Effective Treatment of Lymphedema of the Extremities

Abstract

To define the immediate and long-term volumetric reduction following complete decongestive physiotherapy (CDP) for lymphedema. Design: Prospective study of consecutively treated patients. Setting: Freestanding outpatient referral centers. Patients: Two hundred ninety-nine patients referred for evaluation of lymphedema of the upper (2% primary, 98% secondary) or lower (61.3% primary, 38.7% secondary) extremities were treated with CDP for an average duration of 15.7 days. Lymphedema reduction was measured following completion of treatment and at 6-and 12-month follow-up visits. Intervention: Complete decongestive physiotherapy is a 2-phase noninvasive therapeutic regimen. The first phase consists of manual lymphatic massage, multilayered inelastic compression bandaging, remedial exercises, and meticulous skin care. Phase 2 focuses on self-care by means of daytime elastic sleeve or stocking compression, nocturnal wrapping, and continued exercises. Main Outcome Measures: Average limb volumes in milliliters were calculated prior to treatment, at the end of phase 1, and at 6-to 12-month intervals during phase 2 to assess percent volume reduction. Results: Lymphedema reduction averaged 59.1% after upper-extremity CDP and 67.7% after lower-extremity treatment. With an average follow-up of 9 months, this improvement was maintained in compliant patients (86%) at 90% of the initial reduction for upper extremities and lower extremities. Noncompliant patients lost a part (33%) of their initial reduction. The incidence of infections decreased from 1.10 infections per patient per year to 0.65 infections per patient per year after a complete course of CDP. Conclusions: Complete decongestive physiotherapy is a highly effective treatment for both primary and secondary lymphedema. The initial reductions in volume achieved are maintained in the majority of the treated patients. These patients typically report a significant recovery from their previous cosmetic and functional impairments, and also from the psychosocial limitations they experienced from a physical stigma they felt was often trivialized by the medical and payor communities.

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“…In one of the larger studies of CDT (n 5 299 patients), researchers reported average reductions in limb volumes of 59% (for upper-extremity LE) and 68% (for lower-extremity LE). 7 …”

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“…Components of Combined, Complex or Comprehensive Decongestive Therapy include manual lymph drainage (MLD), multi-layer, short-stretch compression bandaging, lymphatic exercise, skin care, and education in lymphedema management as well as elastic compression garments (Didem et al, 2005;Ko, 1998). There are to phases of CDT: Phase I (Reductive) and Phase II (Maintenance).…”

“…The first phase's frequency and duration should be altered as to produce the best possible outcome of improvements in skin and reduction in swelling of the affected area in the shortest time period. Normally, CDT is completed within 3 to 8 weeks and administered daily, or 5 days per week Ko, 1998;Yamamoto et al, 2008). The second phase of CDT is a self-management program is set up directly following completion of phase I.…”

“…This includes changing compression garments every 4-6 months and equipment replacements and maintenance. Monitoring by a medical profession is, also, essential to the long-term success for lymphedema treatment (Ko, 1998;Hafner et al, 2005;Boris et al, 1994;Johnstone et al, 2006;Lasinski, 2002).…”

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“…Nakao et al (2013) JIN et al, 2009;OASHI et al, 2012;HÄGERLING et al, 2013;KUWAHARA et al, 2013). Segundo Kazenwadel et al (2012) (SLAVIN et al, 1997;KO et al, 1998;SZUBA;ROCKSON, 1998). A linfangiogênese terapêutica tem sido vista como uma estratégia de tratamento com o potencial de reverter os estigmas da insuficiência linfática primária e secundária.…”