Lymphedema

Lymphoedema is a visible and palpable fluid accumulation in the interstitium ( interstitial space ). It is caused by mechanical insufficiency of the lymphatic system. Is a symptom description, not to make the diagnosis. It is based on a chronic inflammatory disease that can affect not only the extremities but also the face, neck, torso, and even the genitals. By mechanical failure, the interstitial fluid can not be removed sufficiently through the lymphatic vessels. This results in a back pressure and the accumulation of fluid in the intercellular spaces (edema).

Lymphödemstadien

• Stage 0, stage of latency ( subliminal edema ) occur no symptoms in appearance.
• Stage 1, reversible stage: Protein-rich edema, only a few small, localized tissue changes fibrosklerotische. The edema is still doughy - soft, it can be easily pressed with your finger a " dent". A high camps of edema (where possible) reduces to some extent the swelling. The Stemmersche character is (mostly) positive.
• Stage 2, spontaneous irreversible stage: At this stage fibrosklerotische changes and a Fettgewebsproliferation take place. The edema is hard and does not respond to high camps with swelling. With the finger can be no or only a very shallow dent press into the skin.
• Stage 3, Elephantiasis: Extensive fibrosklerotische changes and Fettgewebsproliferationen have occurred. The affected area may be swollen up to the deformity. Due to the swelling of the mobility is severely restricted. The skin is prone to bubbles and fistulas, eczema and poorly healing wounds.

Etiologic classification

A distinction lymphedema in a primary and a secondary form.

• In the primary form of the lymphatic vessels and / or lymph nodes are not created or only partially or with a malformation due to a developmental disorder. Whole limbs or body parts can be affected here. The complete lack of lymphatic vessels of an entire region of the body is not compatible with life and leads in the womb or shortly after birth to death.

• In secondary lymphedema the drainage paths are mechanically insufficient as a result of either pathological changes such as tumors, trauma, lymphangitis ( inflammation due to viruses, bacteria, fungi, parasites, etc., also in the rheumatic diseases ), chronic venous insufficiency ( CVI), diabetes, etc., or because of iatrogenic interventions such as surgical scars, radiological exposures, removal of lymph nodes after tumor removal, vein harvesting for bypass surgery, etc.

Diagnostics

• Stemmer 's sign: Can a skin fold on the 2nd and 3rd toes at all or very difficult to stand out, which is a clear sign of lymphedema. The same applies to arms and hands. One speaks of a positive Stemmer 's sign. It comes later in a thickening of the toes with approximately 4- edgy look.
• Ultrasound ( duplex ultrasonography ): With an ultrasound study, the changes of the skin and subcutaneous tissue can be accurately assessed. It provides an indication of whether it is a disease of the lymphatic vessels or veins.
• Lymphografie / Isotopenlymphografie

A representation of the lymphatic vessels and nodes with contrast or X-ray radiation (direct lymphography ) is no longer performed today.

Therapy

The treatment of choice is the Complex Physical decongestive ( KPE ). Below are summarized:

• Manual lymphatic drainage: Manual lymphatic drainage is a special massage technique which softens the lymphoid tissues and the accumulated lymph fluid is transported in the direction of abdominal and chest cavity. With varying pressure, the skin and subcutaneous adipose tissue are massaged. With special handles the therapist encourages the natural movement of the lymphatic vessels, which he favors the transport of lymph. When used consistently - depending on the severity of one or more times per week - the volume of edema is reduced. The therapeutic effect lasts for about 24 hours. Therefore must be supplemental compression treatment.
• Skin Care
• Compression bandage / compression stockings: With a compression bandage the affected arms or legs are wrapped. The external pressure supports the removal of the lymph fluid and thus the degradation of Lymphstaus. Proper bandaging includes not only compression bandages also fleece padding and foam sheets for cushioning. If the swelling decreases, the bandages may be replaced by compression sleeves or stockings. These are specially made gloves, compression sleeves or stockings leg and foot caps of solid flat knit material that is only suitable for the treatment of lymphedema and not for those of venous disease.
• Special movement therapy in compression: Regular exercise exercises to promote lymph flow and build from the lymph. This compression bandages or stockings are worn to enhance the effect of decongestive exercises. The therapist develops a suitable exercise program that depends, inter alia, of which, at what point is the lymphedema for the patient.

Furthermore Lymphabstromwege be restored as part of the Super microsurgery and thereby permanently Lymphwassereinlagerungen be reduced.

No sole therapy option are diuretics ( water pills). A sole treatment with diuretics decreased initially and primarily the vascular fluid volume. The oncotic pull of the plasma is built up only briefly and changed the protein and the protein concentration of the edema is not positive. So you will be able to observe a yo- yo effect. To obtain the desired effect of the diuretic, one will have to be administered continuously, and the diuretic is in increasing concentration. Further note that a diuretic affects Lymphtransportmechanismus.

Precautions

As a precaution, all those activities are understood to prevent the emergence of lymphedema. Any violation of arm / leg affected must be avoided. This includes the avoidance of injections, blood draws, mosquito bites, sunburns, etc. Even constricting clothing can trigger lymphedema. Unfortunately, this disease is: "Once lymphedema, lymphedema always ". All the more reason to pay attention to the rules of conduct or the safety precautions respect.