What is Lymphedema?
Lymph is the protein-rich fluid produced as blood passes through the tissues. Lymph collected from tissues throughout the body drains into lymphatic channels which subsequently drain into the large veins near the heart. Along the way back to the heart, lymph passes through filtering sites called lymph nodes. Lymphedema refers to swelling in an extremity due to excess of lymph. Lymphedema can occur with overproduction of lymph, impaired removal of lymph from tissues, or loss of transport back to the heart. Severe form of lymphedema is termed elephantiasis. Lymphedema can be complicated by infection and ulceration of the leg and in its late stage, can be a disabling condition. It is important to distinguish lymphedema as the cause of leg swelling from swelling due to venous disease because the two require different treatment modalities.
Causes and Symptoms of Lymphedema
Lymphedema can be primary or acquired:
- Primary lymphedema refers to cases in which lymphedema develops without any known cause. It can occur in childhood, young adulthood, or the middle ages.
- Secondary lymphedema refers to cases in which acquired destruction of lymphatic channels, for example, injury, infection, or cancer cause lymphedema. This form is more common since many treatments such as surgery or radiation can interrupt the lymphatic channels.
Lymphedema can be reversible or a permanent condition that will require lifelong management. Diagnosis is made by your physician from the appearance of the extremity and confirmed by a series of tests that will exclude other causes of leg swelling.
Chronic lymphedema can be difficult to control or treat. Swollen limbs become vulnerable to infection. Any injury to the skin, such as a cut, abrasion, scratch, insect bite, or even athlete’s foot can cause a severe infection (cellulites or lymphangitis). Lymphangitis appears as red streaks running up the inside of the leg and thigh and is usually accompanied by a painful swollen leg with fever and chills. It results in further destruction of existing lymphatic channels and intensifies the inadequacy of lymph drainage that is the basic cause of the lymphedema. As swelling becomes worse, tissues in the leg become hardened, and the swelling becomes fixed. This is called fibrosis, a characteristic of advanced chronic lymphedema.
Treatment of lymphedema requires intensive use of external support on the extremity and is only successful in those diligent about following instructions to treat the problem. Attempts at curative surgical procedures to repair the affected lymphatic channels have not been successful enough to gain wide acceptance. Present day management provides control of the problem in most cases by use of external support, frequent leg elevation, and lymphatic massage. Specially designed lymphatic pumps apply pressure through sleeves worn on the extremity. These measures require detailed and supervised programs of patient education by physicians and therapists who have the time and resources to adjust the treatment to fit the individual unique situation.
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