Lymphedema Is there a solution?

What is the lymphatic system?

The lymphatic system is the transport system that is mainly responsible for the return of intercellular proteins to the bloodstream. But what is its usefulness and what is its role in the human body? The transport of proteins from the intercellular space is vital for the human body:

• Defence mechanisms. The ability to remove dangerous exogenous proteins that have been invaded from the external environment, such as bacteria, viruses or other toxic or infectious particles, allows the body to induce defence mechanisms, such as the formation of antibodies, quickly and specifically.

• Preventing the spread of cancer cells. The lymphatic system is also very actively involved in preventing the spread of cancer cells. Disturbances of normal tissue drainage, resulting in lymphedema, always lead to a local immune deficiency.

What does the lymphatic load, or lymph, consist of?

The lymphatic load consists of proteins, water, fat and other cells and is carried by the lymphatic system. The lymph also contains cells such as lymphocytes, macrophages and, in the case of hydrostatic filtration or tissue injury, may also contain erythrocytes.

What factors affect the lymphatic transport system?

The factors affecting the lymphatic transport system are endogenous and exogenous:

• Endogenous factors. The motor activity of lymphatic vessels is the spontaneous lymphatic activity (vasoconstriction) that ensures lymphatic transport. Lymphatic vessels contract systemically, similar to small hearts arranged side by side, following the impulse of their local pacemaker.

• Exogenous factors. The ancillary mechanisms of lymphatic transport are muscle and joint pump, pulsations of adjacent arteries, respiration and heart pump.

What is lymphedema?

Lymphedema is a pathological condition in which the lymphatic vessels are too few, dysformed or non-functional, resulting in an insufficient ability to remove the normal lymphatic load from the interstitial space. In other words, there is a mechanical deficiency.

Types of lymphedema

Primary lymphedema
Primary lymphedema is caused by the incomplete development and/or developmental abnormality of the lymphatic system and its reduced ability to manage the lymphatic load.As a result, at some stage of the person's life, the lymphatic network is deemed inadequate, resulting in the appearance of persistent edema, which becomes chronic and is now characterized as lymphedema.

• Early lymphedema. If primary lymphoedema occurs in children or adolescents and occurs before the age of 35, it is called early lymphoedema.

• Late lymphedema. If primary lymphedema occurs in people older than 35 years, it is called late lymphedema.

It is typical that, most often, the onset of lymphedema occurs after a minor injury or even simple mosquito bites.

Secondary lymphedema
Secondary lymphedema occurs in adults after mechanical failure of the lymphatic system (injury to a part of the lymphatic system). The most common cause is surgical removal of neoplastic lymph nodes (lymph node cleansing) or irradiation of these as part of a treatment plan in cancer patients. Another cause is an injury to the system, e.g. following an accident. In any case, we should mention that lymphedema can occur from 2-3 to 20 or 30 years after the injury procedure.

Where does lymphedema usually occur?

Lymphedema can occur anywhere there are lymph vessels, i.e. anywhere in the body. The most common areas where it is seen are:

• The lower limbs
• The upper limbs
• The genitals

Clinical examination and evaluation using diagnostic tests, such as Stemmer's sign, palpation and observation, are the means to guide the diagnosis of lymphedema.

Symptoms of lymphedema

Symptoms vary depending on the stage of onset.

• In the early stages of lymphedema, a soft, easy-to-move flattened swelling is seen.

• In the chronic stage, there is a proliferation of connective tissue, resulting in gradual hardening of the edema, with hyperkeratosis and epitheliomatosis.

Other symptoms may include the following:

• Thickening of the skin
• Excessive increase in the volume of the affected limb (elephantiasis)
• Lymphorrhea
• Melanocytosis
• Lipid deposition

These areas have a reduced immune capacity against potential infections. In other words, they cannot fight infections as effectively as other parts of the body. Thus, a simple injury to the already sensitive skin can very quickly lead to an erysipelas-type infection or an inflammatory cellulitis, conditions that are painful and dangerous for the overall health of the person.

Is there a cure for lymphedema?

Lymphoedema - even chronic with a severe clinical picture - is manageable and with proper treatment, the person's daily life will be upgraded and improved. In any case, however, diagnosis in the early stages contributes to a better prognosis and progression.

What we do at the "Agios Loukas" Clinic

At the "Agios Lukas" Clinic, our specialized therapists apply the model of integrated decontamination therapy (CDT) and lymphatic drainage (MLT).

First visit and history taking

During the first visit, the lymphedema specialist evaluates and assesses the situation by taking a history and performing a physical examination, in order to organise an individualised treatment plan.

Comprehensive decongestive therapy (CDT)

The comprehensive decongestive treatment includes:

• Specific sequence of special handling
• Compression bandaging using special materials
• Skin care of the affected area
• Physiotherapy
• Elevation

This removes the excess lymphatic load from the area, allowing the lymphatic system to create collateral circulation. Compressive bandaging combined with muscle activation maintains the effect until the next treatment.

At the end of the procedure, a specialised graduated compression garment is measured and manufactured, which the patient must fit and maintain according to the therapist's instructions. The garment helps maintain the effect of the treatments and improves the individual's functionality in daily activities.

Required number of sessions

The number of sessions is determined by the clinical picture. While a stage 1 lymphedema can improve in just 3-4 sessions, an advanced one will need 10-12 treatments before it is ready to receive the compression garment. Possible complications, however, such as an infection or inflammation, can lengthen the overall duration.

Text:
Theophanis Papageorgiou PT, MLD/CDT, Physiotherapist
Department of Physical Medicine and Rehabilitation, "Agios Loukas" Clinic.

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