Lymphoedema

Lymphoedema is a medical condition that occurs when there is a blockage or damage to the lymphatic system, which is responsible for draining fluids from the tissues in your body. This results in a buildup of lymphatic fluid, causing swelling and discomfort in the affected area. Lymphoedema can occur in any part of the body but is most commonly seen in the arms and legs. It can be caused by a variety of factors, including surgery, radiation therapy, infection, and genetics.

Lymphoedema should be considered in patients who have swelling of a body part that has persisted for more than three months (or earlier if it is associated with surgical removal of lymph nodes). It may be associated with a feeling of heaviness and aching, and in the beginning, the swelling may fluctuate in severity from day to day.

There are two main types of lymphoedema:

Primary Lymphoedema

• Congenital abnormalities or malformation of the lymphatic system (presenting under two years of age)
  
• Late-onset due to underlying malformation (presenting over 2 years of age)
  
• Syndromal conditions: lymphoedema-distichiasis, Klippel-Trenaunay syndrome and Prader-Willi syndrome, among others

Secondary Lymphoedema

• Trauma and tissue damage: lymph node excision, radiotherapy, burns, varicose vein surgery, wounds
  
• Malignant disease: lymph node lymphoma, pressure from large tumours
  
• Venous disease: chronic venous insufficiency/ ulceration, post-thrombotic syndrome
  
• Infection: cellulitis/ erysipelas, lymphadenitis, filariasis Inflammation: rheumatoid arthritis, dermatitis,
  psoriasis, sarcoidosis
  
• Medications: calcium channel blockers, corticosteroids, NSAIDs, pregabalin, taxanes
  
• Other: Obesity, lipoedema, dependency oedema, paralysis

When diagnosing lymphoedema, other causes of swelling must be excluded when the following red flags are present

• Sudden swelling
  
• Pain as main complaint
  
• Skin colour change
  
• Lumps, sores & ulcers
  
• History of unmonitored cancer
  
• Paraesthesia (numbness & tingling)
  
• Prominent veins in the swelling region

The best treatment will involve a multimodal regime.

Contradictions for compression include:

• Arterial Insufficiency / Peripheral Arterial Disease
  
• Uncontrolled Heart Failure
  
• Severe Peripheral Neuropathy (e.g. diabetes)

Newer compression treatments are constantly emerging, including:

• Sequential Intermittent Pneumatic Compression
  
• Negative Pressure
  
• Lymph Taping

The general practitioner (GP) plays an important role in managing the long-term care of patients with lymphoedema. The GPs role includes reinforcing:

• Good skincare
  
• Exercise
  
• Antibiotic use
  
• Massage
  
• Travel precautions

GPs can help form a strong multidisciplinary team that may include a lymphoedema specialist, podiatrist, dietitian, and psychologist.

Lymphoedema practitioners are healthcare professionals who specialise in lymphoedema management. They may include physiotherapists, occupational therapists, nurses, and remedial massage therapists who have completed lymphedema management training accredited by the Australian Lymphology Association (ALA). They can be found in larger public hospitals with lymphedema services and as private practitioners.

New treatments are available for the surgical management of lymphedema. These can include:

• Venous stents: Opening veins for blood to flow through the blocked or narrowed vein
  
• Venous ablation: To close off varicose veins which result in fluid build up

• Angioplasty: Inserting a catheter with a balloon or stent into the artery to open a narrowed or blocked artery.
  
• Bypass surgery: Creates a new pathway for blood to flow around blocked or narrowed arteries.

A surgical procedure that removes excess fat from the body. It can be used to reduce the amount of fatty tissue in areas affected by lymphoedema, which can help improve lymphatic flow and reduce swelling.