From the Guidelines
The management of lymphedema involves a comprehensive approach combining physical therapies, compression, skin care, and lifestyle modifications, with referral to a lymphedema specialist for multimodality treatments including manual lymphatic drainage, exercise, and compression therapy 1. The treatment typically begins with Complete Decongestive Therapy (CDT), which includes manual lymphatic drainage, compression therapy using bandages or garments, meticulous skin care to prevent infections, and exercise to improve lymph flow.
- Key components of lymphedema management include:
- Manual lymphatic drainage
- Compression therapy with bandages or garments (20-60 mmHg pressure)
- Meticulous skin care
- Exercise to improve lymph flow
- Weight management, as obesity worsens lymphedema
- For maintenance, patients should continue wearing compression garments, perform self-massage, exercise regularly with low-impact activities, and maintain proper skin hygiene.
- Medications are not primary treatments, but diuretics may occasionally be used short-term for symptom relief, and antibiotics (such as cephalexin or amoxicillin-clavulanate) are necessary for cellulitis, a common complication 1.
- In severe cases refractory to conservative measures, surgical options like lymphovenous anastomosis or vascularized lymph node transfer may be considered, and patients should be counseled on how to prevent or reduce the risk of lymphedema, including weight loss for those who are overweight or obese 1.
From the Research
Management and Treatment of Lymphedema
The management and treatment of lymphedema involve a combination of physical therapeutic approaches and self-care techniques. The basic principle of lymphedema management is 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
Components of Complex Decongestive Therapy
Complex decongestive therapy (CDT) consists of several essential components, including:
- Manual lymph drainage (MLD)
- Compression therapy with bandages or compressive garments
- Exercises
- Skin care
- Education and self-management 3, 4
Phases of Lymphedema Management
The management of lymphedema includes three phases:
- Attack or initial treatment phase: aims to reduce the volume of the lymphedema using complex decongestive therapy
- Maintenance phase: aims to maintain the result using elastic compression, MLD, and self-care techniques
- Withdrawal phase: rarely used, except for genital lymphedema 3
Adjunctive Treatments
Adjunctive treatments, such as intermittent pneumatic compression therapy (IPCT), may be useful in complementing CDT 5, 6. IPCT has been found to be a comparable therapeutic procedure to MLD when properly indicated 6
Importance of Self-Care and Education
Self-care and education are crucial components of lymphedema management, as they enable patients to manage their condition effectively and prevent complications 4, 5. Effective bandaging and lymphatic drainage treatment via manual or automated processes are significant to the success of Phase-I and Phase-II care 5