From the Guidelines
Lymphedema should be managed with a comprehensive approach including manual lymphatic drainage, compression therapy, exercise, and meticulous skin care, as recommended by recent guidelines 1. This approach is crucial in reducing swelling and preventing complications associated with lymphedema. The condition is characterized by swelling in the arms or legs due to a blockage in the lymphatic system, and it is essential to address it promptly to prevent progression and complications like cellulitis.
Key Components of Lymphedema Management
- Manual lymphatic drainage (gentle massage to move fluid)
- Compression therapy (using bandages or garments)
- Exercise (regular low-impact exercise like swimming or walking)
- Meticulous skin care to prevent infections
Daily Management
Patients should wear properly fitted compression garments (typically 20-30 mmHg or 30-40 mmHg pressure) and perform self-massage techniques. Regular low-impact exercise and careful skin hygiene are also essential in preventing infections. Pneumatic compression devices may be used at home for 30-60 minutes daily, as recommended by some guidelines 1.
Importance of Weight Management
Weight management is crucial as obesity worsens lymphedema. While diuretics are generally not recommended for long-term use, some cases may benefit from medications like benzopyrones to reduce protein buildup in tissues. Surgery is reserved for severe cases unresponsive to conservative measures, as stated in recent reviews 1.
Referral to a Lymphedema Specialist
Referral to a lymphedema specialist is recommended for multimodality treatments, including manual lymphatic drainage, exercise, and compression therapy, especially for breast and head and neck cancer patients 1. This comprehensive approach can help effectively manage lymphedema and prevent progression and complications.
From the Research
Lymphedema Treatment
- Complete decongestive therapy (CDT) is effective in reducing lymphedema, although the contribution of each individual CDT component has not been determined 2
- CDT includes manual lymphatic drainage, compression therapy, skincare, and remedial exercises, adapted to the needs of the patient 3
- The standard of care for lymphedema encompasses risk reduction, early detection, Phase-I Complete Decongestive Therapy in a clinical setting, and Phase-II Self Management at home 4
Physiotherapeutic Rehabilitation
- Approaches for conservative management of lymphedema include manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, skin care, pneumatic compression, elevation of the extremities, thermal therapy, complete decongestive physiotherapy (CDT), taping, and aqua lymphatic therapy 5
- Treatment of lymphedema with CDT can achieve a 45-70% reduction in lymphedema volume 5
- Prerequisites for successful physiotherapy are the availability of physicians, nurses and therapists who are specifically trained, educated, and experienced in each method 5
Predictive Factors for Limb Volume Reduction
- Factors associated with limb volume reduction using decongestive lymphatic therapy (DLT) include large initial leg volume, DLT treatment duration of 4 weeks, and peripheral arterial disease 6
- Severe lymphedema with a large limb volume responded well to DLT 6
- There is an urgent need for randomized-controlled trials to standardize DLT and interpret its effectiveness 6