Lenfödem ve Tedavileri

The functions of the lymphatic system; It is to remove foreign substances and microbes in tissues and cells, to recycle lost proteins, to balance the tissue and blood fluid, to add fatty acids, vitamins absorbed in the intestines into circulation and to support the body's defense system. The lymphatic system consists of lymphatic fluid, lymphatic vessels and lymph nodes.

There are two types of lymph circulation, deep and superficial. Deep ones accompany veins, superficial ones are located under the skin. There are valves inside the lymph vessels that prevent the backflow of lymph fluid, just like in veins. Lymph nodes are bean-shaped structures that gather in groups, connecting the lymph vessels. The lymph nodes have vascular sections that allow the entry and exit of lymph fluid. Small lymph vessels containing lymphatic fluid merge in the rib cage region and form large lymphatic ducts and pour into the vein system.

What is Lymphedema?

Lymphedema is the swelling of the body parts due to the accumulation in the tissues due to the failure of the lymph fluid to be carried due to a defect in the lymphatic system.

How many types of lymphedema are there?

Lymphedema is divided into two. The first is primary lymphedema due to genetic structural lymph disorders, and the second is secondary lymphedema due to reasons that were previously intact but due to surgery or radiotherapy.

What is the frequency of lymphedema?

The primary incidence of lymphedema, below 20 years of age, is 1.15 / 100.000.

What is the approximate age of lymphedema?

Primary lymphedema can develop in the middle age group in adolescence or late period following birth. often seen at the onset of adolescence.

What are the symptoms of lymphedema?

It is generally noticed that one foot is bigger than the other in children. Different shoe sizes are on the agenda and an examination of these children reveals that there is lymphedema.

• Pain / Discomfort
• Swelling (starts from the feet and hands, goes up)
• Feeling numb, tingling, pressure or tightness
• Extremity weight
• Infection susceptibility increases
• The skin deteriorates
• Loss of movement
• Wound healing impairment

How is the primary Lymphedema grade classified?

Lymphedema is generally divided into 3 stages. If there is more than 3 cm diameter increase in the leg that develops lymphedema compared to the intact leg, there is mild, moderate increase in diameter between 3-5 cm, and serious lymphedema if there is more than 5 cm diameter increase.

Clinically;

1. With very mild clinical signs
2. Lymphedema clinic is evident but reversible
3. Lymphedema clinic is irreversible
4. Elephantiasis (Elephant leg appearance)

What are the causes of lymphedema?

Primary causes that develop due to insufficient development in the lymphatic system structurally or secondary causes such as surgical operations, infection or radiotherapy are held responsible. Primary lymphedema can develop in infancy, adolescence or in the emergence periods.

Which tests are used for diagnosis?

Our most important diagnostic tool in the diagnosis of lymphedema is scintigraphy.

Figure a, b: No lymphedema / scintigraphy in the left leg, no flow in the thigh and below the knee (European Manual of MedicineVascular Surgery

LYMPHEDEMA TREATMENT

Lymphedema treatment requires complete decongesive treatment. In this treatment; manual physiotherapy, compression therapy, exercise therapy, skin care and patient education are included.

Manual Physiotherapy in Lymphedema

It is aimed to facilitate lymph flow and decrease tissue stiffness by applying manual lymphatic drainage technique professionally by physiotherapists. This technique is a very moderate, slow and rhythmic special drainage technique developed according to the anatomical and physiological infrastructure of the lymphatic system.

Related edema is taken under control and the mobility of the joints is increased. With physiotherapy, cosmetic problems are reduced and psychological well-being is provided.

Compression Bandaging in Lymphedema

• Increases tissue pressure
• Reduces interstitial capillary fluid filtration
• Reduces tissue hardness
• Shapes the extremities

Compression Clothing in Lymphedema; (Protective phase)

• Protecting the affected limb
• Stimulating lymph flow
• Pressure is very important !!
• 10-30 mmhg high extremity
• 30 mmhg low extremity

Pneumatic Compression Pumps in Lymphedema

• They can remove water from the interstitial environment but not proteins
• Negative effect on Lymph collectors
• Water moves from distal to proximal, causing water to accumulate here
• It causes more fibrosis in fibrous tissues

Decongestive Exercise in Lymphedema

• Increases lymphangiomotori
• Provides mobilization of interstitial fluid
• Reduces sympathetic tone
• Increases filtration and cleaning movements in thoracic branch
• Speeds up lymph flow and reduces edema
• Reduces fibrosclerotic tissue
• Maintains NEH width and increases flexibility
• Strengthens the muscles
• Protects and improves posture

Rules to be followed in lymphedema

• Sit frequently or rest while lying down
• Arm should be raised with a pillow while sitting and lying down
• People should not bathe with excessive hot water, enter sauna, steam rooms
• Should not sit in front of heat sources
• Do not do housework that requires excessive reach, such as laundry hangings, with a lymphedema arm

ANTALYA VARICOSE VEINS/Dr.İlhan Gölbaşı