educating the patient and family about the risk of developing lymphoedema and about the early detection of signs of oedema
skin and nail care - to reduce risk of skin infection
extremity positioning - elevation of the limb above the level of the heart when possible
exercise - nonfatiguing exercises may decrease swelling (1)
manual lymph drainage (MLD) - light massages which causes the lymphatic fluid to move away from the affected limb (2)
decongestive lymphatic therapy (DLT) or combined decongestive therapy (CDT) - includes a combination of compression bandaging, skin care and decongestive exercises. It reduces the pain and discomfort caused by lymphoedema (2)
diuretics are often prescribed for lymphoedema yet appear clinically unhelpful - there are no published trials related to the use of diuretics in this setting (2)
antibiotics are used if infection present
secondary lymphoedema requires specific therapy appropriate to the underlying disease
surgery - used in patients where non surgical treatment methods have failed (2):
most effective treatment of lymphoedema is complex decongestive therapy (3):
only 5% of patients with lymphoedema will be suitable for surgery
three main types of surgical procedure, liposuction, debulking operations and bypass procedure
liposuction has been used with promising results but mainly in arm lymphoedema
debulking operations
there are four well-known debulking procedures, Homan's, Charles, Servelle's and Thompson's. All give variable results and complications are common and serious
bypass procedures are undertaken only in specialised centres
(3) Badger CM, Peacock JL, Mortimer PS. A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb. Cancer 2000; 88: 2832-7.
(4) Drug and Therapeutics Bulletin 2000;38 (6): 41-43.
(5) Tiwari F et al. Management of Lower Limb Lymphoedema in the United Kingdom. European Journal of Vascular and Endovascular Surgery 2006; 31 (3): 311-315.
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