Lymphedema is swelling in a part of the body
due to impaired function of the lymphatic drainage system.
Most often this disease presents in the lower extremities,
however may present in the upper extremities, face, trunk,
or external genitalia. (1) Lymphedema is a progressive disease
that develops when lymphatic vessels are unable to rid the
body of waste substances. As in a chronic inflammation,
the body stages an immune response to the increase in tissue
fluid and uncleared wastes. Untreated, lymphedema can cause
skin to harden, change color, become tougher, and ultimately
breakdown. The areas affected are generally more prone to
recurrent infections, cellulites, and lymphangitis. (2)
Abnormalities with the lymphatic system may be caused by a condition
at birth. This type of lymphedema is known as primary lymphedema,
and has a variety of causes. Symptoms may develop at any age.
If there is an absence of lymph capillaries, only a modest amount
of lymph fluid can be carried away. Other times there are too
few lymph vessels in the body, or they are too narrow. Whatever
the cause, primary lymphedema results from insufficiencies in
the lymphatic system to properly rid the body of excess fluid.
(3) Secondary lymphedema is acquired by anything causing harm
to a healthy lymphatic system. Causes may include infection,
trauma, malignant tumors, vein
disease, or certain surgeries. (4) The most common cause
of secondary lymphedema is from therapy associated with cancer.
Radiation therapy can scar lymphatic vessels, while lymph nodes
that have been removed for examination of cancer cells can impede
lymphatic function. (5) In the developing world, lymphedema
is common after a bacterial infection from the Wusheria bancrofti,
otherwise known as filariasis. (6) People with compromised vein
function may also develop secondary lymphedema. The venous system
works in part to transport metabolic waste from tissues and
reabsorb water produced from the filtration of lymphatic fluid.
An “overworked” venous system may in turn cause
impaired lymphatic function. (7)
Despite all, the lymphatic system is a resilient system and can
handle increased loads of interstitial fluid, at least temporarily.
Chronic high levels of interstitial fluid will inevitably cause harm
to the lymphatic system and ultimately edema formation. Fortunately,
there are a variety of treatment modalities that are successful in
controlling this disease. When simple solutions such as elevating
the affected limb fail to reduce the swelling, compression stockings
and sleeves are often used. More aggressive treatments include use
of compression stockings and sleeves used in conjunction with pneumatic
compression pumps, massage therapy, special exercises, and multilayer
bandaging. Combining these various treatment methods, collectively
known as complete decongestive therapy, have been proven to be the
best treatment for lymphedema. (8)
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