What are the treatment options for lymphedema?

Treatment Options for Lymphedema

Patients with clinical symptoms or swelling suggestive of lymphedema should be referred to a therapist knowledgeable about lymphedema diagnosis and treatment, such as a physical therapist, occupational therapist, or specialized lymphedema therapist. 1, 2

First-Line Management: Complex Decongestive Therapy

Complex decongestive therapy is the cornerstone of lymphedema management and consists of four key components:

• Skin care: Essential to prevent infections that can worsen lymphedema 2
• Manual lymphatic drainage (MLD): Specialized massage technique to improve lymphatic flow 2, 3
• Compression therapy: The most critical component, using multilayer bandaging in the initial phase and compression garments for maintenance 2, 3
• Exercise: Supervised, progressive resistance training is safe and beneficial for patients with lymphedema 2, 4

Treatment Phases

Initial/Attack Phase

• Intensive treatment to reduce volume using:
  • Multilayer inelastic bandaging 3
  • Manual lymphatic drainage 3
  • Skin care and exercises 3

Maintenance Phase

• Long-term management to maintain volume reduction:
  • Elastic compression garments (stockings or sleeves) 3
  • Continued skin care and exercises 3
  • Periodic MLD as needed 3

Prevention Strategies

• Weight management: Counsel patients who are overweight or obese on weight loss to reduce lymphedema risk 1, 2
• Infection prevention: Prompt treatment of infections with antibiotics is essential to prevent worsening of lymphedema 2
• Physical activity: Aim for 150 minutes of moderate aerobic exercise weekly plus resistance training at least 2 days per week 1, 4

Adjunctive Treatments

• Intermittent pneumatic compression: May provide additional benefit when combined with standard therapy 3
• Pharmacological options:
  • Diuretics are generally ineffective for pure lymphedema but may help in mixed edema or palliative situations 2, 5
  • Coumarin/flavonoid drugs have shown some benefit in reducing swelling 5

Surgical Options

Surgical intervention should be considered when conservative measures fail to provide adequate symptom relief:

• Excisional procedures: For advanced cases with significant tissue changes 6, 7
• Microsurgical lymphatic anastomoses: To improve lymphatic drainage 6, 7
• Suction-assisted lipectomy: Has shown promise for long-term symptom relief in appropriate candidates 8, 7

Special Considerations

• Early intervention is critical - delaying treatment can lead to progression and increased complications 2
• Lymphedema is generally incurable but manageable with proper treatment 5, 3
• Treatment should continue throughout life to maintain results and prevent complications 3
• For breast cancer survivors, the risk of lymphedema is higher with axillary lymph node dissection than with sentinel lymph node biopsy 2

Common Pitfalls to Avoid

• Delaying treatment, which can lead to progression and complications 2
• Failing to treat infections promptly 2
• Using diuretics as primary treatment for pure lymphedema 2, 5
• Discontinuing compression therapy, which is essential for long-term management 3