La Terapia Descongestiva Compleja (TDC) es llevada a cabo por un terapeuta que ha recibido formación a nivel de especialista y combina los siguientes componentes:
- Cuidado de la Piel
- Drenaje Linfático Manual (DLM)
- Vendajes Multicapa
- Ejercicio
- Prendas de Compresión
- Educación del Paciente
- Bomba de Presoterapia (es un adyuvante opcional y, sólo se aplica si va acompañado de Drenaje Linfático Manual (DLM) realizado por terapeutas a nivel de especialista).
Después del tratamiento inicial (Fase 1), que incluye todos los componentes y que se aplica diariamente y dura varias semanas, se pasa luego al tratamiento de mantenimiento (Fase 2), consistente en compresión mediante una media o manga elástica de baja elasticidad, cuidado de la piel, ejercicio y el Drenaje Linfático Manual (DLM) según sea necesario. En esta segunda fase que es de larga duración, al paciente se le enseña auto-vendaje de mantenimiento, auto-cuidados básicos de la piel, y la práctica de ejercicios. Lea más sobre que país tiene la mejor cobertura sanitaria pública para el tratamiento de linfedema AQUÍ.
De ninguna manera debe este tratamiento altamente especializado ser sustituido, debido a los posibles efectos secundarios graves, por tratamientos para la reducción de edemas llevados a cabo por personas no especializadas. La reducción agresiva del edema puede causar daños en la piel y los vasos. La terapia de compresión aislada sin DLM de las extremidades, sobre todo en pacientes con linfedema que también afecta a los cuadrantes del tronco, puede causar el desplazamiento del edema y aumentar la hinchazón en la raíz de la extremidad, e incluso puede provocar linfedema genital.
AVISO IMPORTANTE
El Linfedema es una enfermedad crónica y progresiva debido a una discapacidad orgánica. El tratamiento clínico del linfedema no es ni un tratamiento cosmético ni estético. El tratamiento del linfedema es para controlar su avance y aliviar los síntomas relacionados con la disfunción del sistema circulatorio linfático. Para prevenir y evitar problemas graves asociados al tratamiento, como el posible desplazamiento del edema a zonas previamente no afectadas cuando se aplica la terapia de compresión para la reducción del volumen, los pacientes deben recurrir a terapeutas altamente especializados con experiencia. La cualificación profesional y la instrucción impartida a distancia en línea no son lo mismo que la instrucción práctica en directo en la formación clínica y la certificación de los terapeutas del linfedema, similar a todos los demás programas de formación en rehabilitación, medicina y cirugía, y especialmente para desarrollar las habilidades manuales necesarias para tratar una enfermedad tan compleja como el linfedema.
Los pacientes deben igualmente tener un especial cuidado a la hora de elegir un "Centro Multidisciplinar de Referencia de Linfedema", ya que no todos los países o centros de referencia proporcionan las mismas opciones de tratamiento. La mejor elección es un centro de referencia que aplica la Terapia Descongestiva Compleja (TDC), que está reconocida como el tratamiento "Estándar de Excelencia" para el linfedema.
- Lea sobre cuales son las principales funciones del Drenaje Linfático Manual AQUÍ.
- Lea sobre cuales son las importantes diferencias entre los dos principales protocolos de tratamiento para Linfedema AQUÍ.
- Lea sobre cuales son las estrategias para la aplicación de tratamientos de bajo coste para el linfedema AQUÍ.
REFERENCIAS
(Pincha sobre los textos para leér los artículos científicos)
SOCIEDADES CIENTÍFICAS
FISIOPATOLOGÍA
- lymphedema.
- Biology of Lymphedema
- Lymph vessels: the forgotten second circulation in health and disease
- Lymphatic Vessel Network Structure and Physiology
- Lymphatic System Flows
- Organ-specific lymphatic vasculature: From development to pathophysiology.
- The lymphatic vascular system: much more than just a sewer.
- The unresolved pathophysiology of lymphedema.
- Lymphedema: A Practical Approach and Clinical Update.
- Coagulation in Lymphatic System.
- Regulation of immune function by the lymphatic system in lymphedema.
