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Lymphedema Management

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Table of Contents

1 ANATOMY 1.1 Circulatory System Components Systemic Circulation 1.2 Lymphatic System Embryology and Development of the Lymphatic System 1.3 Topography 1.4 Components Lymph Fluid Lymphatic Loads Lymphatic Vessels Lymphatic Tissues 1.5 Lymphatic Watersheds Sagittal Watershed Horizontal Watershed Watersheds between the Trunk and the Extremities 1.6 Interterritorial Anastomoses 1.7 Lymphatic Drainage and Regional Lymph Node Groups of Different Body Parts Lymphatic Drainage of the Scalp, Face, and Neck Lymphatic Drainage of the Neck Lymphatic Drainage of the Trunk Lymphatic Drainage of the Upper Extremity Lymphatic Drainage of the Lower Extremity Recommended Reading 2 PHYSIOLOGY 2.1 Heart and Circulation 2.2 Blood Pressure Blood Capillary Pressure 2.3 Capillary Exchange Diffusion Osmosis and Osmotic Pressure Colloid Osmosis and Colloid Osmotic Pressure Filtration and Reabsorption 2.4 Physiology of the Lymphatic System Lymph Time Volume and Transport Capacity of the Lymphatic System Safety Factor of the Lymphatic System 2.5 Insufficiencies of the Lymphatic System Dynamic Insufficiency Mechanical Insufficiency Combined Insufficiency 2.6 Edema and Lymphedema at a Glance Edema Lymphedema 2.7 Understanding Starlings Equilibrium Recommended Reading 3 PATHOLOGY 3.1 Lymphedema Definition Incidence of Lymphedema Lymphedema Incidence among Non-Breast Cancer Patients Lymphedema Genetics Etiology of Lymphedema Stages of Lymphedema Grading of Lymphedema Based on Severity Precipitating Factors for Lymphedema Avoidance Mechanisms Complications in Lymphedema Axillary Web Syndrome Impact of Lymphedema on Quality of Life Diagnosis of Lymphedema 3.2 Evaluation of Lymphedema Research in Lymphedema: Issues of Measurement and Assessment of Occurrence Radiation-Induced Brachial Plexopathy and Lymphedema Imaging of the Lymphatic System Therapeutic Approach to Lymphedema 3.3 Chronic Venous and Lymphovenous Insufficiency Definition of CVI Post-thrombotic Syndrome Venous Dynamics in the Lower Extremities Pathophysiology of CVI Stages of CVI Complications Evaluation Therapeutic Approach 3.4 Wounds and Skin Lesions Common Skin Changes and Wound Types Associated with Chronic Lymphedema Wound Bed Preparation 3.5 Lipedema Definition Etiology and Natural History Pathology and Pathophysiology of Lipedema Stages Evaluation Therapeutic Approach Invasive Modalities 3.6 Traumatic Edema Definition Pathophysiology Effects of Inflammation on the Lymphatic System Therapeutic Approach 3.7 Inflammatory Rheumatism Definition Anatomy of a Synovial Joint Pathophysiology Effects on the Lymphatic System Therapeutic Approach 3.8 Reflex Sympathetic Dystrophy Definition Pathology and Stages Lymphatic Involvement Therapeutic Approach 3.9 Cyclic Idiopathic Edema Complete Decongestive Therapy References Recommended Reading 4 COMPLETE DECONGESTIVE THERAPY 4.1 History and Background Discovery of the Lymphatic System Development of Complete Decongestive Therapy 4.2 Goal of Complete Decongestive Therapy 4.3 Components of Complete Decongestive Therapy Manual Lymph Drainage 4.4 Compression Therapy Effects of Compression Therapy Laplace's Law Compression Bandages Compression Garments 4.5 Exercises and Lymphedema Breathing Exercises Resistive Exercises Aerobic Exercises for Lymphedema 4.6 Skin and Nail Care 4.7 The Two-Phase Approach in Lymphedema Management Intensive Phase Self-Management Phase 4.8 Documentation Techniques for Lymphedema 4.9 CDT for Cancer Survivors Introduction Surgery Radiation Therapy Breast Radiation Chemotherapy Targeted Therapy Guidelines for Safe CDT Intervention Summary References Recommended Reading 5 TREATMENT 5.1 General Considerations 5.2 Application of Basic MLD Techniques on Different Parts