is lymphedema management?
Lymphedema is best managed by a multidisciplinary team including certified lymphedema therapists, which creates a personalized treatment based on a comprehensive assessment . If ulcers are present, referral and collaboration with wound care specialists are recommended. If the patient has infection/cellulitis, consultation with primary care or infectious disease providers is warranted. See 'Algorithm for Management of Lymphedema' in this topic.
What is the surgical management of lymphedema?
For well-selected patients with chronic lymphedema, surgical management offers a chance for reduction of limb volume, decreased episodes of infection and improved quality of life. This topic provides updates on recent surgical advancements, along with specific indications and guidance on preoperative evaluation.
What is CDT therapy?
Complex decongestive therapy (CDT) is also known as Combined Physical Therapy (CPT) or Complex Decongestive Physiotherapy (CDP). It is the standard of care for management of lymphedema, although high certainty evidence endorsing this concept is lacking. [10] [11] CDT is regarded as a noninvasive and cost-effective therapy that reduces limb volumes in both upper and lower extremity lymphedema. [12]
What is CDT treatment?
[10] [11] CDT is regarded as a noninvasive and cost-effective therapy that reduces limb volumes in both upper and lower extremity lymphedema. [12] CDT is performed by lymphedema specialists.
How much increase in lymphedema?
Minimal: typically > 5 to < 20% increase in limb volume. Moderate: 20-40% increase. Severe: > 40% increase. Some clinics prefer to use > 5 to < 10% as minimal and > 10 to < 20% as mild. An adequate treatment plan for lymphedema aims to: Treat the cause and other factors impeding healing.
What is the importance of patient education in lymphedema?
Early recognition of transient swelling following cancer-related surgery can help implement a care/prevention plan that attempts to prevent progression to advanced stages [3].
How long after a compression can you increase diuretics?
Dose can be reassessed 24-48 hours after initiation of compression therapy. Long term use is discouraged due to potential to induce fluid and electrolyte imbalance.