- Oxidative stress in chronic lymphoedema.
- Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.
- Hemostatic properties of the lymph: relationships with occlusion and thrombosis.
- Secondary lymphedema: Pathogenesis
- Gastrointestinal Lymphatics in Health and Disease
- Intestinal lymphangiectasia in adults
- Role of the lymphatic vasculature in cardiovascular medicine
- The lymphatic vasculature in disease
- Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.
- The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review
- Peripheral Edema
- The lymphatic system and the skin. Classification, clinical aspects, and histology.
- Lymphedema and cutaneous diseases.
- Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
- Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).
- Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
- Lymphatic Flow: A Potential Target in Sepsis.
- Infectious complications of lymphedema.
- Acute inflammatory exacerbations in lymphoedema.
- Inflammatory Manifestations of lymphedema.
- Cellulitis.
- Clinical features, microbiological epidemiology, and recommendations for the management of cellulitis in extremity lymphedema.
- Challenges of cellulitis in a lymphedematous extremity.
- Diagnosis and management of cellulitis.
- Cellulitis risk factors for patients with primary or secondary lymphedema.
- Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg.
- Prevention of dermatolymphangioadenitis by combined physiotherapy.
- Erysipelas: a common potentially dangerous infection.
- Malignant tumors as complications of lymphedema.
- Lymphedematous areas: Privileged sites for tumors, infections, and immune disorders.
- Lymphedema-related angiogenic tumors and other malignancies.
- Lymphedema: an immunologically vulnerable site for the development of neoplasms.
- Lymph stasis promotes tumor growth
- A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema.
- Stewart-Treves Syndrome
- Congenital lymphedema complicated by pain and psychological distress: case report
- Lymphatic Pain in Breast Cancer Survivors
- Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts?
- Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer
- Quality of life in patients with primary and secondary lymphedema in the community
TRATAMIENTO
- Treatment of limbs lymphedema.
- Nonoperative treatment of lymphedema.
- Lymphedema: From diagnosis to treatment.
- Lymphedema-clinical picture and therapy.
- Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
- Diagnosis and management of lymphatic vascular disease
- Effective treatment of lymphedema of the extremities.
- Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.
- Intensive Treatment of Lower-Limb Lymphedema and Variations in Volume.
- Effectiveness and safety of Complete Decongestive Therapy of Phase I.
- Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities.
- Effects of Phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer-related lymph edema.
- Does lymphoedema bandaging reduce the risk of toe ulceration?
- Study of 700 referrals to a Lymphedema Program.
- Worldwide assessment of healthcare personnel dealing with lymphoedema.
- Földi M, Földi E. Földi’s textbook of lymphology for physicians and Lymphoedema therapists.
- Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients
- Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography
- The risk of genital edema after external pump compression for lower limb lymphedema.
- The management of genital lymphoedema
- The management of deep vein thrombosis in lymphoedema: a review.
- Lymphedema-associated comorbidities and treatment gap.
- A study of the advantages of elastic stockings for leg lymphedema.
- Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.
- Medical compression stockings for chronic venous diseases and lymphedema: Scientific evidence and results of a patient survey on quality of care.
- Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic edema: a randomized controlled trial protocol.
- Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema.
- Occupational leg edema-use of compression stockings.
DISCAPACIDAD
- Disability and lymphedema.
- Lymphedema and employability.
- Worse and worse off: the impact of lymphedema on work and career after breast cancer
- Functioning in lymphedema from the patient's perspective using the International Classification of Functioning, Disability and Health (ICF).
- Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors
- Postural Stability in Patients with Lower Limb Lymphedema
- Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema
DISFIGURACIÓN
- Adjusting to disfigurement: processes involved in dealing with being visibly different
- Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments
- Quality-of-life and body image impairments in patients with lymphedema
- Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers
CALIDAD DE VIDA
- The impact of lower limb chronic oedema on patients' quality of life
- Quality of life in patients with primary and secondary lymphedema in the community
- Evaluating the effect of upper-body morbidity on quality of life following breast cancer treatment.
- Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study
- The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema
IMPACTO PSYCHOSOCIAL
- Psychosocial Impact of Lymphedema.