of the Body Lateral Neck and Submandibular Area Abbreviated Neck Sequence Posterior Neck and Occipital Area Face Posterior Thorax Lumbar Area Anterior Thorax Abdomen (Superficial and Deep Manipulations) Upper Extremity Lower Extremity 5.3 Treatment Sequences Truncal Lymphedema Unilateral Secondary Upper Extremity Lymphedema Bilateral Secondary Upper Extremity Lymphedema Unilateral Secondary Lower Extremity Lymphedema Bilateral Secondary Lower Extremity Lymphedema Unilateral Primary Lower Extremity Lymphedema Bilateral Primary Lower Extremity Lymphedema Genital Lymphedema Phlebolymphostatic Edema Lipolymphedema Head and Neck Lymphedema Pediatric Lymphedema 5.4 Elastic Taping for Lymphedema General Information Indications and Contraindications Preparation and Materials Application Patient Education for Elastic Taping Removal 5.5 Treatment Strategies for Common Complications of Lymphedema Surgical Scars Debulking Scars Hyperkeratosis Abnormal Folds Odors and Odor Control Fungal infections Radiation Trauma PapillomasLymph cysts, varicosities Collateral veins Limb paralysis Self induced lymphedema (Artificial, Factitious) Malignant lymphedema Cellulitis 5.6 CDT Treatment Protocol Variations: Primary and Secondary Lymphedema Adaptations for the primary lymphedema patient Adaptations for the secondary lymphedema patient 5.7 Adapting CDT to the palliative patient Set realistic goals Strengths and limitations of each CDT modality CDT management of generalized edema Conclusion 5.8 Lipedema Treatment: Understanding the diagnosis and patient profile Misguidance and misdiagnosis Psychological perspective and Personality attributes Identifying lipedema and adapting treatment Practical guidelines for therapy Alternative treatments Compression garments (see also garment fitting section) 5.9 Application of Compression Bandages Required Materials Lymphedema Bandaging: Selecting Foam Padding Lymphedema Bandaging: Practical Guidelines Upper Extremity Bandaging Lower Extremity Bandaging 5.10 Bandaging Procedures using Foam Padding Arm Bandaging Procedure using foam padding (in detail) Leg Bandaging Procedure using foam padding (in detail) 5.11 Genital Lymphedema Treatment Secondary Genital Lymphedema Primary Genital Lymphedema Predisposition to develop lymphedema Complications Surgical Treatment Conservative Therapy 5.12 Truncal Lymphedema Lymphedema of the Thorax Lymphedema of the Abdomen 5.13 Bandaging in Presence of Wounds Precautions and Contraindications Treat the Wound Apply Compression Summary 5.14 Measurements for Compression Garments Measuring for Stockings and Pantyhose Measuring for Arm Sleeves Measuring for Hand and Finger Compression Garments Compression Neck and Chin Straps and Face Masks Compression Garments for the Upper Thorax and Breast 5.15 Compression Bandaging Alternatives: Guidelines to Choosing the Right Homecare Systems Rationale for an Alternative Important Considerations Product Categories Maximizing the Benefits of Alternative Devices Patient Education/Long-term Compression Therapy Suggested modifications by product category 5.16 Treatment Considerations in Managing the Morbidly Obese Patient The Problem Equipment Treatment Challenges 5.17 Patient Education Lymphedema Therapists Self-Bandaging Decongestive Exercises Self-MLD Precautions Lymphedema and Air Travel 5.18 Surgical Treatment Surgical Treatment of Lymphedema Breast and Axillary Reconstruction Primer for the Certified Lymphedema Therapist References Recommended Reading 6 ADMINISTRATION 6.1 Setting Up a Lymphedema Clinic Personnel Required Space Equipment Marketing Issues 6.2 Suggested Materials to Start Up a Lymphedema Program 6.3 Reimbursements and Billing CPT Codes Recommended Reading

About the Author

Founder and Execuive Director, Norton School of Lymphatic Therapy, Matawan, NJ, US

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