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Although Lymphedema has afflicted the population for centuries,
little was understood about the disease. Only in the past ten to
fifteen years have clinicians begun to seriously focus on its treatment.
Lymphedema is an accumulation of lymphatic fluid that causes swelling
in the arms and legs. Edema occurs when venous and/or lymphatic
vessels are impaired. When the impairment is so great that the lymph
fluid exceeds the lymphatic transport capacity, an abnormal amount
of protein fluid collects in the tissues of the extremity. Untreated,
this stagnant, protein-rich fluid not only causes tissue channels
to increase in size and number, but also reduces oxygen through
the transport system, interferes with wound healing and provides
a culture medium for bacteria that can result in various infections.
Lymphedema can occur from idiopathic or unknown causes. This is
called Primary Lymphedema. Lymphedema can be present at birth, either
idiopathically or associated with arterial-venous abnormalities,
hemangioma, or lymphangioma.
Breast or abdominal surgery can result in Secondary Lymphedema.
Surgical removal of a tumor and the adjacent lymph nodes and vessels
can block lymph fluid from flowing naturally through its system.
Other surgeries that require lymph node removal are those performed
for skin cancer (melanoma), gynecological cancers, bladder or colon
cancer and prostate or testicular cancer.
Radiation therapy used in the treatments
of various cancers and some AIDS-related diseases, can damage otherwise
healthy lymph nodes by causing scar tissue to form and thus, interrupt
the normal pathway of the lymphatic fluid.
Lymphedema can occur secondary to an infection that interrupts
normal lymphatic pathway function. A severe traumatic injury may
also trigger the onset of lymphedema.
According to the World Health Organization, lymphedema affects
250 million people worldwide. Others estimate that one in every
twenty-five will suffer from some form of lymphedema during their
lifetime. The M.D. Anderson Hospital in Houston, Texas reports that
approximately 15% of all women with breast cancer will develop lymphedema
over the course of their lifetime and that lymphedema resulting
from prostate cancer is on the rise.
Lymphedema is a chronic condition and often begins with a swelling
in the hands or feet. Early diagnosis and treatment improves both
the prognosis and the condition. Left untreated, the limbs become
more edematous and the skin hardens, losing its elasticity (fibrosis).
Moreover, untreated lymphedema leads to infection and sometimes,
irreversible complications.
Compression must be applied to the limb to reduce the swelling.
Surgical compression stockings or sleeves can apply compression.
Manual Lymph Drainage (MLD) is performed by specially trained therapists,
utilizing a gentle massaging technique in conjunction with a pumping
motion. Some treatment centers use a special bandaging technique.
Increasingly, compression pumps are being used to treat lymphedema.
The system consists of a pump and an appliance (sleeve) which fits
over the extremity. Air pressure is applied to the appliance which
in turn, applies pressure to the extremity. The basic pump applies
a uniform pressure over the extremity. The better devices consist
of a pump and appliance with three or more segment which sequentially
apply pressure along the extremity, distally to proximally.
Since lymphatic pressure is greater distally than proximally, the
preferred method of compression therapy would be to mimic the lymphatic
system. This is accomplished by means of a pump that applies gradient
pressure to the segmented appliance. This system mimics the lymphatic
system wherein it applies gradual, gradient pressure distally to
proximally, moving the accumulated fluid from the affected extremities
back into the body where it can be naturally eliminated. It simulates
a gentle massaging action. Pressure and the subsequent effectiveness
can be gradually increased as the patient becomes more tolerant.
These devices are low cost, lightweight, quiet, comfortable and
easy to use for home therapy. Because of its comfort and ease of
use, compliance is very high. It is the cost-effective way to treat
lymphedema and venous insufficiency.
Compression therapy additionally, is extremely effective in curing
decubitus ulcers and the lower of the extremities.
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