A clinical study of lymphedema management

Authors

  • Mahesh M. S. Department of Plastic Surgery, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka
  • Rajashekar Jade Department of General Surgery, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka
  • Naveen N. Department of Plastic Surgery, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka
  • Prema Dhanraj Department of Plastic Surgery, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka
  • Hanumanthaiah K. S. Department of General Surgery, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka

DOI:

https://doi.org/10.18203/2349-2902.isj20160487

Keywords:

Lymphedema, Chronic oedema, Complex decongestive physiotherapy, Manual lymph drainage, Treatment

Abstract

Background:Lymphedema is chronic disorder of the lymphatic system characterized by impaired lymphatic return resulting in swelling of the affected area. Though it is an important cause of morbidity, epidemiology and impact of this condition on patients or health services is only modestly known. Management of lymphedema primarily aims at reducing or halting progression of swelling and to prevent associated infection. A combination of skin care with moisturizers and emollients, compression bandages, isotonic exercise and regular massage are used in treatment of the disease. The notion of using external physical means to incite lymphatic drainage has a sound physiological basis. However with currently available poor evidence of relative effectiveness of methods it is improbable to rely on a single technique alone.

Methods: 33 patients presenting with lymphedema in department of plastic surgery, RRMCH, were included in the study. Patients with congenital lymphedema were excluded from the study group. Therapy was individually tailored for each patient. Patients were evaluated for the efficacy of the treatment initiated at 1, 3, 6 and 9 months. Treatment methods included complex decongestive physiotherapy (CDP), use of elasto-compressive bandages, and multi-layered lymphedema bandages (MLLD) along with limb elevation, meticulous skin care and remedial physiotherapy.

Results:Of the 33 patients, 12 were males, 20 females and one third gender. 11 patients had upper-extremity lymphedema, 21 patients had lower-extremity lymphedema and 1 patient had scrotal lymphedema. Patients underwent Conservative treatment alone, Pneumatic Compression, Complex Decongestive Physiotherapy (CDP) or Miller’s Debulking Procedure. Both volumetric assessment and patient satisfaction were considered to assess the outcome of treatment. Necessary changes were done in the treatment thereafter.

Conclusions:Lymphedema is a debilitating disease with both physical and mental implications on the patient. The management should involve the patient too. The psychological aspect of the patient should also be addressed. Treatment should be tailored and changes be made appropriately as per requirement. With no current definitive therapy, a holistic approach is to be employed.

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Published

2016-12-08

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Section

Original Research Articles