Lymphedema: A Review and Case Profiles
Author: Fred Kahn MD, FRCS (C)
Source: Meditech International Inc.
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Lymphedema of the extremities remains a therapeutic challenge. As a result many different treatments have been devised but none have been routinely effective.
Two types of lymphedema occur, primary and secondary. Primary lymphedema is rare, the result of a congenital abnormality of the lymphatic system. Secondary lymphedema, the most common form, may be acute or chronic. It results from obstruction or interruption of the lymphatic channels. Fluids and proteins, transudate from cells or exudate from both lymphatic and vascular channels collects in the superficial connective tissues and fails to be absorbed by the lymphatic system. Duration varies from weeks to years.
The acute form generally follows trauma and is easily resolved by conventional methods. The chronic version is a more vexing problem, only minimally improved by existing technologies with rapid recurrence when therapy ceases. Chronic lymphedema most frequently occurs post-mastectomy or subsequent to a variety of other surgical procedures that involve resection of the lymph channels and nodes. It can also be a complication secondary to congestive heart failure, chronic liver disease, thrombophlebitis, systemic infections and gravitational dependency. In its late stages it is characterized by firm induration with accompanying cyanosis as arterial compression occurs.
- Elevation of extremity above level of heart
- Variety of compression techniques
- Fitted garments
- Manual Procedures
It should be noted that there is no effective drug therapy available. Diuretics are frequently utilized but not recommended for long term use. The above listed conventional therapies do not provide long term solutions. Outcomes are usually limited at best and require prolonged periods of treatment without permanent relief or cure.
180 year old male.
3 to 4 years. Progressive in nature.
Post harvesting long saphenous vein (coronary bypass procedure)
Recurrent congestive heart failure
Initially affected extremity circumference mid-calf 6 cm greater than opposite side Firm non-pitting induration
- Poor venous filling
- No palpable arterial pulse distal to femoral pulse
Ten one-hour sessions over a four week period utilizing the BioFlex Low Intensity Laser Therapy System. Treatment was applied over the sympathetic nervous system and locally.
- Mid-calf circumference same as opposite side
- Resolution of cyanosis and induration
- Restoration of venous filling and peripheral arterial pulses
- Normal skin temperature
- Absence of sensation of heaviness, chronic aching
- Activity level restored to normal
- No regression or recurrence four months post-cessation of treatment.