From the Guidelines
Managing lymphedema requires a comprehensive approach focusing on reducing swelling and preventing complications, with the cornerstone of treatment being Complete Decongestive Therapy (CDT) that includes manual lymphatic drainage and compression therapy, as recommended by recent guidelines 1. The treatment of lymphedema involves several key components, including:
- Manual lymphatic drainage (gentle massage to move fluid)
- Compression therapy (using bandages, garments, or pneumatic compression devices)
- Meticulous skin care to prevent infections
- Targeted exercises to improve lymph flow Patients should wear properly fitted compression garments daily, especially during physical activity, and weight management is crucial as obesity worsens lymphedema. Elevation of the affected limb above heart level when possible helps reduce swelling. Some key points to consider in the management of lymphedema include:
- Avoiding extreme heat, tight clothing, blood pressure measurements or injections in the affected limb, and heavy lifting
- Referral to a rehabilitation specialist for treatment consisting of manual lymphatic drainage and, if tolerated, compressive bandaging 1
- A collaborative strategy between the primary care physician and specialist to maintain surveillance for signs and symptoms suggestive of lymphedema 1 For acute flare-ups or infections, antibiotics like cephalexin may be prescribed, and low-level laser therapy and surgical options like lymphovenous anastomosis or vascularized lymph node transfer may benefit selected patients. It is essential to focus on the early identification and management of lymphedema among patients with breast cancer, and patients who develop clinical symptoms or swelling suggestive of lymphedema should be referred to a therapist knowledgeable about the diagnosis and treatment of lymphedema 1.
From the Research
Guidelines for Managing Lymphedema
The management of lymphedema involves a combination of therapies, including complex decongestive physical therapy, which is divided into two phases:
- Edema reduction phase: an initial intensive treatment phase aiming for limb volume reduction
- Maintenance phase: a long-term phase to sustain a manageable limb volume 2, 3, 4
Components of Lymphedema Treatment
The components of lymphedema treatment include:
- Manual lymph drainage (MLD)
- Pneumatic pump drainage
- Low-stretch bandaging
- Exercises
- Skin care 2, 3, 4 In the maintenance phase, the goals are for the individual to be able to wear a well-fitted appropriate gradient pressure garment during the day and compression bandaging (or a device that serves as an alternative to bandaging) at night, to maintain good skin care, to continue with therapeutic exercise, and to self-perform manual lymphatic drainage (or use a mechanical device that can perform manual lymphatic drainage) for the area of the body with impaired lymphatics 2.
Effectiveness of Treatment Components
The effectiveness of the various components in each phase, as well as the motivation and compliance of the patient, differs 2. Further randomized trials are required to determine which component or combination of components in complex decongestive therapy works most effectively 2. Complete decongestive therapy (CDT) is effective in reducing lymphedema, although the contribution of each individual CDT component has not been determined 5.
Home Management and Patient Compliance
Home management includes many of the same elements as Phase-I therapy, with adaptations for home treatment 4. 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 4. Poor patient compliance with time-consuming technique-dependent home care regimens contributes to losing gains achieved in the clinic 4. The use of an advanced programmable IPC device for lymphedema treatment may support successful home management by addressing some of the home treatment barriers 4.