domingo, 15 de julio de 2018

WHAT IS THE BEST TREATMENT OPTION FOR LYMPHEDEMA - Organic Lymphatic Vascular Disease - First-line Treatment - Choosing a Lymphedema Expert Reference Centre - Primary Lymphedema - Secondary Lymphedema - Lymphostatic Elephantiasis - Lymphatic Filariasis / Podoconiosis - Best Practices Management Guidelines - Treatment Protocol - Patient Care Pathways - Preventive Medicine - Rehabilitation Stratagies

Lymphedema is a progressive disfiguring and disabling disease of the skin, classified as a functional, immune, and lymphatic circulatory system disorder (Organic Lymphatic Vascular Disease). The lymphatics are an active and integrated component of the immune response, and in lymphedema, there is always an increased susceptibility to infection due to the compromised immune system. Read more about what is an Organic Impairment HERE

Lymphedema arises when there is a disruption of lymphatic flow (Organic Impairment), leading to the buildup of lymphatic fluid. It is clear that no patient or their lymphedema is the same and neither is its progress. Some patients with lymphedema have few symptoms, and can easily do different degrees of physical activity, while others feel the strain, experience increased swelling with minimum effort, or even suffer varying degrees of disability and severe complications. Read more about lymphedema and Infectious Cellulitis HERE. 

Therapy of peripheral lymphedema is divided into conservative non-operative and operative methods. The best first-line non-surgical treatment for lymphoedema, considered the "Gold Standard" treatment, is known as "COMPLETE DECONGESTIVE THERAPY (CDT)"

Complete Decongestive Therapy (CDT) is backed by longstanding experience and generally involves a two-stage treatment program that can be applied to both children and adults and consists of two phases: Phase I is aimed at reducing lymphedema volume and mobilizing the increased interstitial fluid to normalize tissue homeostasis, and the aim of Phase II is maintenance and optimization of the therapeutic success. Earlier treatment is reported for the best results. 

The frequency and intensity of the components of CDT in Phase I and Phase II should depend on the clinical edema findings and Stage of the lymphoedema and be adapted to clinical changes. The isolated application of single components in Phase I is not recommended, and thus should be used in its entirety. 

Complete Decongestive Therapy is undertaken by a therapist who has undergone training at the specialist level and who combines the following components:

  • Skin Care
  • Manual Lymphatic Drainage (MLD)
  • Multilayer Bandages
  • Exercise
  • Compression Garments
  • Patient Education
  • Compression Pumps (this is an optional adjuvant, and must be accompanied by Manual Lymph Drainage (MLD) conducted by therapists at the specialist level)).

After the initial treatment (Phase 1), which includes all the components and is applied daily and lasts several weeks, the next step is the maintenance treatment (Phase 2), which consists of compression by low-stretch garments, skin care, continued exercise, and MLD as needed. In this second phase, which is long-term, the patient is taught self-bandaging for maintenance, basic self-care of the skin, and exercise practice. Read more about which country has the best public healthcare coverage of lymphedema HERE

The success of Complete Decongestive Therapy (CDT) depends on it being administered by an experienced certified therapist. CDT is considered safe, however, patients should consult with their physician before beginning treatment. Indications, contraindications, and the application of individual therapeutic measures depend on several factors: the stage of lymphoedema at the start of treatment, comorbidities, the age of the patient, and the patient’s individual life circumstances. 

Failure of Complete Decongestive Therapy (CDT) should be confirmed only when intensive non-operative treatment in a clinic specializing in the management of peripheral lymphedema and directed by an experienced clinical lymphologist has been unsuccessful. Read more about the signs, symptoms, and complications of lymphoedema HERE.

In no way should this highly specialized treatment be replaced, due to the possible serious side effects, by edema reduction treatments carried out by non-specialists. Aggressive reduction of swelling can cause skin and vessel damage, Isolated compression therapy of the extremities, particularly in patients with lymphedema also affecting the quadrants of the trunk, may cause displacement of edema and increase swelling at the root of the extremity, and may even lead to genital lymphoedema


Lymphedema is a serious chronic and progressive disease due to lymphatic dysfunction (Organic Lymphatic Vascular Disease). The clinical treatment of lymphedema is neither a cosmetic nor an aesthetic treatment. The treatment of lymphedema is to control its progression and alleviate the symptoms related to dysfunction of the lymphatic circulatory system. 

To prevent and avoid serious complications associated with treatment, such as the possible displacement of edema to previously unaffected areas when compression therapy is applied for volume reduction, patients should use highly specialized and experienced therapists. 

Professional qualification and instruction delivered remotely online are not the same as live hands-on practical instruction in the clinical training and certification of lymphedema therapists, similar to all other rehabilitation, medical, and surgical training programs, and especially for developing the necessary manual skills to treat a disease as complex as lymphedema. 

Patients should also take special care when choosing a Multidisciplinary Expert Center of Reference for Lymphedema, as not all countries and centers provide the same treatment options. The best choice is a center of reference that provides Complete Decongestive Therapy (CDT”, which is recognized as the Gold Standard treatment for lymphedema.

  • Read about what are the principal functions of Manual Lymphatic Drainage HERE.
  • Read about what are the main differences between the two principal lymphedema treatment protocols HERE. 
  • Read about what are the strategies for the implementation of low-cost treatment options for Lymphedema HERE.


(Click on the texts to read the research articles)











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.
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