LYMPHEDEMA

Lymphatic System
• A series of lymphatic vessels
similar to the circulatory system
carrying lymphatic fluid through
-out the body to transports
lymphatic.
• A scavenger system that
removes from the interstitial
spaces excess: fluid, proteins,
fats, cellular debris , other
large particle size matter.
 Lymphedema
Lymph fluid is comprised of protein, salts, water, and
white blood cells. The build up of extra protein rich
fluid is what we call
Lymphedema:
• Occurs when there is a build up of lymphatic fluid
because the system is unable to process the load
• Build up of fluid in the body due to a blocked lymph
node or damage to the lymph vessels
• Usually in the arm or legs, but can occur in other
regions such as the trunk or face
 Types of Lymphedema
• Primary: which is a developmental
abnormality either congenital or hereditary
• Occurs most often in lower extremities
• May be present at birth or may develop later
in life
– congenital - present at birth
– praecox – before age 35
– tarda - after age 35
• Impaired development of the lymph system
 Types of Lymphedema
• Secondary: Which is the most common form caused from a
known insult to the lymphatic system such as lymph node
dissection, radiation, trauma, surgery, infection, CVI,
immobility, illness, chronic venous insufficiencies or self
induced
• Caused by damage to the lymph system by some insult
– Infection - cellulitis
– Trauma
– Radiation - fibrosis
– Surgery - lymph node dissection / other surgery
– Chemotherapy - scarring
– Tumors - “malignant Lymphedema”
– Lymphatic Filariasis
 Lymphedema Stages
• Stage O: Latency stage: No swelling noted, but
there exists a subnormal transport capacity.
Education is important at this stage
• Stage 1: Edema is present, but fluctuates.
Responds to elevation
• Stage 2: “Spontaneously irreversible”: Tissue
becomes harder more fibrotic and pitting is
difficult
• Stage 3: “Elephantiasis: Extreme increase in
fibrotic tissue with skin changes such as open
wounds, papillomas and deep skin folds
 Who is at Risk for Lymphedema?
• Those with cancer that has spread to the lymphatic system
• People who have undergone treatment for
breast/prostate/uterine/ lymphoma/melanoma
• cancers
• Surgery
• Surgical removal of lymph nodes
• Chemotherapy
• Radiation
• Those who have been injured or sustained trauma to the
body that damaged the lymph vessels or nodes (i.e. general
surgery, car accidents, etc.)
• Infections (i.e. cellulitis)
 Complicating Factors
• Extent of damage to lymph system
• Obesity
• Age
• Infection of an at-risk extremity
• Vigorous distal extremity exercises, particularly
with a dependent limb
• Poor patient compliance
• “Cording” – Axillary Web Syndrome
• Supplemental cancer treatments
 S & S of Lymphedema
• Mild to extreme edema
• May be pitting or non-pitting
• Skin may be indurated and/or brawny
(hardened and thickened)
• Skin color may be darker, and may be flaky
• Heaviness, pain etc
 Differential Diagnosis
• Edema secondary to CHF
• Lymphedema
• Malignant Lymphedema
• Chronic Venous Insufficiency (CVI)
• Lipidema/Lipolymphedema
• Combinations of the above
 So, what’s the problem?
• The increased distance between the blood vessels and
the tissues combined with lymphostasis causes several
problems:
– #1: Nutritional status is impaired
– #2: Immune response is impaired
– #3: Mechanical stress
• The skin and tissues underneath are in a state of
malnutrition
• Wounds heal slower or not at all
• Mechanical stresses continuously damage the wound
bed
• This allows for opportunistic infections to occur
 Assessment of edema
Establish diagnosis
• Patient Interview
• Medical history; previous Rx
• Onset and time of swelling
• Distribution
• Precipitating/Reducing factors
• Symptoms e.g. Heaviness, pain etc Effect on
function
• Psychological effects
 Assessment of edema
Physical Examination
• Site of swelling
• Severity/Stage of swelling
• swelling-
• Palpation
• Skin condition
• Function
• Clinical edema measurements
 Treatment of Lymphedema
• Complex Lymphatic Therapy
• kinesiotaping
• Light lymphatic massage
• Diuretics
• Fluid restriction
• TED hoses
• Pump
• Draining of fluid
• De-bulking surgery
• Amputation
 Steps To Take To Decrease Risk
Be Physically Active
• Contraction of muscles improves lymphatic
flow
• Use your extremity for normal everyday
activities to maintain strength
• Exercise regularly
• Do not over tire your extremity, listen to your
body, if it hurts = stop, rest, elevate