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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.
This text contains excerpts from various
papers on lymphedema.
Robert G. Friedenrich is CEO of Bio Compression Systems,
Moonachie, NJ, a company that pioneered
the compression therapy equipment.
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