Surgical Treatment and Rehabilitation Strategies for Upper and Lower Extremity Lymphedema: A Comprehensive Review

Abstract

Lymphedema is a chronic disabling condition affecting a growing number of patients worldwide. Although lymphedema is not life-threatening, several reports underlined detrimental consequences in terms of distress, pain, functional impairment, and infections with a relevant decrease in quality of life. Currently, there is no cure, and the therapeutic management of this condition aims at slowing down the disease progression and preventing secondary complications. Early diagnosis is paramount to enhance the effects of rehabilitation or surgical treatments. On the other hand, a multidisciplinary treatment should be truly integrated, the combination of microsurgical and reductive procedures should be considered a valid strategy to manage extremity lymphedema, and rehabilitation should be considered the cornerstone of the multidisciplinary treatment not only for patients not suitable for surgical interventions but also before and after surgical procedures. Therefore, a specialized management of Plastic Reconstructive Surgeons and Physical and Rehabilitative Medicine physicians should be mandatory to address patients’ needs and optimize the treatment of this disabling and detrimental condition. Therefore, the aim of this review was to characterize the comprehensive management of lymphedema, providing a broad overview of the potential therapy available in the current literature to optimize the comprehensive management of lymphedema and minimize complications.

Early Referral for Breast-Cancer-Related Lymphedema: Do We Follow the Evidence? A Two-Year Prospective Multicenter Cohort Study

“…Conservative treatment of more advanced stages of LE consists of Complex Decongestive Therapy (CDT), with elements such as manual lymph drainage, compression bandages, skincare, and exercise. In relation to the current debate about the relevance and contribution of the different treatment modalities within the CDT, a recent review of de Site et al underlines the importance of compression therapy as the cornerstone of the treatment and advocates the use of a multidisciplinary integrated approach emphasizing exercise therapy, self-management, and lifestyle [ 36 ].…”

Efficacy of kinesio taping on upper limb volume reduction in patients with breast cancer-related lymphedema: a systematic review of randomized controlled trials

“…In this scenario, a comprehensive rehabilitation approach is needed to target the multidimensional effects of lymphedema with physical therapy, weight management, and dietary supplements to reduce upper limb volume and improve overall well-being of patients with BCRL. 12 - 16 Following the current guidelines, 14 BCRL should be treated conservatively with a complete decongestive therapy (CDT), as well as physical exercise, manual lymphatic drainage, and multilayer compression bandages. 17 - 20 Moreover, an early and appropriate intervention can lead to a diminishing complication incidence, improving the prognosis of the clinical status.…”

Combination of conservative and surgical methods in the treatment of giant lymphedema of the scrotum: A case report

“…As a rule, conservative therapy allows for significant improvement in the patient's condition, especially in the early stages of the disease. An important aspect is an integrated approach in the choice of conservative techniques ( 5 ) We use complex physical decongestive therapy (Complex Decongestive Therapy according to M. Földi), which allows not only to achieve a reduction in edema by more than 75%, but also to maintain the results achieved during the treatment.…”