Lymphedema
Webpages concerning "Lymphedema"
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Wikipedia-Article "Lymphedema"
| Lymphedema | ||
|---|---|---|
| ICD-10 code: | I89.0, Q82.0, I97.2 | |
| ICD-9 code: | 457.0, 457.1, 757.0 | |
Lymphedema (or "Lymphoedema", "lymphatic obstruction") is a condition of localized fluid retention caused by a compromised lymphatic system. The lymphatic system (often referred to as the body's "second" circulatory system) collects and filters the interstitial fluid of the body. Lymphedema has been barely recognized as being a serious health problem; however, this is slowly changing due to education and awareness. Still, Doctors and medical staff who practice in fields where this disease is uncommon may fail to correctly diagnose the condition due to the apparent lack of information regarding this disease.
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Causes
Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary). It was most frequently seen after surgery and radiation therapy, which may cause unintended damage to the lymphatic drainage system. It was especially common after surgery or radiation therapy were used in combination to treat breast cancer. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from proper function. Many cancer patients find this condition may develop after their therapy has concluded. The symptoms of Primary Lymphedema may not become apparent for many years. In the lower extremity it will be unilateral or bilateral.
Lymphedema affects both men and women. In women, it was most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occuring in the arm on the side of the body in which the surgery is performed, and in the lower limbs or groin after hysterectomy surgery. In men, lower-limb Lymphedema is most common, occuring in one or both legs or occasionally in the groin.
Aircraft flight has been linked to the onset of Secondary Lymphedema in patients who have had post-cancer surgery (likely due to decreased cabin pressure). Some cases of lower-limb Lymphedema have been associated with the use of Tamoxifen, which can also cause blood clots and deep vein thrombosis (DVT).
Symptoms
When the lymphatic impairment becomes so great that the lymph fluid exceeds the lymphatic system's ability to transport it, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid causes tissue channels to increase in size and number, reducing the availability of oxygen. This interferes with wound healing and provides a rich culture medium for bacterial growth that can result in lymphangitis (infection).
Symptoms may include severe fatigue, a heavy swollen limb or localized fluid accumulation in other body areas, deformity ("elephantiasis"), discoloration of the skin overlying the Lymphedema, recurrent episodes of cellulitis, and in severe cases, skin ulcers and infections. Each case is different. In certain exceptionally-severe cases, prolonged, untreated Lymphedema can lead to a form of cancer known as Lymphangiosarcoma.
Lymphedema may also result in psychological distress. The normal, daily-living lifestyle can become severely limited.
Lymphedema should not be confused with edema arising from venous insufficiency, which is not Lymphedema. However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder which is treated the same way as Lymphedema (see Treatment below).
Staging
Whether Primary or Secondary, Lymphedema develops in a number of stages, from mild to severe:
- Stage 1 (spontaneously reversible): Tissue is still at the "pitting" stage -- when pressed by the fingertips, the affected area indents and holds the indentation. Usually upon waking in the morning, the limb or affected area is normal or almost normal in size.
- Stage 2 (spontaneously irreversible): The tissue now has a spongy consistency and is "non pitting" -- when pressed by the fingertips, the tissue bounces back without any indentation. Fibrosis found in Stage 2 Lymphedema marks the beginning of the hardening of the limbs and increasing size.
- Stage 3 (lymphostatic elephantiasis): At this stage, the swelling is irreversible and usually the limb(s) or affected area is very large. The tissue is hard (fibrotic) and unresponsive; some patients consider undergoing reconstructive surgery called "debulking."
Illustration
Presented here is a case of unilateral herediatary Lymphedema which had been present for 25 years without treatment:
 Comparison of normal and swollen limb |
 Size of swollen foot, toes underneath |
 Another view of lymphedemic foot |
 Foot and leg (held vertically) |
Treatment
Treatment of Lymphedema can include the use of pneumatic sequential compression pumps, compression sleeves and bandaging. Some physical therapists or other practitioners of manipulative therapy are trained to perform what is known as a "lymphatic release" or "manual lymph drainage" (MLD) by massaging areas of the body where lymph is found to be flowing irregularly. Such releases are intended to unblock poorly-circulating lymph fluid by stimulating the lymph nodes, thereby increasing the flow of lymph.
The massage technique was pioneered in the 1930's by Dr. Emil Vodder and is now recognized as a primary tool in Lymphedema management. Therapists can receive certification in Manual Lymph Drainage massage through special classes conducted by the Academy of Lymphatic Studies and the Lymphology Association of North America.
Increasingly, sequential compression pumps are being used to treat Lymphedema. The system consists of an air pump and an appliance (sleeve) which fits over the extremity. Air pressure is applied to the appliance, which in turn applies pressure in a preset sequence to the extremity. The better devices consist of a pump and appliance with three or more segments which sequentially apply pressure along the extremity, distally to proximally. Several reputable manufactuers provide multichambered pneumatic Lymphedema pumps:
Since lymphatic pressure is greater distally than proximally, the preferred method of compression therapy would be to mimic the lymphatic system. This is accomplished by means of a pump that applies gradient pressure to the segmented appliance. This system mimics the lymphatic system wherein it applies gradual, gradient pressure distally to proximally, moving the accumulated fluid from the affected extremities back into the body where it can be naturally eliminated. It simulates a gentle massaging action. Pressure and the subsequent effectiveness can be gradually increased as the patient becomes more tolerant. These devices are expensive, although most medical plans will cover the cost if the device is medically necessary; the pumps are generally comfortable and easy to use for home therapy. It should be noted that these devices are not the same as devices that have been advertised on television commercials.
For every-day use, such as walking or performing basic tasks, compression sleeves and stockings are available for use. While these garments provide only minimal compression, they are ideal for daily activities and may be used along with other therapies. A phrase popular with Lymphedema therapists is, "A little compression is better than no compression."