From the Guidelines
The most effective treatment for lymphedema is Complete Decongestive Therapy (CDT), which combines manual lymphatic drainage, compression therapy, exercise, and meticulous skin care to prevent infections, as recommended by the most recent and highest quality study 1.
Treatment Options
The treatment of lymphedema involves both conservative and surgical approaches. Conservative management includes:
- Manual lymphatic drainage (gentle massage to stimulate lymph flow)
- Compression therapy (using bandages, garments, or pneumatic compression devices) with pressures typically ranging from 20-60 mmHg
- Exercise to improve lymph flow and reduce swelling
- Meticulous skin care to prevent infections
Surgical Options
Surgical options are considered when conservative measures fail and include:
- Lymphovenous anastomosis (connecting lymphatic vessels to veins)
- Vascularized lymph node transfer
- Debulking procedures for advanced cases
Additional Considerations
Weight management is crucial as obesity worsens lymphedema, and patients should be educated on the importance of maintaining a healthy weight and increasing physical activity 1. Early intervention produces better outcomes as lymphedema is progressive and causes irreversible tissue changes over time. While not curable, proper management can significantly reduce swelling, prevent complications, and improve quality of life.
Key Recommendations
- Refer patients with lymphedema to specialists, such as lymphedema therapists, for proper management 1
- Use compression garments with pressures ranging from 20-60 mmHg to reduce swelling
- Educate patients on the importance of weight management, physical activity, and infection risk minimization to reduce the risk of lymphedema progression 1
From the Research
Treatment Options for Lymphedema
The treatment options for lymphedema include:
- Complex decongestive lymphatic therapy (CDT) which has been the method of choice in conservative management of lymphedema 2
- Manual lymph drainage (MLD) usually requires skilled therapists 2
- Compression bandaging (CB) and physical exercises 2
- Pneumatic pump drainage, low-stretch bandaging, exercises, and skin care 3
- Self-lymph drainage, low-stretch bandaging, or compressive garments, and sometimes pneumatic pump drainage, exercises, and skin care 3
- Phase-I Complete Decongestive Therapy in a clinical setting, and Phase-II Self Management at home 4
- Manual lymphatic drainage (MLD), short-stretch compression bandaging, decongestive exercise, skin care, and sometimes intermittent pneumatic compression (IPC) 4
- Physiotherapeutic rehabilitation of lymphedema, including 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
- Intermittent pneumatic compression (IPC) and/or manual lymphatic drainage (MLD) associated to compression stockings in the maintenance treatment of lymphedema 6
Phases of Treatment
The treatment of lymphedema can be divided into two phases:
- Edema reduction phase: an initial intensive treatment phase aiming for limb volume reduction 3
- Maintenance phase: a long-term phase to sustain a manageable limb volume 3
Effectiveness of Treatment Options
The effectiveness of different treatment options for lymphedema has been studied, with results showing:
- CDT can achieve a 45-70% reduction in lymphedema volume 5
- IPC and MLD can be effective in maintaining lymphedema treatment, with IPC showing a significant improvement in quality of life 6
- CB and physical exercises can be an essential part of lymphedema management, with results similar to CDT without the use of Vodder MLD 2