Lymphoedema

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Lymphoedema develops when the lymphatic system can no longer fulfill the function described above.
Lymphoedema consists of accumulated fluid in the tissues, mainly in the limbs and occasionally throughout the body.

Protein-rich oedema
is reorganised into tissue by the blood proteins over the course of time.

This eventually results in an increase in connective tissue, which, without treatment (CDT*1), sooner or later becomes hardened.

Signs of lymphoedema

Gradual swelling of a limb, rarely of several limbs
A feeling of heaviness at the affected site
Positive Stemmer‘s sign*2: the skin on the second toe or finger cannot be raised between two fingers, instead it feels taut and hard
Initially the skin pits when pressed with a finger at the affected site
The natural skin folds around the joints become much deeper
At later stages, hardening (fibrosis) of the affected site

Diagnosis

Doctors with experience in lymphology can usually recognise which type of oedema it is from the patient‘s history and by inspection and palpation (feeling the surface of the body). Modern medical imaging technology, such as ultrasound, indirect lymphography, lymph scintigraphy and MRI*3, may be used in some cases, if the clinical picture is unclear and to rule out malignant processes.

Why does lymphedema develop?

There are basically two types of lymphoedema:

1. Primary lymphoedema is congenital:

In this case, some areas of the lymphatic system show defective development. Although damage is present, there is often little or no sign of primary lymphoedema before puberty. Hormonal changes lead to a more pronounced tendency for oedema and an increase in the lymph-obligatory load. The limited capacity of the lymphatic system to transport it away is no longer adequate – oedema develops and eventually becomes evident.

2. Secondary lymphoedema results from various conditions:

• The removal of lymph nodes in the course of cancer surgery

• Damage to the lymphatic system as a result of surgical interventions

• Radiotherapy

• Infections with bacteria, fungi or tropical nematodes (filariasis)

• Injuries

• Burns

• Lipoedema

• Complicated bone fractures

The course of the disease is divided into various phases:

Stage 0 – subclinical stage

Damage to the lymph vessels, no visible or palpable oedema.

Stage 1 – reversible stage

The soft oedema appears over the course of the day and is reduced or disappears entirely when the limbs are elevated. The tissue pits when pressed and the area holds the indentation for a short time.

Stage 2 – spontaneously irreversible stage

The oedema persists even after prolonged periods of rest. The skin is often already fibrotic (hardened) and not even elevation reduces the swelling. There is little or no pitting when the skin is pressed.

Stage 3 – lymphostatic elephantiasis

Complicated swelling characterised by gross skin changes and fibrotic tissue, which may be wart-like or take the form of small blisters or fistulas which leak lymph, sometimes resulting in huge swellings.

Treatment

The fact is that consistent treatment compliance is the only way to prevent

lymphoedema from worsening.

Complex decongestion therapy (CDT*1) is the tried and tested first-line therapy in the

treatment of lymphoedema. By increasing drainage this removes the lymph congestion

to reduce the swelling and stimulates the activity of the body’s lymphatic system.

It may also serve to eliminate pre-existing connective tissue fibrosis

CDT phase 1 – Decongestion phase

Depending on the stage of the disease, this is performed either in an outpatient setting or in hospital.

1. Manual lymphatic drainage (MLD*3) – daily, several times if needed

2. Skin care / hygiene

3. Subsequent compression bandaging with short-stretch bandages

4. Exercise

5. Healthy diet and, if necessary, weight reduction

6. Psychological care / self-motivation

7. Reduction Kit – Contact us for more information

In addition, the use of intermittent mechanical compression (IMC*2) can have a positive effect on lymphoedema and its sequelae. Magnetic-field, ultrasound, ozone and CO2 therapy are also used in some cases. A slimming diet is also frequently necessary, as obesity leads to a worsening of the oedema.

CDT phase 2 – Maintenance phase

1. MLD*3 – one to three times a week (depending on the stage) and compression bandaging with short-stretch bandages

2. Skin care / hygiene

3. Subsequently wearing flat knit compression garments – Contact us for more information

4. Exercise

5. Healthy diet

6. Self-motivation