Treatment Information
Unfortunately, there is no cure or effective surgical option for lymphedema. Early intervention, proper treatment and vigilant self-management are essential for the control of lymphedema.
Treatment goals:
- Stop the progression of lymphedema by increasing the circulation in the affected limb, thereby improving the limb's overall health and function and preventing infections that further damage the remaining lymphatics.
- Reduce the size of the affected limb, thus decreasing pain, increasing mobility and functionality, improving skin condition, minimizing the chance of infection, and enhancing comfort level and self-confidence.
- Strengthen the natural capacity of the remaining lymphatic return system by stimulating the movement of lymphatic fluid through alternate channels.
- Reverse lymphatic fibrosis, the hard, tissue-like build-up that begins as soon as lymph fluid transport is slowed, which left untreated, may lead to increasing disfigurement and impairment.
Lymphedema is a life-long condition, requiring continued and diligent management. If ignored and allowed to advance, it will almost always become steadily worse, more difficult to manage, and less likely to return to a less severe stage. Although managing lymphedema may involve some lifestyle changes and a few restrictions, living a normal, active life is still possible.
Determining the appropriate therapeutic program depends greatly on the nature and severity of the lymphedema, as well as patient tolerance and compliance. A combination of treatment modalities, based on the individual, often proves to be the most effective way to manage lymphedema. The recommended treatment plan is normally based on an approach called Complete or Complex Decongestive Therapy (CDT) or Complete Decongestive Physiotherapy (CDP), both essentially sharing the same meaning. This approach combines manual lymph treatment (a treatment method using a series of light, rhythmic strokes to reduce swelling and improve the return of lymph to the circulatory system) with compression techniques and self-care education and training.
Successful management of lymphedema depends on patient compliance. Patients may find one method easier to apply or more effective over another. The treatment modality that works best, alone or in conjunction with another, may differ depending on the individual. Sometimes, only trial and error will determine what is most effective. Results are achieved slowly and are painstaking to maintain. Because lymphedema can be disfiguring and is sometimes painful and disabling, there are often psychosocial considerations and lifestyle adjustment issues that patients must deal with on a continual basis. Lymphedema can affect self-image, interfere with routine activities, limit what clothes can be worn, and remind cancer survivors of the disease they thought they had overcome, therefore frustration is understandable but needs to be overcome.
Education
Education is an essential part of your care, and will include meticulous skin care, edema prevention, exercise and self-management of your lymphedema.
Elevation
Often the first suggestion made is to elevate the extremity higher than the level of the heart, making use of gravity to assist lymphatic flow. Although this may be effective with mild edema, it most often provides only a temporary solution. For larger extremities, elevation must be combined with other forms of lymphedema management. However, elevation in conjunction with other treatment methods is very beneficial, using gravity to promote circulation.
Exercise
Exercise recommended to aid in the treatment of lymphedema can vary greatly. However, the rationale for some form of exercise can be substantiated by lymphatic physiology. Lymphatic fluid moves as the body moves, and muscle contractions serve as a pumping force, facilitating lymphatic flow. Individualized exercise programs used in conjunction with compression bandaging can enhance lymphatic drainage, and restore strength, flexibility and endurance.
The following are basic guidelines when starting an exercise program. Be aware that overuse and overstress to the limb can aggravate your lymphedema, or even bring on a sudden onset of swelling.
- Always discuss any exercise program with your physician before you begin.
- Exercise moderately.
- Start new exercise programs slowly and increase activity gradually to avoid muscle strain.
- Warm up and cool down adequately with any exercise program.
- Swimming, walking, bicycling and low impact aerobics are recommended activities.
- Avoid fatigue, injury and overheating.
- Drink plenty of water to keep the body hydrated.
- Try to exercise in an air-conditioned environment.
Compression Garments
 Compression garments will limit the amount of swelling and thereby slow the advancement of lymphedema, as well as maintain the reduction in swelling achieved following other treatments.
Elastic compression garments such as graduated compression hosiery and arm sleeves are effective in helping promote the venous and lymphatic return by gently compressing the limb with graduated pressure - pressure which is greater distally (direction farthest from the heart) than proximally (direction closer to the heart). The specific external pressure applied to the limb also has a massaging effect on the muscle pump. Elastic stockings and arm sleeves are primarily designed to maintain and support the limb, not to reduce its size. Garments should be applied in the morning to prevent gravity from pulling fluid down into the limb. They should be worn daily while active, and removed for sleeping when the body is recumbent and the stronger external pressure of elastic garments is not necessary. Elastic stockings and arm sleeves are an essential adjunct to manual lymph treatment, compression bandaging at night, and compression pumps.
Compression hosiery can be custom made to your measurements, or ready-to-wear depending on the size and shape of your limb. Compression hosiery today is considered cosmetically acceptable, is available in many styles and colors, and patient compliance is excellent.
