Management of lymphoedema

General treatment methods include:

• 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

Reference:

• (1) . National Institute for Health and Clinical Excellence (NICE). Interventional procedure overview of liposuction for chronic lymphoedema
• (2) National Cancer Institute 2008. Lymphedema
• (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.
• (6) Morrell R.M et al. Breast Cancer-Related Lymphedema. Mayo Clin Proc. 2005;80(11):1480-1484