A comprehensive overview of lymphedema covering subjects as symptoms, diagnostics, research, causes and pictures
The goal of therapy is to restore function, to reduce physical and mental suffering and to prevent infection.
Medical lymphedema therapy
First-line treatment is a complex physical therapy, by lymphedema improvement in the manual lymphatic drainage massage, the physical exercise and the pneumatic artificial massage. It is indicated the use of elastic stockings, bandaging in multiple layers or using pneumatic pumps. Keeping the foot in an elevated position compared to the rest of the body is essential. It is indicated to take care of your skin and debridement of skin ulcerations to prevent cellulite.
In secondary edema it is treated the basic cause of lymphedema. In the case of cellulite it is indicated the antibiotic lymphedema therapy with agents such as penicillin or cephalosporins. The cases associated with obesity are indicated by weight loss.
Pharmacological lymphedema therapies
This therapy is made with a group of drugs that are effective in treating lymphedema when combined with complex physical therapy. It help with the decrease of the edematous excess fluid, it soaks the foot, lowers the skin temperature and decreases macrophages, leading to proteolysis and protein reabsorption. Topical retinoids are helpful in chronic lymphedema. Oral or topical therapy with these agents helps decrease the inflammatory and fibrotic changes.
Surgical lymphedema therapy
This lymphedema therapy is not curative, it's just palliative. There are some effective procedures which involve the lymph drainage through the subcutaneous tissue through a silicone tube connected to a single direction valve. It is rarely indicated as an initial treatment. This lymphedema therapy is reserved for cases that does not improve with conservative measures or when the affected extremity is twisted and changes the patient's quality of life.
The goal of surgical lymphedema therapy is the volume reduction, the improvement of the function, thus facilitating the maintenance therapy and preventing complications.
Charles procedure consists of radical excision of the affected subcutaneous tissue with tissue grafting.
Venous-lymphatic anastomosis is performed rarely in severe cases of lymphedema with functional venous system. It is only effective in the secondary lymphedema. Recalcitrant cases require amputation.
Lymphangiography was the standard criterion assessment of the lymphatic system for many years. This technique has been shown to cause an inflammatory reaction of the endothelial remaining lymphatic channels, leading to scarring, atrophy and obliteration lit. Lymphangiography was replaced with less invasive techniques and it is no longer used.
Lymphoscintigraphy has replaced lymphangiography. It does not promote destruction of lymphatic channels and it can be used to define anatomy and functions, to assess the dynamics and the lymph flow and it determines the severity of the obstruction.
CT scan and MRI can define the architecture of the lymph nodes. They have a very high cost and have few advantages over lymphoscintigraphy. They are indicated in the case of suspected neoplasm.
Doppler ultrasound is used to assess the venous and the lymphatic flow in the system. The presence of a deep vein thrombosis is a differential diagnosis of a single extremity swelling and it can occur concurrently with lymphedema.
Histological examination is indicated if there are areas of ulceration and if the lymphedema looks suspicious. In the chronic lymphedema it can be observed the fibrosis and the inflammatory infiltration.
Differential diagnosis of lymphedema is made with the following conditions: cellulites, skin manifestations of heart disease and kidney disease, erysipelas, venous insufficiency, deep vein thrombosis, postoperative complications, Baker cyst, and idiopathic edema.