Lymphedema is the accumulation of protein-rich fluid in the interstitium, which causes chronic inflammation and reactive fibrosis of the affected tissues.
Types of Lymphedema
There are two main types of lymphedema, primary and secondary. Both types relate to lymph vessels or lymph nodes missing, damaged, removed or otherwise impaired.
Primary Lymphedema
Primary lymphedema is due to a developmental defect (malformation, dysplasia) of the lymph vessels and/or lymph nodes. Primary lymphedema can be either congenital or hereditary.
Primary lymphedema can present as a variety of abnormalities:
- Aplasia: Lymph collectors, capillaries or lymph nodes are inherently missing.
- Hypoplasia: The diameter of the lymph collectors is reduced and/or the number of collectors is below normal level.
- Hyperplasia: The diameter of the initial lymphatics and/or lymph collectors is larger than normal.
Primary lymphedema is also classified according to age of onset:
- Congenital: Present at birth
- Praecox: Presents before the age of 35
- Tardum: Presents after the age of 35
Secondary Lymphedema
Caused by an insult to the lymphatic system and can appear at any age. Causes may include:
- Surgery / radiation for cancer: Lymph node dissection that is often associated with cancer therapy can disrupt lymph flow. Radiation can cause tissue fibrosis which can also impair lymph flow.
- Malignant Tumors: These tumors can compress lymph vessels and decrease flow. Also, cancer cells can penetrate lymph vessels and proliferate and block flow.
- Trauma: Crushing injuries, burns, and other traumas to the body can affect the lymphatic vessels inhibiting flow.
- Infection: Chronic or recurrent bouts of acute lymphangitis can cause failure of the lymphatic vessels.
- Chronic Venous insufficiency: The constant increased strain placed on the lymphatic system from increased filatration from CVI can cause lymphatic insufficiencies.
- Obesity: The increased lymphatic load associated with obesity, often in conjunction with increased pressure on lymph nodes, can impair lymphatic flow.
- Self-Induced: A tourniquet is used on the limb to cause lymphatic and venous obstruction.
- Filariasis: A parasitic disease caused by microscopic worms that are transmitted when an infected mosquito bites a person. The adult worms live in the lymphatic system and lead to impairment.
Signs and Symptoms
- Swelling in the arm or leg
- Onset may be slow or rapid
- Progressive
- Pitting
- Most often starts distally
- A heavy or tight feeling in the affected area
- Cellulitis
- Fibrosis
- Decreased range of motion
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Lymphedema Management
Complete Decongestive Therapy (CDT) is an intensive program with multiple components. CDT is divided into two phases:
- Phase I – Decongestion
- Manual Lymphatic Drainage (MLD): a light, skin stretching massage aimed to promote fluid flow in the desired direction.
- Compression Therapy: Short-stretch compression bandages are utilized to decrease limb volume
- Decongestive Exercises: The muscle pumping action that occurs with exercise helps promote lymphatic flow.
- Skin and Nail Care: Lymphedema patients are highly susceptible to infection and must be meticulous about their skin and nail hygiene.
- Phase II – Maintenance
- Manual Lymphatic Drainage (MLD): MLD is highly beneficial in the maintenance phase to preserve decreased edema and to reduce edema when an increase occurs.
- Compression Therapy: Compression garments, such as JOBST® Elvarex®, are worn after full decongestion is achieved to maintain limb volume.
- Decongestive Exercises: Continued exercise promotes lymphatic flow.
- Skin and Nail Care: Lifelong management of healthy skin and nails will help prevent infections.
JOBST provides compression garments that offer effective compression therapy for patients. When compression therapy is prescribed for patients, contact JOBST to learn more about how compression therapy can be used to effectively treat lymphedema.
Lymphedema is estimated to impact ~3M people in the United States.
Source: BSN medical research
