Lymphedema: New Concepts in Diagnosis and Treatment

Abstract

Purpose of Review This review's aim is to coalesce current evidence regarding the lymphatic system and lymphedema, bridge the gap from traditional approaches to emerging concepts, and present simple strategies that can be immediately implemented into everyday clinical practice.Recent Findings New evidence of the microcirculation redefines all edema as lymphedema and having the potential to result in chronic inflammation and deleterious soft tissue changes. These soft tissue changes are easily identifiable through simple manual tests that also help direct interventions. CDT is the gold standard of treatment, but components are evolving with the emergence of new technologies and new understandings of mechanobiology. The lymphatic and integumentary systems are interdependent, requiring concurrent lymphedema and wound management strategies. Summary Optimization of the lymphatic system is key to edema management and wound healing. Future research is needed to progress individualized diagnostics of lymphatic vasculature so treatment interventions can be customized to each patient.

Wound Healing with Electrical Stimulation Technologies: A Review

“…Although lymphatic drainage is not a major step in wound healing, lymphoedema is associated with chronic wounds and impedes wound recovery [68]. Moreover, the lymphatic system is part of the skin organ; therefore, lymphedema pathology must be treated concurrently, especially in the context of the chronic wound [69].…”

Wnt Signaling Regulates the Lymphatic Endothelial Transdifferentiation of Adipose-Derived Stromal CellsIn Vitro

“…Secondary lymphedema is often caused by lymphadenectomy, radiation, trauma, and infection (Deng et al, 2012;Szuba et al, 2002). Accumulation of protein-rich fluid, chronic inflammation, hypertrophy of adipose tissue, and fibrosis are common pathological changes in the swelling area (Bjork and Hettrick, 2019). Although several therapy strategies have been developed to reduce symptoms, there is no cure currently (Bjork and Hettrick, 2019).…”

“…Accumulation of protein-rich fluid, chronic inflammation, hypertrophy of adipose tissue, and fibrosis are common pathological changes in the swelling area (Bjork and Hettrick, 2019). Although several therapy strategies have been developed to reduce symptoms, there is no cure currently (Bjork and Hettrick, 2019). The surgical treatments have many shortages; in endovascular stent placement cases, displacement and deformation of the stents are widely seen (Raju et al, 2001), auto-transplantation of lymph nodes often cause damage to other parts of the body (Nguyen and Suami, 2015), and lymphovenous shunt operation is technically difficult, which could not be done without the help of microscope (Koshima et al, 2000).…”

New technologies in vascular rehabilitation

“…In the rehabilitation field, it is possible to identify multiple treatment methods aimed at reducing lymphedema. The most common ones, identified today as a gold standard for the treatment of this pathology, are compression therapy using compression bandage or graduated compression elastic stockings and manual lymphatic drainage (Bjork and Hettrick, 2019). However, new approaches to the treatment of oedemas have emerged over time, in many cases superimposable or complementary in terms of results compared to those indicated above (Bjork and Hettrick, 2019).…”

“…The most common ones, identified today as a gold standard for the treatment of this pathology, are compression therapy using compression bandage or graduated compression elastic stockings and manual lymphatic drainage (Bjork and Hettrick, 2019). However, new approaches to the treatment of oedemas have emerged over time, in many cases superimposable or complementary in terms of results compared to those indicated above (Bjork and Hettrick, 2019). Intermittent Pneumatic Compression therapy (IPC) has proven to be a valid tool in the treatment of distal oedemas (Rockson, 2018;Feldman et al, 2012).…”