In treating lymphedema the most common goal is in the effort to control the swelling and other problems that is caused by lymphedema.
Once done, damage to the lymph system cannot be repaired and thus there is no cure for lymphedema or for having lymphedema. When speaking of treatment it is meant to control the swelling that is caused by lymphedema while keeping other problems, such as infection, cellulitis, or thickening of skin on the limb, from developing or becoming worse. The common treatment of lymphedema is Physical Therapy by a lymphatic specialists. Physical therapy treatment is often a combination of MLD, exercise and wrapping. The goal of these treatments is to help the patient continue with activities of daily living, dealing with and decreasing pain to improve or regain mobility and use of the limb. Drug therapy is rarely used in the treatment of lymphedema.
In addition, to physical therapies, there are a number of treatments that may be employed by the patient.
Massage therapy (manual therapy) for lymphedema should begin with someone specially trained in treating lymphedema. In this type of massage, the soft tissues of the body are lightly rubbed, tapped, and stroked. It is a very light touch, almost like a brushing. Massage may help move lymph out of the swollen area into an area with working lymph vessels. Patients can be taught to do this type of massage therapy themselves.
When done correctly, massage therapy does not cause medical problems. Massage should not be done on any of the following:
Open wounds, bruises, or areas of broken skin.
Tumors that can be seen on the skin surface.
Areas with deep vein thrombosis (blood clot in a vein).
Sensitive soft tissue where the skin was treated with radiation therapy.
Most commonly used, specialty bandages are used to help move lymph fluid out of a swollen leg as well as preventing the area from refilling with fluid once more. A great advantage to the use of bandages is the help that they grant lymph vessels to move lymph in near normal capacity. Bandaging is often the first treatment plan that patients and therapists seek and often when lymphedema has not improved with other treatments it is sometimes helped with bandaging.
Garments, Sleeves, Stockings or Pressure garments
Individuals whose lymphedema is significantly under control or has been diagnosed very quickly often turn to the wearing of pressure garments. Pressure garments, or stockings, are made of fabric that puts a controlled amount of pressure on different parts of the arm or leg to help move fluid and keep it from building up. Garments are not meant to help in the reduction of lymphedema. Some patients may need to have these garments custom-made for a correct fit. Wearing a pressure garment during exercise may help prevent more swelling in an affected limb. It is important to use pressure garments during air travel, because lymphedema can become worse at high altitudes.
Compression devices are pumps connected to a sleeve that wraps around the arm or leg and applies pressure on and off. The sleeve is inflated and deflated on a timed cycle. This pumping action may help move fluid through lymph vessels and veins and keep fluid from building up in the arm or leg. Compression devices may be helpful when added to combined therapy. The use of these devices should be supervised by a trained professional because too much pressure can damage lymph vessels near the surface of the skin.
Important to the care and treatment of lymphedema is the caring of the skin on the affected limb. The goal is to prevent infection and to keep skin from drying and cracking. There are many types of lotions that your therapist can suggest. The use of pure, cold pressed castor oils or sween creams are able to help with the reduction of redness and help with scaling and cracking.
Excess weight can often further exacerbate lymphedema. A healthy reduction in weight can help with relieving crushed lymph vessels and allowing lymph fluid to begin to flow more readily. If you’re overweight, you’re more likely to experience problems with lymphedema. The theory is that when your body has extra fat, those tissues require more blood vessels. This creates a higher volume of blood and lymph in the arms and chest, placing a greater burden on the remaining lymph nodes and vessels. Studies have shown that losing weight can significantly improve lymphedema symptoms in people who are overweight. Talk to your doctor or lymphedema therapist about creating a diet and safe exercise plan for bringing your weight down to a healthy range.
Surgical treatment of lymphedema is often a a controversial subject for many. There is no cure for lymphedema, yet it can offer a sense of hope for those that suffer extreme lymphedema. Surgery is a treatment option for a very small, selected percentage of the patients who have lymphedema.
The two categories of surgical intervention that are currently available in the United States are lymphatic reconstruction and excisional surgeries.
Lymph node transplant is surgery in which lymph nodes are moved from one part of the body (usually the abdomen) to the lymphedema affected area. The transplanted lymph node theoretically stimulates the growth of new lymph channels into and out of the transplanted node.
Anastamotic reconstruction attempts to restore lymph flow through a surgical re-joining of the damaged lymph channel either to another lymphatic vessel or to a vein.
Debulking is a surgical intervention that removes large excesses of skin and soft tissue overgrowth occurs as a complication of longstanding lymphedema
Liposuctionis a specialized adaptation of the procedure that permits the surgeon to remove overgrown fatty tissue that resides under the skin. This can become necessary in lymphedema because of the tendency for fatty overgrowth to commonly occur when lymphedema is chronic. In properly selected patients, the lymphedema limb can be restored to normal size through surgery. The operation is performed under general anesthesia, but is minimally invasive. The surgical technique has been perfected in Europe over the past two decades and now has an extensive documentation of efficacy without complications or untoward outcomes.