From the Guidelines
Lymphedema treatment should focus on reducing swelling and preventing complications through a comprehensive approach called Complete Decongestive Therapy (CDT), as recommended by the most recent and highest quality study 1.
Key Components of CDT
- Manual lymphatic drainage (a specialized massage technique that helps move fluid from congested areas to functioning lymph vessels)
- Compression therapy using bandages or garments (20-60 mmHg pressure) worn daily
- Meticulous skin care to prevent infections
- Targeted exercises to improve lymph flow ### Additional Considerations
- For acute flare-ups, antibiotics like cephalexin 500mg four times daily for 10-14 days may be needed to treat cellulitis 2
- Patients should maintain ideal body weight, avoid limb constriction, protect affected limbs from injury, and elevate the affected area when possible
- Advanced cases might require surgical interventions such as lymphovenous anastomosis or vascularized lymph node transfer
- Pneumatic compression devices (30-60 mmHg for 30-60 minutes daily) can supplement treatment
- Diuretics are generally not recommended as they don't address the underlying problem and may cause electrolyte imbalances ### Importance of Early Intervention Early intervention is crucial as lymphedema is a chronic, progressive condition that requires ongoing management to prevent worsening of symptoms and complications like recurrent infections and decreased mobility 3 ### Referral to a Specialist Patients with clinical symptoms or swelling suggestive of lymphedema should be referred to a therapist knowledgeable about the diagnosis and treatment of lymphedema, such as a physical therapist, occupational therapist, or lymphedema specialist 4, 5
From the Research
Treatment Options for Lymphedema
- Compression garment use and intensive bandaging are the mainstay of therapy in diagnosed cases of lymphedema, as well as lymphatic massage 6
- Complex Decongestive Lymphatic Therapy (CDT) has been the method of choice in conservative management of lymphedema, which includes manual lymphatic drainage (MLD), compression bandaging, and physical exercises 7
- CDT without the use of Vodder MLD and compression bandaging (CB) may be an essential part of lymphedema management, with similar results in reduction of edema volume and improvement in health-related quality of life 7
Surgical Options
- Several surgical options are available for patients who are unresponsive to conservative therapy, including excisional approaches, microsurgical lymphatic anastomoses, and circumferential suction-assisted lipectomy 6
- Suction-assisted lipectomy has shown promise for long-term relief of symptoms in selected patients 6
Collaborative Lymphoedema Management
- Conservative treatment of lymphoedema in palliative care involves complete/complex decongestive therapy (CDT) using manual lymphatic drainage (MLD), compression therapy, skincare, and remedial exercises 8
- A collaborative clinical protocol can improve access to lymphoedema management for patients in hospice care, with a partnership approach between local district nursing services and specialist lymphoedema physiotherapist 8
Standard of Care for Lymphedema
- 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 9
- Phase-I therapy includes manual lymphatic drainage (MLD), short-stretch compression bandaging, decongestive exercise, skin care, and sometimes intermittent pneumatic compression (IPC) 9
- Home management includes many of the same elements, with adaptations for home treatment, and significant to the success of Phase-I and Phase-II care is effective bandaging and lymphatic drainage treatment 9
Guidelines for Diagnosis, Assessment, and 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 10
- Recommended management involves Complex Decongestive Therapy (CDT) followed by self-management using skincare, self-lymphatic drainage massage, exercise, and compression 10