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Lymphedema

AUTHOR: Benoît Cartier

What is Lymphedema?

The lymphatic circulation is a network of interconnected tubes and channels in the body that returns excess tissue fluid into the blood circulation. Unlike arteris and veins where blood flow is fast; the tissue fluid flows slowly through the lymphatic system. Lymphedema is a condition caused by blockage of this system resulting in excess fluid accumulation and limb swelling.

What causes lymphedema?

The causes of lymphedema is classified into two categories: primary and secondary. The primary lymphedema is caused by shortage or obstruction of lymphatic channels at birth that may become apparent early or late in life. The secondary or acquired lymphedema results from another known disease or condition such as cancer, surgery, infections or accidental injury that damage the lymphatic system, causing lymphatic obstruction and swelling.

What are the symptoms of lymphedema?

In primary lymphedema, the swelling starts during puberty at the ankles on both sides. Swelling comes on gradually but in a progressive fashion. Primary lymphedema is more common is women. Often a relative in the family already has lymphedema. In secondary lymphedema, the swelling develops in the months or years following the injury or surgery . In both primary and secondary lymphedema, patient may develop recurrent infections in the skin of the swollen limb. Infections tend to cause further damage to the lymphatic system worsening swelling in a vicious cycle of disease progression.

Diagnosis and tests for lymphedema

Your doctor needs to know the detailed circumstances surrounding the onset of lymphedema. Symptoms, duration, previous surgery, injury, infection, travel history is important. Your doctor will thoroghly examine the limb documenting location, color and skin texture, extent of swelling, drainage, scars, and presence of abnormal veins. Diseases that cause secondary lymphedema must be looked for and ruled out (hypothyroidism, parasitic infection, cancer, venous disease,post phlebetic syndrome). The best test for making the diagnosis is lymphoscintigraphy, which consists of injecting radioisotopes in the affected limb (web space of the hand or foot) and follow its path using special cameras

Lifestyle modification for lymphedema

Weight loss helps to reduce lymphedema. Accumulations of fat under the skin hinder lymphatic drainage. A diet high in fat overloads the lymphatic system which is problematic in lymphedema patients who already have damaged lymphatic systems. A diet low in fat reduces the overload of the lymphatic system, reduces body weight and at the same time improves lymphatic drainage. Exercise also helps to improve the lymphatic drainage. One should avoid injuries to the affected limb of lymhedema in order to not further damage the lymphatic system. One should be very vigilent again skin infection in the limb and treat promptly with antibiotics if infection is suspected.

Non-surgical and medical management for lymphedema

The non-surgical treatment remains the mainstay of lymphedema treatment. These treatment consists of: exercise, compression stockings, surveillance against infections, lymphatic manual drainage, and compression bandaging. The use of diuretics is rarely indicated. Unfortunately, there is no cure for lymphedema. The purpose of the treatment is to decrease the volume of the affected limb and as a result will make it more functional. Wearing a sleeve or compression stockings is the best guarantee of long term success.

Guidelines for Intervention for lymphedema

All abnormal swelling of limb should be investigated to find the cause. The patients having undergone cancer surgery with axillary (e.g. mastectomy) should have a preventative treatment: wearing a sleeve or a compression stocking, observation for infection, antibiotic use as soon as cellulite is suspected, because any infection may further compromise the lymphatic drainage. In case the lymphedema worsens, manual lymphatic drainage and compression bandaging clinics are helpful but unfortunately not always covered by the provincial medical insurance.

Surgical treatment for lymphedema

Rarely do patients require surgical treatment. The goal of surgical treatment is to reduce volume of the limb, improve its function and reduce the frequency of infections. The surgical techniques can be divided into two groups: physiological and excisional. The objective physiological techniques is to reconstruct lymphatic drainage. Most surgeons have no experience with this type of procedure and there are very few reported results. The excisional techniques involve excision of skin tissue and subcutaneous tissue in order to reduce the volume of limb.

Endovascular Treatment for lymphedema

None

When should I see my doctor?

All abnormal edema of a limb shall be evaluated by a doctor and any patient with a condition risking of developing lymphedema must be monitored by a doctor in order to intervene as soon as symptoms worsen. All patients with lymphedema should have a prescription of antibiotics in their possession at the beginning of the first signs of skin infection, because the delay to see a doctor and start treatment could be detrimental.

References and Resources

Vascular Conditions

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