Lymphoedema: Causes, Symptoms, And Treatment Options

Write short note on Lymphoedema.

Answer. Lymphoedema is the accumulation of lymph in extracellular and extravascular fluid compartment commonly in subcutaneous tissue.

It is due to defective lymphatic drainage.

“Treatment Options For Lymphoedema“

Lymphoedema Classification

Primary without any identifible lymphatic disease.

Secondary is acquired.

“Role Of Lymph Nodes In Lymphoedema Development”

Lymphoedema Pathophysiology

Decreased lymphatic contractility, lymphatic valvular insuffiency, lymphatic obliteration by infection, tumor or surgery causes all effcts and pathology of lymphoedema.

This leads to lymphatic hypertension and dilatation causing lymph stasis, accumulation of proteins, glycosamines, growth factors,and bacteria.

“Compression Therapy For Lymphoedema“

There is more collagen formation, deposition of proteins, fibroblasts, ground substance causing firosis in subcutaneous and outside deep fascia.

Muscles are normal without any edema but may get hypertrophied.

“Role Of Lymphoscintigraphy In Lymphoedema Diagnosis”

Lymphoedema Clinical Features

Most commonly lower limb is involved.
Presence of swelling in the foot which extends progres sively in the neck and show tree-trunk pattrn leg.
Presence of bufflo hump in dorsum of foot.
Athlete’s foot with joint pain and disability
Fever, malaise and headache
Initially pitting edema occurs which later on become
Non-Pittng.
Stemmer’s sign is positive, i.e. skin over dorsum of foot cannot be pinched because of subcutaneous firosis.

“Early Symptoms Of Lymphoedema”

Lymphoedema Grading of lymphoedema

This is given by Brunner

Latent: No clinically apparent lymphoedema
Grade I: Pittng edema which more or less disappears on elevation of the limb.
Grade II: Non-pittng edema occur which does not reduce on elevation
Grade III: Edema with irreversible skin changes like firosis,papillae, figuring.

“Tests For Diagnosing Lymphoedema“

Lymphoedema Treatment

Conservative:

Elevation of limb, exercise and weight reduction.
Static isometric activities should be stopped such as prolong standing or carrying heavy weight.
Rhythmic movements should be encouraged such as swimming,massaging
Daily wearing of below-knee stockings
Trauma and infection should be avoided.
Complex decongestive therapy should be given.
It occurs in two phases, i.e. intensive therapy and maintenance therapy.

“Signs Of Lymphoedema In The Legs”

Lymphoedema Surgeries:

Excision of lesion can be done by Charle’s or Homan’s operation.
Physiological: Omentoplasty can be done.
Combination ofExcision and physiological: Both excision and creation of communication between superfiial and deep lymphatics. Sistrunk and Thompson’s operation can be done.
Bypass procedures can be done
Limb reduction surgeries can be done.