From the Guidelines
Lymphoedema has several benign causes, including primary lymphoedema and secondary lymphoedema, and management focuses on reducing swelling, preventing complications, and improving quality of life through Complete Decongestive Therapy (CDT). The causes of lymphoedema can be categorized into primary and secondary lymphoedema. Primary lymphoedema is caused by genetic or congenital abnormalities of the lymphatic system, while secondary lymphoedema results from damage to lymphatic vessels due to various factors such as surgery, radiation therapy, infections like cellulitis, trauma, immobility, obesity, and venous insufficiency 1.
Some key points to consider in the management of lymphoedema include:
- Manual lymphatic drainage (gentle massage techniques to redirect lymph flow)
- Compression therapy (using bandages, garments, or pneumatic compression devices)
- Meticulous skin care to prevent infections
- Exercise to improve lymph flow
- Elevation of the affected limb
- Weight management, as obesity worsens lymphoedema
- Medications like diuretics may have limited effectiveness for lymphoedema but may be used in specific situations
- Antibiotics are prescribed promptly for cellulitis, with prophylactic antibiotics sometimes used for recurrent infections
- For severe cases unresponsive to conservative measures, surgical options include lymphovenous anastomosis, vascularized lymph node transfer, or debulking procedures 1.
The most effective approach to managing lymphoedema is a comprehensive one, incorporating multiple therapies and lifestyle modifications, as supported by the most recent and highest quality studies. Patient education about self-management, including self-massage techniques, proper compression garment use, skin care, and exercise, is essential for long-term management. Early intervention typically yields better outcomes, as chronic lymphoedema leads to fibrosis and tissue changes that make treatment more challenging 1.
In terms of specific recommendations, the American Cancer Society and the American Society of Clinical Oncology have endorsed guidelines for the management of lymphoedema in cancer survivors, which include referral to a lymphedema specialist for multimodality treatments, including manual lymphatic drainage, exercise, and compression therapy 1.
Overall, a comprehensive and multidisciplinary approach to the management of lymphoedema is crucial for improving outcomes and quality of life for individuals with this condition.
From the Research
Benign Causes of Lymphoedema
- Lymphoedema can be primary, resulting from a genetic abnormality, or secondary, caused by injury, including non-accidental injury, or following treatments such as radiotherapy and/or surgery 2, 3.
- Primary lymphoedema is caused by developmental lymphatic vascular anomalies, while secondary lymphoedema is acquired and arises as a result of an underlying systemic disease, trauma, or surgery 3.
- The condition is characterized by a high protein oedema and secondary skin changes 2.
Management of Lymphoedema
- Compression therapy is an effective and common approach to the management of lymphoedema, a chronic condition requiring long-term treatment 2.
- Complex Decongestive Therapy (CDT) followed by self-management using skincare, self-lymphatic drainage massage, exercise, and compression is a recommended management approach 4.
- Suction-assisted lipectomy is a preferred operative intervention for symptomatic patients who have failed conservative therapy, as it effectively removes excess subcutaneous fibro-adipose tissue and can improve underlying lymphatic function 5.
- Maintenance of a normal body weight and an active lifestyle can help reduce the severity of the disease 5.
Diagnosis and Assessment
- Definitive diagnosis of lymphoedema requires lymphoscintigraphy, as other causes of lower extremity enlargement can be confused with lymphoedema 5.
- A limb volume measurement of >10% in the affected limb compared to the unaffected limb can confirm a lymphoedema diagnosis 4.
- An integrated medical, psychological assessment, and physical examination are recommended for diagnosis and assessment 4.