Chapter 169 - Lymphedema nonoperative treatment Flashcards
Roles of the lymphatic system
1) immune response 2) maintain fluid balance 3) absorption of fat and fat-soluble nutrients
Non-surgical therapy for lymphedema
1) manual lymphatic drainage 2) compression 3) pharmacotherapy 4) laser therapy 5) hyperbaric oxygen 6) intermittent negative pressure
What type of lymphedema is CVD-induced
secondary lymphedema often mis diagnosed
Lymphedema etiology tree
FIGURE 169.2
Stages of lymphedema
FIGURE 169.3
4 grades of lymphedema from the Common Terminology Criteria for Adverse Events
TABLE 169.1
Attempts to prevent filariasis by mass admin of this drug
Diethylcarbamazine + ivermectin
methods to reduce incidence of lymphedema for cancer treatments
sentinel lymph biopsy first
Risk of lymphedema in developed countries
1) cancer treatment 2) recurrent cellulitis
Characteristics of malignant lymphedema
1) sudden onset 2) rapid progression 3) pain 4) paresthesia, paresis or paralysis 5) skin changes 6) dilated superficial veis
Characteristics of benign lymphedema
1) unilateral 2) normal skin color (unless stage III) 3) positive stemmer sign 4) no pain, paresis/paralysis 5) dorsum hand/foot involved with swelling 6) deep natural skin folds
Preventing lymphedema progression
1) hygiene 2) low salt, high protein diet 3) proper compression 4) walking and aerobic 5) monitor limb volume 6) avoid infection and trauma 7) limb elevation 8) wear loose fitting clothes
Complex decongestive therapy components
1) manual lymphatic drainage 2) compression bandage 3) compression garment 4) compression devices
Complex decongestive therapy phases
PHASE 1 (reductive): reduce size of affected area; proper skin care PHASE 2 (maintenance): life-long self-maintenance
Patient compliance to CDT
60-70%
General volume reduction with CDT
50%
Manual lymphatic drainage first developed by
Emil Vodder 1936
Manual lymphatic drainage steps
1) divide into 6 areas of drainage territories: cervical, axillary and inguinal bilaterally 2) massage intact section adjacent to area of interest 3) massage area of interest not effective alone needs to use with compression
Compression bandage key points
1) tubular bandage lining 2) foam polyester or cotton under cast padding 3) digit bandages 4) multiple layer of short bandages with limited stretch ability when pulled
Two pressure types produced with compression bandage
1) low resting pressure 20-30 mmHg 2) high working pressure
Adjustable compression wraps
Can be self-applied by patients replace compression bandages
Compression garments key points
1) used in phase 1 and 2 and in prophylaxis in high risk 2) deliver 20-50 mmHg compression with higher pressure more distal
Contraindication to compression garments
1) arterial insufficiency 2) acute cardiac failure 3) extreme limb shape distortion 4) very deep skin folds 5) extensive skin ulceration 6) severe peripheral neuropathy 7) lymphorrhea
Non-elastic support devices
alternative to night time wrapping self-applied by patients no clear evidence yet
