Lymphedema Treatment

Treatment for lymphedema varies depending on the severity of the oedema and the degree of fibrosis of the affected limb. Most people with lymphedema follow a daily regimen of treatment as suggested by their physician or certified lymphedema therapist. The most common treatments for lymphedema are a combination of direct lymphatic massage, compression garments or bandaging and the use of intermittent sequential gradient pumps. Complex decongestive physiotherapy is an empiric system of lymphatic massage, skin care, and compressive garments. Although a combination treatment program may be ideal, any of the treatments can be done individually.

Compression

Garments

Elastic compression garments are worn by a person with lymphedema on the affected limb following complete decongestive therapy to maintain edema reduction. Depending on the therapist's discretion, a compression garment may be custom-fit or purchased in over-the-counter, standard sizes. Compression garments are meant to be worn every day to maintain edema reduction and must be replaced on a regular basis.

Bandaging or Wrapping

Compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the higher tension necessary to safely reduce lymphedema and may in fact end up producing a tourniquet effect. During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas.

A new adjunct treatment is being taught to therapists using a special type of tape called Elastic therapeutic tape. It is used to help soften edemas.

Sequential Gradient Pump Therapy

Sequential Gradient Pump Therapy has been utilized for over 30 years throughout the world. Compression pump technology utilizes a multi-chambered pneumatic sleeve with overlapping cells, to gently move the lymph fluid. These compression devices are recognized treatments and approved by Medicare and most insurance plans in the USA. Patients may often receive treatment on a pump for 10-15 minutes before an MLD (Manual Lymphatic Drainage) session to help break up fibrotic (hard) tissue. By softening or breaking up the fibrosis, the MLD Therapist may be more effective with the given treatment. Many patients may benefit from a pump without ever going to MLD sessions, as they are very beneficial, but not a requirement. However, after completion of the appropriate number of MLD sessions, many patients will benefit from a home use of a sequential pump.

A recent Stanford University medical studyshowed that patients receiving the ''combined modalities'' of MLD/CDT and pneumatic pumping had a greater overall reduction in limb volume than patients receiving only MLD/CDT.

However, an Indian study has shown that for Filarial patients, simple compression is better than Heat therapy. The authors felt that sequential therapy is not required.

Complete Decongestive Therapy or Manual Lymph Drainage

Complete decongestive therapy (CDT) is a primary tool in lymphedema management consisting of manual manipulation of the lymphatic ducts, short stretch compression bandaging, therapeutic exercise, and skin care. The technique was pioneered by Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders. Initially, CDT involves frequent visits to a certified therapist with a doctor's prescription. Once the lymphedema is reduced, increased patient participation is required for ongoing care, along with the use of elastic compression garments and non-elastic directional flow foam garments.

Manual manipulation of the lymphatic ducts consists of gentle, rhythmic massaging of the skin to stimulate the flow of lymph and its return to the blood circulation system. In the blood’s passage through the kidneys, the excess fluid is filtered out and eliminated from the body through urination. The treatment is very gentle and a typical session will involve drainage of the neck, trunk, and involved extremity (in that order), lasting approximately 40 to 60 minutes. CDT is generally effective on non-fibrotic lymphedema and less effective on more fibrotic legs, although it has been shown to help break up fibrotic tissue.

Surgical techniques

Surgical techniques for correcting lymphedema may be excisional or physiological. Excisional techniques include:

Circumferential excision of the lymphedematous tissue followed by skin grafting (Charles technique); longitudinal removal of the affected segment of skin and subcutaneous tissue and primary closure (Homans technique); excision of subcutaneous tissue and tunneling of a dermal flap through the fascia into a muscular compartment of the leg (Thompson technique).

Lympholymphatic anastomosis (autologous lymphatic grafts to bridge obstructed lymphatic segments); lymphovenous shunt (anastomosis of lymphatic channels to veins); lymphangioplasty enteromesenteric flap omental transfer (pedicled portion of omentum transposed to the affected limb).

Modified Liposuction has been developed in Sweden in recent years to remove adipose tissue associated with longstanding lymphedema, primarily in the upper region. This technique is meant to reduce the volume of a limb and does not cure lymphedema. Compression garments and compression bandages must still be worn after the operation.

Early prevention and disease regression in breast cancer

In 2008 an NIH study revealed that early diagnosis of lymphedema in breast cancer patients (called stage 0 in the article) associated with an early intervention, a compression sleeve and gauntlet for 1 month, led to a return to pre operative baseline status. In a 5 year follow up patients remained at their pre operative baseline, suggesting that pre clinical detection of lymphedema can halt if not reverse it progression.