Conservative Treatment of Lymphoedema of the Limbs

Abstract

Management of Lymphoedema is extremely variable in the medical profession, ranging from aggressive diagnostic procedures, which may aggravate the disease (lymphography by oily contrast mediums) in combination with therapeutic nihilism to precipitous operations. Scattered between these two contraversial extreme positions are quite a number of various conservative methods - some of which being in conflict with the anatomy and physiology of the lymph vascular system and the pathology of Lymphoedema. Lymphoedema, if left untreated, or is treated inadequately, may lead to invalidity and to death if Stewart-Treves Syndrome develops. Unnecessary surgery may have disastrous consequences. The paper describes how Lymphoedema can be treated with success, free of any side effects, by complex physiotherapy.

Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment

“…It involves a series of gentle circular movements, starting with stimulation of the axillary lymph node chain contralateral to the surgical manipulation and of the inguinal chain homolateral to the surgical manipulation. This is followed by gentle movements at a site distant from the area of congestion, moving gradually towards the swollen limb (12,18,22,23). lymphoscintigraphy is an effective technique for evaluating the lymphatic systems of the upper and lower limbs (5,24,25).…”

Evidence-Based Usefulness of Physiotherapy Techniques in Breast Cancer Patients

“…This is always performed from proximal to distal regions, with wavelike maneuvers in the upper arm region and then the forearm and hand, until reaching the fingers (Fig. 5) (Foldi et al, 1985;Camargo & Marx, 2000;Williams et al, 2002;Linnitt, 2005). The direction of lymphatic drainage should respect the anatomy of the lymphatic system, and it is very important to take into consideration the deviation in the region of the deltoid muscle (Stanton et al, 2009;Sarri et al, 2010).…”

“…Evacuation of the lymphatic fluid by means of manual lymphatic drainage diminishes the pressure on the tissue and increases the effective ultrafiltration pressure. Elastic bandages increase the tissue pressure and counterbalance the elastic insufficiency, thereby avoiding recurrence of lymphatic fluid accumulation in the interstices (Foldi et al, 1985). Compressive bandaging is an important technique, because it boosts the effects achieved through the preceding lymph drainage.…”

“…Concomitantly with using the compression garments, the patient should also comply with the guidance previously given regarding limb care, hydration and kinesiotherapy. (Foldi et al, 1985;Roucout & Oliveira, 1999;Andersen et al, 2000;Camargo & Marx, 2000;Huit, 2000;Hampton, 2003). In our institution, we use compression garments in conjunction with self-massage and kinesiotherapy in cases of initial lymphedema, with significant improvements achieved.…”

“…The second phase, called the maintenance phase, has the aims of keeping the interstitial pressures in balance and optimizing the results obtained from the first phase of the treatment. It consists of using compression garments, skincare, hydration, kinesiotherapy and manual self-massage (Foldi et al, 1985;Camargo & Marx, 2000;Bergmann et al;Leal et al, 2009;Sarri et al, 2010).…”