- Associations between chronic disease, age, and physical and mental health status
- A network analysis of psychological flexibility, coping, and stigma in dermatology patients
- 'Abandoned by medicine'? A qualitative study of women's experiences with lymphoedema secondary to cancer, and the implications for care
- People are neglected, not diseases.
- Chronic edema/lymphoedema: under-recognized and under‐treated.
- Lymphatic Medicine: Paradoxically and unnecessarily ignored.
- Medical education: a deficiency or a disgrace.
LINFEDEMA PEDIÁTRICO
- NORD: Rare Disease Database - Lymphedema
- Medical management of lymphedema.
- Primary lymphedema in childhood.
- An approach to familiar lymphedema
- Pediatric Children Lymphedema
- Primary Lymphedema French National Diagnosis and Care Protocol (PNDS).
- Lymphatic filariasis: an infection of childhood.
- Lymphatic filariasis in children: clinical features, infection burdens and future prospects for elimination.
- Podoconiosis: Clinical spectrum and microscopic presentations.
- Podoconiosis: A Possible Cause of Lymphedema in Micronesia.
- A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis, and leprosy.
- The impact of acute adenolymphangitis in podoconiosis on caregivers.
- Neglected tropical diseases and disability-what is the link?
- Locomotor disability in bancroftian filarial lymphoedema patients.
- Neglected patients with a neglected disease?
- Neglected tropical diseases and mental health: a perspective on comorbidity.
- People are neglected, not diseases.
- Addressing Inequity: Neglected Tropical Diseases and Human Rights.
- Neglected Tropical Diseases, Conflict, and the Right To Health.
- Peripheral Edema
- Phlebolymphedema
- Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management
- Role of the lymphatic vasculature in cardiovascular medicine
- Communication between lymphatic and venous systems
- Phlebopathies and occupation
- Phlebopathies and workers
- Evidence of health risks associated with prolonged standing at work and intervention effectiveness
- Leg edema formation and venous blood flow velocity during a simulated long-haul flight
Welches ist die beste Behandlung für Lymphödeme / што з'яўляецца лепшым сродкам для лячэння лимфедемы / což je nejlepší léčba lymfodémy / som er den bedste behandling for lymfødem / joka on paras hoito Lymfedeema / quel est le meilleur traitement pour le lymphoedème / που είναι η καλύτερη θεραπεία για το λεμφοίδημα / שהוא הטיפול הטוב ביותר עבור lymphedema / जो लिम्पेडेमा के लिए सबसे अच्छा उपचार है / amely a lymphedema legjobb kezelése / yang merupakan pengobatan terbaik untuk lymphedema / sem er besta meðferðin fyrir eitilfrumnafæð / quale è il miglior trattamento per il linfedema / yaiku perawatan paling apik kanggo lymphedema / kuris yra geriausias gydymas limfedemai / wat ass déi beschten Behandlung fir Lymphödem / yang merupakan rawatan terbaik untuk lymphedema / wat de beste behandeling is voor lymfoedeem / som er den beste behandlingen for lymphedem / który jest najlepszym lekarstwem na obrzęk limfatyczny / qual é o melhor tratamento para o linfedema / care este cel mai bun tratament pentru limfedem / что является лучшим методом лечения лимфедемы / vilket är den bästa behandlingen för lymfödem / lenfödem için en iyi tedavi hangisidir / đó là cách điều trị tốt nhất cho bệnh bạch huyết / وهو أفضل علاج للوذمة اللمفية / ដែលជាការព្យាបាលដ៏ល្អបំផុតសម្រាប់ lymphedema / 這是淋巴水腫的最佳治療方法 / 임파 부종에 가장 좋은 치료법 / リンパ浮腫の最良の治療法である / ലിംപേദെമയ്ക്കുള്ള ഏറ്റവും മികച്ച ചികിത്സയാണ് ഇത് / जसले लिम्बुमामाको लागि उत्तम उपचार गर्दछ / ซึ่งเป็นวิธีที่ดีที่สุดในการรักษา lymphedema / đó là cách điều trị tốt nhất cho bệnh bạch huyết.
