WHAT IS LYMPHEDEMA?

Lymphedema is the abnormal collection of fluid in the tissues due to disruption of the flow of the lymphatic system, typically occurring in extremities, causing swelling, sometimes weeping and ulcerations. The lymphatic system is a network of vessels similar to veins and capillaries that are connected to lymph nodes that help remove toxins and waste products from the body. When there is a disruption or blockage in the lymph nodes, the fluid running though those vessels leaks into the surrounding tissues causing swelling.  Lymphedema that continues uncontrolled can be very lifestyle limiting and lead to complications such as wounds or cellulitis (infection of the skin).

WHAT CAUSES LYMPHEDEMA?

Lymphedema can be either primary or secondary.

Primary lymphedema is thought to be a result of genetic mutation.  It can be further divided between lymphedema praecox, occurring primarily between the ages of 9 and 25 and predominantly in females, or lymphedema tarda, generally recognized as occurring after the age of 35.

Secondary lymphedema is a disruption in lymphatic flow due to other conditions or trauma.  Some conditions that can lead to secondary lymphedema include chronic venous insufficiency, cancer, surgery at or near the area of lymph nodes, radiation therapy, external trauma, previous severe cellulitis, and obesity. 

STAGES OF LYMPHEDEMA

Stage 1 Lymphedema

Stage 1 lymphedema is characterized by a puffy appearance of the extremity extending to the farthest point (either hand or foot). When the skin is pushed it leaves an indentation that takes several seconds to resolve. This is called pitting. In stage one the swelling may be relieved by leg elevation and is often better first thing in the morning after lying down all night and worsens as the day progresses.

Stage 2 Lymphedema

In stage 2, the swelling continues and may get worse. It does not respond to leg elevation.  The skin develops a spongy consistency and pitting is less present.  This is happening because constant swelling is creating scar tissue in the underlying tissue.  Thickening of the skin and sometimes discoloration that typically begins around the ankle area is also noted in this stage.

Stage 3 Lymphedema

At this stage, the skin becomes very dry and scaly and the affected extremity becomes very large. Because the skin is very dry, it is prone to cracking more easily and clear or amber colored fluid may begin weeping through these small cracks. The skin also develops a cobblestone texture as the fluid is collecting between the network of fibrotic or scarred tissue beneath. Blisters may also form as fluid builds up. Those blisters opening can lead to ulcers and place the patient at risk for cellulitis (infection of the skin). At this stage, the weight of the affected limb(s) can have a significant impact of mobility and lifestyle and affect a person’s ability to perform their activities of daily living.

TREATMENT 

There is no cure for lymphedema, but it can be managed to reduce the swelling and to maintain that reduction. The treatment, which is multifactorial and focuses on stopping progression and improving symptoms, included, leg elevation, graduated compression bandages or garments, exercise, skin and/or wound care and manual lymphatic drainage.

Compression

Compression bandaging is a multilayered bandage applied by a trained professional. The bandages are changed at regular intervals to reduce the limb size and maintain good skin to prepare for long term management with compression garments. Garments are available in varying styles and are measured to fit once sufficient limb reduction has been achieved with compression bandaging.  An additional tool to help in managing swelling is a pneumatic pump.  This is a device with a sleeve that is worn on the affected limb(s) that inflates in sequence encouraging movement of fluid out of the limb.  Good long-term management of lymphedema can be achieved using a pump in combination with compression garments and manual lymphatic drainage.

Manual Lymphatic Drainage

Manual lymphatic drainage (MLD) is a form of light massage.As opposed to deep tissue massage, manual lymphatic drainage is a systemic, rhythmic method of purposefully stretching the skin to increase in the flow of the lymph fluid through the lymph nodes. A lymphedema patient can perform MLD on themselves in conjunction with their compression garments and pneumatic pump for effective long-term management.  MLD is also part of complete decongestive therapy along with compression bandaging as done by a certified lymphedema therapist.

Skin and Wound Care

When a person with lymphedema has a wound, it is not advised for them to try and take care of it themselves.  It is best managed by a clinician who has experience treating chronic wounds that are related to lymphedema and/or chronic venous disease.  A wound care specialist will have the expertise to know which dressings and treatments to use to promote wound healing and prevent complications such as infection.  Once healed, they may prescribe specific over the counter or prescription moisturizers to keep skin supple and healthy.

Exercise

Regular exercise plays an important role in managing lymphedema.  As muscles flex and relax they contribute to the movement of lymphatic fluid through the body.  A clinician familiar with lymphedema can recommend exercises suited to any person’s ability and tolerance.  It can be as simple as regular walking or foot and ankle exercises while seated.

At Associates in Vascular Care we can provide the lymphedema patient with the tools needed to manage their lymphedema, heal and prevent wounds related to lymphedema, and improve quality of life.