From the Guidelines
To treat leg lymphedema, start with complete decongestive therapy (CDT), which includes manual lymphatic drainage, compression therapy, exercise, and skin care, as recommended by recent guidelines 1. When it comes to compression therapy, wear graduated compression stockings (20-30 mmHg or higher as prescribed) during the day and use multi-layer bandaging at night, as supported by evidence from the Journal of the American College of Radiology 1. Some key points to consider when treating leg lymphedema include:
- Perform gentle exercises like walking, swimming, or specific lymphedema exercises to help move fluid, as suggested by the Ca-A Cancer Journal for Clinicians 1
- Keep your skin clean and moisturized to prevent infections
- Elevate your legs whenever possible, especially when sitting or sleeping
- For severe cases, pneumatic compression devices can be used at home for 30-60 minutes daily
- Avoid standing for long periods, maintain a healthy weight, and protect your legs from injury It's also important to note that lymphedema is caused by damaged or blocked lymphatic vessels that cannot properly drain fluid, leading to swelling, and while there's no cure, these management techniques can effectively reduce swelling, prevent complications, and improve quality of life, as indicated by the Journal of Clinical Oncology 1. If you develop sudden increased swelling, redness, pain, or fever, seek medical attention immediately as these may indicate an infection.
From the Research
Treatment Options for Leg Lymphedema
- The treatment of lymphedema aims to reduce the volume and prevent infectious and joints mobility complications, and is usually symptomatic, thus it should be continued throughout the life 2.
- The four pillars of the complex decongestive therapy of limb lymphedema are skin cares, manual lymph drainage, compression therapy with bandages, and exercises 2.
- Compression is the most important treatment, and lymphedema can be improved by only bandages, but a sustained improvement of lymphedema cannot be seen without bandages 2.
- The management of lymphedema includes three phases: attack or initial treatment that aims to reduce volume of the lymphedema and maintenance phase to maintain the result and finally withdrawal phase 2.
Decongestive Lymphatic Therapy (DLT)
- DLT systems, including skin care, exercise, compression bandaging, and manual lymphatic drainage, can be used to reduce limb volume in patients with lymphedema 3.
- Factors associated with limb volume changes include large initial leg volume, DLT treatment duration, and peripheral arterial disease 3.
- Severe lymphedema with a large limb volume responded well to DLT in a multicountry prospective study 3.
Multidisciplinary Approach
- A multidisciplinary approach, involving bench researchers, lymphatic therapists, medical physicians, and lymphedema surgeons, is recommended for treating patients with lymphedema 4.
- This approach can improve outcomes in lymphedema treatment and provide a better quality of life for patients 4.
Guidelines and Recommendations
- International guidelines recommend an integrated medical, psychological assessment, and physical examination, with a limb volume measurement of >10% in the affected limb to confirm a lymphedema diagnosis 5.
- Recommended management involves Complex Decongestive Therapy (CDT) followed by self-management using skincare, self-lymphatic drainage massage, exercise, and compression 5.
- High-quality guidelines are available to guide lymphedema care, but their suitability for low-resource settings is unclear 5.
Surgical Techniques
- Lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are effective treatments for lymphedema, and can be used to treat multiple limbs in a single operation 6.
- Patients with multiple limb lymphedema can be treated safely and effectively combining both LVA and VLNT in a single operation, with subjective improvement in symptoms and decreased use of compression garments and pumps 6.