Short stretch compression bandages are minimally elastic. They compensate for the diminished skin pressure associated with lymphedema, and prevent the reaccumulation of evacuated, stagnating lymph fluid. The more inelastic the bandage is, the greater the potential working pressure (pressure produced when the muscle pump works against the resistance of the bandage, as when exercising). Inelastic and short stretch bandages have advantages over elastic garments because they force a higher working pressure and greater muscle pump efficiency. Conversely, because of the low resting pressure (pressure exerted when the muscle is inactive and
relaxed), compression bandages may be worn day
and night with good patient compliance.
Compression bandaging is applied in layers. The digits (fingers and toes) are individually wrapped with gauze bandages. A tubular bandage, made of primarily cotton, is worn underneath the compression padding and bandages to protect the skin and absorb excess perspiration. Padding bandages are applied just prior to the actual compression bandages to cushion the limb (especially over skin creases or bony prominences) and to prevent sharp indentations and irritations to the skin. In addition, they serve to distribute the pressure evenly over the limb. The last stage is the actual short stretch compression bandages used to apply the final compression. They are wrapped with mild to moderate tension in an overlapping pattern in a distal to proximal direction.
Lymphedema Bras are fashionable comfort and gentle compression for swelling due to chest and breast lymphedema.
NightSleeve™, made of one-way stretch, multi-layered material that applies pressure throughout the sleeve, thereby gently and comfortably evacuating fluids and preventing their return. This is a simple and effective alternative to cumbersome bandages
Compression Devices
Compression pumps are designed to promote venous and lymphatic circulation, and remove edema from the extremity by progressively moving fluid in a distal to proximal direction.
 The effect of the mild intermittent, sequential pressure is to increase interstitial pressure, thereby driving intercellular fluid into the venous capillary system. The most effective pumps are multi-chambered, and deliver calibrated, gradient pressure. Pumps are generally viewed as being most effective when combined with other treatment methods such as manual lymph drainage (MLD®). MLD® prepares the quadrants near the affected limb to be able to accept the excess fluid being forced out of the limb and to transport the lymph to a cluster of operative lymph nodes. Treatments should then be followed with compression bandaging or garments to maintain the results.
Manual Lymph Drainage (MLD®)
The Dr. Vodder method of MLD® is a manual, therapeutic method of stimulating the movement of lymph fluids in the tissues. The gentle, rhythmic, pumping, massaging movements follow the direction of lymph flow and transport lymphatic fluid from congested areas to the functioning lymphatics, often producing rapid results with lymphedema patients. Through the pumping and stretching effect on the lymph vessels, MLD® stimulates the contraction of lymph vessels, helping to move the lymph forward and drain the connective tissue.
Combined Decongestive Therapy (CDT)
CDT is a combination of MLD®, compression bandaging, exercises and skin care. It may also involve breathing exercises, compressive garments and dietary restrictions. It has been shown to relieve the edema, fibrosis and the accompanying pain and discomfort associated with these conditions. Basically, patients undergo an intensive course of treatment, usually lasting three to four weeks and may often see a good reduction in swelling during this time. Maintenance therapy is usually required at less frequent intervals in order to maintain the reduction. Patients are given specific guidelines to help maintain their reduction at home as well.
CircAid® Arm-Sleeves and Leggings are non-elastic, and are an alternative to bandaging. They are considered easier to apply, and have the advantages of non-elastic compression- high working pressure and low resting pressure. CircAid® System is a unique, adjustable band closure system of inelastic Velcro strips. Compression levels can be sustained even when the limb size is reduced by simply re-adjusting the Velcro strips, rather than completely re-wrapping the limb with bandages. Because the bands are non-stretch, there is no reduction in compression regardless of the age of the device, unlike compression bandages and hosiery which lose their compression over time.
 JoViPak® and Tribute , sleeve-like units filled with hundreds of foam polyurethane chips to cover edematous or indurated tissue. These devices are designed so that the soft outer fabric is stitched in elongated channels which simulate the recommended pattern for manual lymph drainage (MLD). Thus, when external pressure is applied to reduce the effects of swelling, these devices not only cushion the area, they facilitate the entire remedial process, also helping to prevent or relieve fibrosis. This system should be used under short-stretch bandages, with a pneumatic compression pump or under an outer compression binder.
MedAssist , a non-elastic, adjustable limb containment system that combines a custom-fabricated elastomeric liner with an adjustable strapping system to maintain limb reductions.
ReidSleeve®, a device utilizing special convoluted foam  with areas of high and low pressure to provide a gentle, gradient pressure to increase lymphatic outflow. Pressure is applied by a series of straps and is regulated with the use of a special gauge.
Successful management of lymphedema often depends on the proper blend of treatments. The combination that works best will differ depending on the individual. Find facilities or treatment centers that are familiar with all the treatment options and keep abreast of advances in the treatment of lymphedema. It is also advisable to keep in touch with local and national support groups. The Internet is an excellent source of information as well.
Please Note: These guidelines are provided for informational and educational purposes only. Please discuss all treatments with your doctor and therapist.
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