HOW CAN WE TREAT LYMPHATIC EDEMAS?
90% see satisfactory improvement with medical treatment, and in other cases, after exhausting the possibility of medical treatment, surgical intervention is required.
1- Psychological Methods:
This is an illness that, in many occasions, the cause cannot be confirmed. The patient becomes desperate because of their aesthetic appearance and slow improvement. Work must be planned with the patient and it helps if the patient understands that only through perseverance can they obtain the desired effect. The effectiveness of treatment is usually related to the establishment of an effective treatment plan as soon as possible.
2- Preventative And Hygienic Methods:
By looking for two primordial objectives: to not increase the contribution of liquid interstitial and to encourage its evaluation. This is achieved by avoiding excessive exposure to heat, avoiding skin infections, elements that impede adequate venolymphatic circulation (like leg bands, tight socks, very tight or girdles). The former is complimented with mobilization of the affected extremities and sleeping with them elevated. Exercise should be done lightly and swimming is particularly beneficial.
3- Physiotherapeutic Methods:
The principal objective is to improve functionality of the affected membrane through drainage, as much fluid as protein molecules, avoiding the reappearance of the oedema. There are various ways to employ this method:
a) Manual Lymphatic Drainage: This is done without force or aggressive movements. All of the movements imitate the flow of lymph in the vessels, acting on the nervous system in the muscular wall of the lymphatic vessels. This action is carried out on various levels: sedative, stimulant and tone builder. Because of its mechanical action it produces the following effect: induces balance in the nervous system, inducing a relaxation of the smooth lymphatic muscle area. It also produces an inhibiting of pain, facilitates the arrival protein filled material and discards the peripheral ganglion tissue, and from there is processed by the defence systems of the body.
b) Intermittent Pneumatic Pressotherapy: Intermittent Pressotherapy has its advantages over continuing global pressotherapy that has become dangerous, because it does not permit the relaxation of its conductors. During the intermission pressure is applied in lower distal levels and is increased at a rate in which it gets closer to the centre of the body. The period of decompression encourage aspiration fluid by the capillaries and the pressure of the expulsion towards pre-collectors.
c) b) Endermology. Subdermal therapy (Siluette or LPG), is a highly technological technique that utilizes a system of aspiration and two rollers. These rollers turn electromagnetically in one direction and the other in accordance with the chosen path. Between both rollers lies a zone that exerts negative pressure. The pairing of vacuum/rollers and the manner of contact allow for the opening, decompression and stretching of the different arterial structures, venous structures and lymphatic vessels, encourage better blood flow with nutritive elements, while at the same time eliminating heavy molecular proteins, residual metabolic cells and permitting the reabsorption of interstitial oedemas.
4- Compressive Methods:
a) Low-elastic adhesive bandages: Should be renewed every 3-6 days. They present many inconveniences: allergies, hygiene problems, and the impossibility of using other treatments (manual drainage, presso or endermology).
b) Unmovable Elastic Bandages: exert significantly more distal than local pressure, complicating vascular and titular hypertension. They are usually used during the day and removed at night. They have the inconvenience that they are difficult to put on correctly, but are very effective.
c) Elastic Methods: This is usually the most esthetical and reliable option. There are different models. They should be used with high compression, should be monitored periodically to avoid ischemia, regional compression and loss of pressure.
5- Pharmaceutical Methods:
Lymphopharmaceuticals(1)
- Rutosides, rescues or escine, melliotus officinalis, diosmin, dobesilate, calcium, hydrosmin.
(1) anales de cirugía cardiaca y vascular 2001;7(1):56-57
6- Surgical Treatment Of Lymphadema:
This is only done in extreme cases (grade IV or V lymphedema). Surgical treatments are complementary and initial treatment is always conservative.
In conclusion, it should be kept in mind that this treatment is prioritised conservatively and is life long.