Lymphedema: Physical and medical therapy
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
A multifaceted management approach termed complex decongestive therapy (CDT) is considered the international therapeutic “gold standard” for lymphedema by many societies and lymphedema experts.1,4–7 By incorporating an empirically derived integral lymphatic massage known as manual lymphatic drainage (MLD) with compression bandaging and exercises, CDT decreases and controls swelling in the lymphedematous limb and restores its function. In addition to removing excess interstitial fluid from the limb, CDT softens associated fibrotic induration and mobilizes excess protein as well. The MLD component of CDT is purported to redirect and enhance the flow of lymph through the uninvolved initial cutaneous lymphatics, as well as to augment the dilation and contractility of the larger lymphatic conduits. Initial gentle massage of the contralateral (healthy) trunk and limb creates a watershed pathway for lymphatic flow from the subsequently manipulated affected extremity. The massage begins at the base of the lymphedematous limb and progresses to the distal segment. Figure 63.1 provides an excellent illustration of the correct sequence of truncal–limb MLD.6Table 63.1 lists the components of the two-phase CDT program composed of a treatment phase (phase I) followed by a maintenance phase (phase II).
General Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Conservative management includes: Patient education: Self-management of symptoms, maintenance of body weight and hygiene (especially in the lower limb) and infection risk reduction.Skin care: To manage and reduce of complications of lymphoedema. Involves aseptic skin washing and emollient use.Complex decongestive physiotherapy: Massage of the limb from distal to proximal − manual lymphatic drainage aims to redirect flow to intact lymphatics.Compression garments: Multi-layer inelastic lymphoedema bandaging or compression stocking; should be used once oedema is controlled.Medical treatment focuses on the efficient treatment of episodes of ulceration, infection and cellulitis.
Lymphoedema – investigation and treatment
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland in Manual of Venous and Lymphatic Diseases, 2017
Manual lymphatic drainage by massage aims to progressively move fluid from more distal to proximal sites. Various techniques are advocated, but they have several features in common. Ideally, a session should last for about one hour, performed at least daily, for a course of up to three weeks. Manual lymphatic drainage should commence with a deep breathing program to clear the abdominal and thoracic lymphatics and prepare them for fluid delivery from the more distal sites.
Physical therapy in patients with systemic sclerosis: physical therapists’ perspectives on current delivery and educational needs
Published in Scandinavian Journal of Rheumatology, 2022
SIE Liem, NM van Leeuwen, TPM Vliet Vlieland, GMW Boerrigter, CHM van den Ende, LAJ de Pundert, MR Schriemer, J Spierings, MC Vonk, JK de Vries-Bouwstra
With respect to the content of physical therapy, our finding that exercise therapy was one of the most frequently used treatment modalities is in line with one German study (8). Our study adds to these results with a more detailed description of the treatment modalities employed. Moreover, in our study, the physical therapists were the source of information, whereas the German study was based on physician reports. We found that half of the physical therapists performed massage, but we did not specify the type of massage. The study by Belz et al (8) only looked at one type of massage, manual lymphatic drainage, making it difficult to compare these proportions. Importantly, in our study, SSc-specific exercises, including hand and mouth exercises, were employed less frequently than aerobic or muscle strengthening exercises. The extent to which these exercises could have been included in the home exercises given to the SSc patients remains to be explored. Yet, the current provision of hand and mouth exercises seems relatively low as, in general, approximately one-third of SSc patients experience difficulties with mouth opening, and at least half of the patients have limited hand function (18, 19). This difference could probably be explained by a combination of a lack of information in the referral, a lack of patients’, physicians’, and physical therapists’ awareness of the possibility, and/or a lack of knowledge.
Simultaneous upper limb melanoma and breast cancer related lymphedema management
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Dimitrios Dionyssiou, Athanasios Papas, Avra Drougou, Athanasios Tsamaldoupis, Georgios Arsos, Efterpi Demiri
With the use of ICG lymphangiography, patent functional lymphatic channels were identified and marked distal of the dermal back flow area of the left forearm volar surface. The location for LVAs was chosen to be situated distally of the melanoma region, in order avoid any misconception of interference in a potential metastatic route at the central lymphatic circulation. Under microscopic view, three LVAs were performed in an end-to-end anastomosis fashion at the volar ulnar area of the forearm (Figure 2), and immediate restoration of the lymph outflow was confirmed using ICG fluoroscopy. Two weeks after the operation she was instructed to implement our LVA-lymphedema protocol daily manual lymphatic drainage and bandage for 10 days, following by a pressure garment Class II for twelve months during day time.
Applied physiotherapeutic and occupational therapeutic interventions within palliative care: an exploratory survey
Published in Progress in Palliative Care, 2019
Bert Leysen, Arne Van Daele, Tom Verrept, Wim Saeys
Ninety-one therapists who treated palliative patients within the last year used a variety of different interventions. Massage (51%) was applied most frequently followed by mobilizations (49%) and exercise therapy (46%). Passive techniques (14%) were the most commonly used mobilization interventions and within exercise therapy, these were cardiovascular (10%) and resistance training (10%). Other frequently applied interventions were: manual lymphatic drainage (MLD) (42%), walking rehabilitation (40%), breathing therapy (32%) and transfer training (32%).