Lymphedema is a progressive disease that is caused by an injury or malformation to the lymphatic system. It results in an accumulation of protein-rich fluid in the interstitial space. It typically appears unilaterally, but when it appears bilaterally it is always asymmetrical.

 

The gold standard for treatment of Lymphedema is Complete Decongestive Therapy (CDT). CDT has 4 components, and all components are essential for Lymphedema patients. Those 4 components are as follows: skin care, manual lymphatic drainage, compression, and decongestive exercises.

 

Skin Care: use a mild soap regularly and low pH moisturizers, because with lymphedema the diffusion distance increases, which places these patients at a high risk for bacterial and fungal infections due to a decrease in local immunity/ protection that is normally provided by the skin. (These patients are highly susceptible to recurring cellulitis and fungal infections of the skin and nails.)

 

Manual Lymph Drainage (requires the skills of a Certified Lymphedema Therapist-CLT):

Via 5 different types of superficial, manual strokes the following effects may occur:

• Improves the activity of lymph vessels
• Allows CLTs to re-route the lymph flow around blocked areas into more centrally located healthy areas
  • Creates a suction effect on distal lymph collectors
• Increases local sympathetic response
• Increase general parasympathetic effects
• Increases lymph production
• Stimulates lymphangiomotoricity (the speed at which lymph vessels/ valves contract resulting in speed of lymphatic fluid flow)
• Fibronolytic effect
• Increase in venous return
• Analgesic effect via the pain gate pathway phenomenon
  • Promotes pain control

 

Compression: always use short stretch bandages initially; never use long stretch bandages (i.e. ace bandages) because they have a low working pressure and high resting pressure

• LaPlace’s Law: pressure must be more at the most distal point of the extremity and less at the most proximal point of the extremity, in order to create a gradient the promotes return of lymphatic fluid to the trunk and regional lymph nodes
• Patients will eventually be appropriate for compression garments that do not require the skills of a professional, and can be maintained without further treatment along with the other components of CDT.

 

Decongestive Exercises: this is not strenuous cardio or weight lifting; this is simply light aerobic exercises and movement against the compression bandages.

 

Lymphedema is not edema. Edema is a water accumulation in tissues secondary to renal, kidney, heart failures, pregnancy, or venous insufficiencies. Edema may eventually become lymphedema due to damage to the lymphatic system if not treated correctly, effectively, or in a timely manner.

 

Joachim Zuther, Marina Maduro, Kirat Shah. “Course Manual”. Academy of Lymphatic Studies. Richmond, Virginia. 22 March 2015. Lecture.