Lymphedema: Causes, treatments and a new surgery that can improve quality of life

Article by Kristine Secrest of Orlando Health's Rehab Institute

Lymphedema refers to a build up of fluid caused by a blockage of the lymphatic system that creates swelling. Although this swelling usually occurs in an arm or leg, it can occur anywhere in the body. The lymphatic system is an important part of your immune system and filters waste from the body. When there is damage to the lymphatic system, the lymph fluid builds up in the tissues causing swelling. Depending on the damage, the swelling can range from mild to severe. Unlike the watery swelling of simple edema (swelling), lymphedema is a protein-rich fluid that can cause fibrosis or hardening of the skin and tissue when it accumulates.  Removal of or damage to lymphnodes as a part of cancer treatment can cause lymphedema. It can also be as a result of long-term venous insufficiency, recurrent infections or trauma. Primary lymphedema is a rare condition that is caused by problems with the development of the lymphatic system. This can be present at birth or can come on at puberty or even later. Until recently, there was no cure for lymphedema other than massage and compression. Now, people suffering from lymphedema have a surgical option that may help relieve symptoms, called vascularized lymph node transfer (VLNTx).

Lymphedema symptoms can include:

• Swelling, usually of the arm or leg, however the swelling can occur in the chest, abdomen or neck depending on where the damage occurs
• A feeling of heaviness or tightness
• Restricted motion in the arms or legs
• Aching or pain can occur due to the swelling although lymphedema generally is not painful
• Recurrent infection
• Hardening or thickening of the skin

Treatment

When seeking treatment for lymphedema, you should make sure that your therapist has had special training in order to make sure you receive optimal treatment. Ask for a certified lymphedema therapist or at least inquire about how much experience your therapist has had treating lymphedema. Treatment of lymphedema focuses on reduction of the swelling and control of the symptoms. Reduction of the lymphedema is achieved through an intensive phase of therapy and consists of manual lymph drainage, bandaging, skin care and exercises.

Manual lymph drainage (MLD) is a massage technique performed to reroute fluid from an area of congestion to an area of healthy lymphatics that can receive and process the fluid properly. Bandaging the affected area with short stretch bandages to further reduce the swelling follows MLD. Short stretch bandages are used because they offer compression without constriction that can cause decreased circulation. During bandaging specific exercises are encouraged to further increase lymphatic flow from the damaged area into healthy lymphatics. Good skin care with lymphedema is crucial to prevent infection, which is more common with lymphedema and will make the swelling and lymph damage worsen. After this intensive phase reduces the swelling then maintenance is needed. This is done through a home program that the therapist will teach you. This will include self-massage, compression, exercises and continued skin care. Compression garments can be for day or nighttime. The daytime garments are stretchy to allow more movement for daytime activities and the nighttime garments are usually more bulky and have less stretch to help reduce the swelling further. The nighttime garments are usually worn in place of having to bandage the area at night. Exercise with the daytime garments on is encouraged for improving lymphatic flow, muscle stretching, range of motion and general health. Compression pumps are used sometimes to help treat some forms of lymphedema. These can have adverse affects with some patients that are more harmful than helpful and should only be used with the recommendation of a certified lymphedema therapist.

Vascularized lymph node transfer (VLNTx) is a new procedure in which lymphnodes from a healthy part of the body are transferred to the area of lymphnode removal or damage. The transferred lymphnodes then grow new lymph vessels in order to help reduce and process the excess fluid. Often this procedure does not cure the lymphedema but does reduce the swelling and pain and improves the hardness of the skin and can reduce or eliminate infections. A specially trained reconstructive surgeon performs VLNTx and therapy before and after surgery is crucial for the optimal outcome. There are very few surgeons performing this procedure in the United States and Orlando Health is the only facility in Florida that offers this surgery. Lymphedema is a complex and frustrating condition that lasts a lifetime, however with the help of a knowledgeable healthcare team, it can be managed.