HOW IS LYMPHATIC OEDEMA TREATED?
90% of patients achieve a satisfactory improvement with medical treatment. In other cases, and after medical treatment has failed, surgery is required.
1. Psychological Measures
In many cases, it is impossible to identify the cause of the disease and the patient gets very concerned about his or her aesthetic body image and slow progress. Treatment must be planned in collaboration with the patient and he or she needs help in understanding that constancy is required to reach the desired results. The effectiveness of the treatment is directly related to the precocity with which the treatment is started.
2. Hyegenic And Preventive Measures
These measures are aimed at two main objectives: Not to increase the uptake of interstitial tissue and to favour its evacuation. This is achieved by avoiding excessive exposure to heat, by avoiding skin infections, avoiding garments that impede adequate venous/lymphatic circulation (such as bands or suspenders, tight socks, very tight underwear, girdles, etc.) These precautions are aided by moving the involved limbs, sleeping with the legs elevated, etc. Exercise must be mild and swimming is considered the most beneficial.
3. Physiotherapeutic Measures
The main objective is to favour the function of the affected limbs by draining the liquids as well as the proteic molecules, avoiding the simultaneous reappearance of oedema. There are several types:
a) Manual lymphatic drainage: Movements are carried out gently, avoiding aggressive manoeuvres. All movements mimic the flow of lympha in the vessels, acting on the nervous system of the vascular wall of lymphatic vessels. Its action mechanism acts on several levels: sedating, stimulating and toning effect. Its mechanical action exerts the following effects: it induces a balance in the nervous system causing a relaxation of the lymphatic white musculature. An inhibitory activity of pain is also produced, facilitating the uptake of proteins and transports waste products from the tissues to peripheral nodes so that waste products are processed by the defines mechanisms of the body.
b) Intermittent pneumatic presotherapy: Intermittent presotherapy (sequential) presents many advantages over constant presotherapy, which may be dangerous as it does not allow relaxation of the conducts. In intermittent mesotherapy lower pressures are applied at a distal level. The pressure is gradually increased as we approach the centre of the body. The period of decompression favours the aspiration of liquid by the capillary vessels and expulsion towards precollectors.
c) Endermology: Subdermal therapy (Siluette o LPG) is a high technology technique that employs an aspiration system and two rollers. These rollers will rotate electromechanically in one direction or another, according to the direction selected. The area that exerts a negative pressure is located between both rollers. The combination of vacuum and rollers and the way in which they come into contact allow the opening, decompression and pulling of the different arterial venous and lymphatic structures, favouring an enhanced blood flow with its nutrients whilst eliminating high molecular weight proteins and waste metabolic products. It also helps in the reabsorption of interstitial oedemas.
4. Compressive Measures
a) Non-elastic or slightly elastic adhesive bandages: These must be changed every 3 to 6 days and present several drawbacks: allergy, difficult hygiene and impossibility to apply other treatments (manual drainage, preso or endermology).
b) Compression bandages: They exert pressure more distally than proximally, making tissue and vascular hyperpressure more difficult. They are usually worn during the day and taken off at night. One of the drawbacks is that they are very hard to put on but they are rather efficient.
c) Elastic bandages: This is the most aesthetic and reliable option. Several models are available. Strong compression models are preferable although they need to be controlled regularly to avoid ischemia, regional compression and loss of pressure.
5. Pharmacological Measures
Lymphatic drugs (lymphodrugs) (1)
-Rutosides, ruscus or escine, diosmine, calcium dobesilate, hidrosmine.
(1) Anals of Vascular and Cardiac Surgery 2001; 7 (1): 55-57
6. Surgical Treatment Of Lymphedema
It is only performed in extreme cases (grades 4 and 5 lymphedema). Surgical treatment is always adjuvant and the initial treatment is always conservative.
In summary, treatment for this condition is conservative in most cases and lifelong.