Treatment of lymphedema
The primary goal of a lymphedema treatment is reduction of the congestion in the lymphatic vessels and surrounding tissues. On the one hand, this should provide relief to the affected person; on the other hand it should inhibit or reduce the progression of the disease and possible further consequences and complications.
However, lymphedema cannot be cured. With a therapy started as early as possible and pursued consistently, the disease can however be well treated such that the patients can manage the disease and any restrictions.
Treatment of the lymphedema with complex physical decongestive therapy in 2 phases
The standard treatment for lymphedema is the complex physical decongestive therapy (CPD). This consists of two phases of different treatment intensities (decongestion and maintenance) and the following coordinated components:
1. Remoisturising skin care, skin cleansing if required (e.g. in the event of tinea) and protection from skin injuries and infections.
2. Manual lymph drainage (MLD), supplemented at need with additive manual techniques from a trained therapist. If required, the treatment can be supplemented by the use of an intermittent compression apparatus in the practise or clinic or as a home device.
In the decongestion phase, the manual lymph drainage should be performed at least 5 times per week, or even daily if possible. The frequency of the manual lymph drainage in the decongestion phase should be adjusted according to the clinical findings, e.g. 1 to 2 times per week.
3. Compression therapy with special, multilayered temporary compression bandages (decongestion phase) and/or lymphological compression stocking aids (maintenance phase).
4. Decongestion-promoting sport/physiotherapy, ideally with compression or in water.
5. Education and training for individual self-therapy.
6. If required, psychological care and guidance may be helpful.
The special role of compression therapy
Medical compression therapy forms the basis for a successful edema therapy during both the decongestion phase and as part of the maintenance phase. Different products are appropriate depending on the phase and disease stage.
Decongestion phase:
In der Entstauungsphase wird unmittelbar nach der manuellen Lymphdrainage ein meist aus mehreren Komponenten bestehender Kompressionsverband (Bandage) angelegt. Short-stretch bandages provide the dressing with a high working pressure. For relatively uncomplicated leg shapes, so-called wrap dressings (non-elastic dressings with velcro) can be applied as an alternative for the decongestion.
Maintenance phase:
The task of the compression aid is to maintain the result achieved in the decongestion phase and to avoid aggravation of the edema.
In der Erhaltungsphase werden meist nach Patient:innen-Mass gefertigte flachgestrickte Kompressionsstrümpfe (z. B. OPTIFORM FLEX / HOLD / FEEL von Sigvaris) angewendet. Only for very mildly pronounced edema without variations in circumference and toe/finger swelling can circular-knitted compression stockings with high material strength also be used for well treated lymphedema. However, compared to flat-knitted aids they have a higher risk of generating constrictions in the tissues.
Flat-knitted compression aids are individually manufactured for the patient. The knitting technique means nearly every body region as well as large volumes or extreme differences in circumference can be provided for. The material is thicker and less elastic in order to provide a planar, constant pressure on the leg. Correctly adjusted and worn, the stockings fit perfectly, provide an exactly defined pressure and ensure relief of the affected region.
In selected cases, additional surgical treatment of the lymphedema can supplement the conservative therapy. Surgical therapy should be considered if a patient shows a level of suffering or increase in complications and subsequent damage despite conservative therapy of the lymphedema.
