From the Guidelines
Lymphedema treatment should focus on reducing swelling and preventing complications through a comprehensive approach called Complete Decongestive Therapy (CDT), which includes manual lymphatic drainage, compression therapy, meticulous skin care, and targeted exercises to improve lymph flow, as recommended by the most recent and highest quality study 1.
Key Components of Lymphedema Treatment
- Manual lymphatic drainage: a specialized massage technique that helps move fluid from congested areas to functioning lymph vessels
- Compression therapy: using bandages or garments with 20-60 mmHg pressure depending on severity
- Meticulous skin care: to prevent infections
- Targeted exercises: to improve lymph flow
Additional Considerations
- For mild cases, compression garments worn daily (typically 20-30 mmHg) may be sufficient
- Pneumatic compression devices can provide additional benefit when used for 30-60 minutes daily
- Medications are not primary treatments, but diuretics like furosemide may occasionally be used short-term under medical supervision
- Antibiotics (commonly cephalexin 500mg four times daily or amoxicillin-clavulanate 875/125mg twice daily for 7-14 days) are necessary if infection develops
- Weight management is crucial as excess weight worsens lymphedema
- Surgery is reserved for severe cases unresponsive to conservative measures
- Early intervention produces better outcomes as lymphedema is progressive and easier to manage in earlier stages when the tissue hasn't become fibrotic, as supported by 1
Importance of Early Detection and Referral
- Regular examination is required to detect early lymphedema, which may be reversible or manageable with early physiotherapy
- Patients should be referred to specialists (i.e. lymphedema therapists) if lymphedema needs treatment
- Education of patients to reduce obesity, increase physical activity, and minimize infection risk is recommended, as emphasized by 1
From the Research
Treatment Options for Lymphedema
- The treatment of lymphedema aims to reduce the volume and prevent infectious and joints mobility complications, and is usually symptomatic, requiring continued treatment throughout life 2.
- The four pillars of complex decongestive therapy for limb lymphedema are skin care, manual lymph drainage, compression therapy with bandages, and exercises, with compression being the most important treatment 2.
- The management of lymphedema includes three phases: attack or initial treatment, maintenance phase, and withdrawal phase, using techniques such as complex decongestive therapy, multilayer inelastic bandaging, manual lymphatic drainage, and elastic compression 2.
Effectiveness of Treatment
- The effectiveness of treatment must be evaluated by objective methods, measuring the perimeters of members or volumes 2.
- Complex decongestive therapy is very effective in restoring a better quality of life, although it does not provide a cure for lymphedema 2.
- Studies have shown that compression bandaging and physical exercises can be as effective as complex decongestive therapy with manual lymph drainage in reducing edema volume in postmastectomy arm lymphedema 3.
- Intermittent pneumatic compression and self-lymphatic drainage can be an effective alternative to manual lymphatic drainage and compression bandage combination therapy 4.
Components of Treatment
- Manual lymphatic drainage (MLD) is a key component of complex decongestive therapy, although its contribution to the overall effectiveness of the treatment has not been fully determined 5, 6.
- Compression bandaging is an essential part of lymphedema management, and can be used in combination with other treatments such as MLD and exercises 2, 3.
- Intermittent pneumatic compression (IPC) can be used as an alternative to MLD, and can be effective in reducing edema volume and improving quality of life 5, 4.
- Skin care and exercises are also important components of lymphedema treatment, and can help to reduce the risk of complications and improve overall health and well-being 2, 5.