From the Guidelines
Lymphedema evaluation and treatment should begin with a thorough physical examination and medical history, followed by 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)
- Compression therapy using bandages or garments (20-60 mmHg pressure)
- Meticulous skin care to prevent infections
- Targeted exercises to improve lymph flow
Importance of Early Intervention
Early intervention is crucial in lymphedema treatment, as it can lead to better outcomes and prevent irreversible tissue changes, recurrent infections, and decreased quality of life if left untreated 1.
Additional Considerations
- Weight management is crucial, as obesity worsens lymphedema
- Medications, such as diuretics, may occasionally help with short-term fluid reduction, but are not primary treatments
- Surgical options, like lymphovenous anastomosis or vascularized lymph node transfer, are reserved for cases unresponsive to conservative management
Patient Education and Self-Care
Patients should be taught self-massage techniques and proper skin hygiene, including daily washing with mild soap, thorough drying, and application of low-pH moisturizers, to maintain skin health and prevent infections 1.
Referral to Specialists
Referral to a lymphedema specialist is recommended for multimodality treatments, including manual lymphatic drainage, exercise, and compression therapy, as outlined in recent guidelines 1.
From the Research
Lymphedema Evaluation and Treatment
- Lymphedema treatment encompasses risk reduction, early detection, Phase-I Complete Decongestive Therapy in a clinical setting, and Phase-II Self Management at home 2
- Phase-I therapy includes manual lymphatic drainage (MLD), short-stretch compression bandaging, decongestive exercise, skin care, and sometimes intermittent pneumatic compression (IPC) 2
- Home management includes many of the same elements as Phase-I, with adaptations for home treatment, and significant to the success of Phase-I and Phase-II care is effective bandaging and lymphatic drainage treatment via manual (MLD) or automated (IPC) processes 2
Components of Lymphedema Treatment
- Complete decongestive therapy (CDT) is effective in reducing lymphedema, although the contribution of each individual CDT component has not been determined 3
- Manual lymph drainage (MLD) has been shown to be strongly decongestive during a 3-week decongestion therapy for breast cancer-related lymphedema, with a high effect size 4
- Compression bandaging (CB) and physical exercises can be as effective as CDT augmented by MLD in reducing edema volume in more advanced postmastectomy arm lymphedema 5
Guidelines for Lymphedema Management
- International guidelines recommend an integrated medical, psychological assessment, and physical examination, with a limb volume measurement of >10% in the affected limb to confirm a lymphedema diagnosis 6
- Recommended management involves Complex Decongestive Therapy (CDT) followed by self-management using skincare, self-lymphatic drainage massage, exercise, and compression 6
- High-quality guidelines are available to guide lymphedema care, but their suitability for low-resource settings is unclear 6