Management of lymphedema

Abstract

The basic principle of the management of lymphedema is so called complex decongestive physical therapy. This therapy is divided into two phases: (i) edema reduction phase--an initial intensive treatment phase aiming for limb volume reduction; and (ii) maintenance phase--following long-term phase to sustain a manageable limb volume. The first phase consists of a number of physical therapeutic approaches which are: manual lymph drainage, pneumatic pump drainage, low-stretch bandaging, exercises, and skin care. Long-term maintenance phase consists of self-lymph drainage, low-stretch bandaging, or compressive garments, and sometimes when indicated pneumatic pump drainage, exercises, and skin care.

Effect of a 10-week yoga programme on the quality of life of women after breast cancer surgery

“…Lymphedema of the upper extremities can appear as a complication of surgical treatment of breast cancer and it affects 10-30% of patients [ 10 ]. Well-chosen exercises make lymph flow more efficiently and thus, they decrease the risk of lymphedema occurrence, or reduce the severity of the existing one [ 10 ]. Yoga poses (asanas), including trunk twists, massage, purify and regenerate organs of the abdominal cavity.…”

Management of lymphoedema

“…Ultrasonographic evaluation enables the measurement of the thickness of the skin and subcutaneous tissue. The quantifi cation of the degree and uniformity of the skin and subcutis swelling using ultrasonography may prove a simple, useful, and reliable outcome measure of lymphoedema [20]. Other diagnostic or investigational tools are magnetic resonance lymphography, indirect (water soluble) lymphography, near infrared fl uorescent imaging, fl uorescent microlymphangiography, dual energy x-ray absorptiometry or bi-photonic absorptiometry, and genetic testing.…”

“…The requirement for custom garments must be determined individually; general indications include irregular limb contour and extensive fi brosis. Compression garments should be replaced every 6 months [20]. Compression bandaging and compression garments demonstrate eff ectiveness in various stages of the treatment of lymphoedema.…”

“…It represents an objective evaluation of limb volume and ensures a valid measurement. For clinician diagnosis, limited data are available at this time [20,21].…”

“…To achieve the best results, the CDT should take place at least 5 days in each week. Hospitalisation is preferred for some patients, including immobile patients, patients with complications and comorbidities, and those who cannot undergo therapy in everyday regime on an outpatient basis [19,20]. Phase 2 of the CDT is a long-term maintenance therapy, individualised to the requirements of each patient.…”