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Physical Medicine Rehabilitation & Clinical Neurophysiology

What is Lymphedema?

Lymphedema is a condition in which lymph fluid collects in tissues, causing swelling in the arms or legs.

Lymph fluid between the cells slowly blends into the blood differently from the blood circulation. If the lymph nodes and lymph canals carrying the lymph fluid are damaged or congenitally defective, the lymph fluid accumulates into body parts to compose lymphedema. This is usually progressive and if not treated in time, permanent.

The reasons:

The reasons for some cases of lymphedema cannot be explained. Some other cases of lymhedema may develop after mammoplasty, radiotherapy, or secondary to infection or trauma. Removal of lymph nodes for the treatment of some cancer types, i.e. breast cancer, poses a risk for lymphedema. If the patient is exposed to radiotherapy after the removal of lymph nodes, the risk of developing lymphedema increases even more. It is also possible to develop lymphedema following orthopeadic and other surgical interventions on the leg.

Phases of Lymphedema

Lymphedema may develop shortly after surgery but it may not manifest itself for almost 15 years. It starts with mild symptoms with progression in all cases. Lymphedema includes three phases

Phase I: Reversible phase of lymphedema. Temporary swellings occur. It increases during the day and then disappears after resting at night.

Phase II: Chronic irreversible lymphedema. Progresses with continuous swelling, numbing, pain, burning and limitation of movement.

Phase III: Lymphostatic Elephantiasis Limb deformation, significant limitation of movement and functions and severe pain.

What are the symptoms?

* Unilateral pitting edema

* Asymmetry of an extremity

* Painless, heavy, stretched and puffy extremities

* Hardening, thickening and discolouration of the skin

* Edema that starts with the hand or foot and progresses

* Restriction of joint movements

* Recurring infections

Treatment

It usually takes a long time to initiate the treatment due to the inability to determine the appropriate treatment, lack of information or misinformation. And this causes delays in the treatment. Lymphedema is treated with complex decongestive physiotherapy. This method includes the combination of manual lymphatic drainage and then a compression therapy with bandaging specific to lymphedema.

Manual lymphatic drainage uses light touch to move excess lymph and fluid out of the tissues and back into the lymphatic vessels. At the end of the therapy, the patient is provided with a compression garment. This therapy reduces extremity volume and stimulates lymph flow. Bandaging for the treatment of lymphedema prevents re-accumulation of lymph fluid in the limb by applying high pressure during muscle activity and low pressure during muscle rest. These therapies are supported with special exercising programs determined by the physiotherapists. The treatment takes approximately 3-5 weeks. The patient is provided with treatment every day.

The majority of the patients achieve full recovery, partial regression or prevent progression upon these therapies. If the patient is not provided with a treatment at all, lymphedema may cause irreversible complications.