Lymphedema what is it??

Lymphedema is a notoriously debilitating progressive condition with no known cure. The unfortunate patient faces a lifelong struggle of medical, and sometimes surgical, treatment fraught with potentially lethal complications.

The underlying problem is lymphatic dysfunction, resulting in an abnormal accumulation of interstitial fluid containing high molecular weight proteins. This condition underscores the tremendous importance of a normally functioninglymphatic system, which returns proteins, lipids, and accompanying water from the interstitium to the venous circulation near the subclavian vein–internal jugular vein junction, bilaterally. The normal and abnormal flow of interstitial fluid through the lymphatic system are demonstrated below.

The body quadrants of superficial lymph drainage.(1) Normal lymphatic flow in (a) deep systems and (b) superficial systems. Note the small collateral vessels interconnecting the 2 systems. (2) Lymphedema develops from obstruction, dilation of valves, valvular insufficiency, and subsequent reversal of lymphatic flow.

Recent studies

In a randomized, single-blinded clinical trial, Torres et al investigated whether early physiotherapy can reduce the percentage of patients who develop clinically significant secondary lymphedema following breast cancer surgery. The study included 116 women (patients who did or did not receive early physiotherapy) who had undergone breast cancer surgery involving dissection of the ancillary lymph nodes. In the early physiotherapy group, treatment included manual lymph drainage, scar tissue massage, and progressive active and action-assisted shoulder exercises. At 1-year follow-up, the authors found that 25% of patients (14 patients) in the control group had developed secondary lymphedema, compared with 7% of patients (4 patients) in the early physiotherapy group. Torres et al concluded that in women who have undergone the above-described breast cancer surgery, early physiotherapy may help to prevent postoperative secondary lymphedema for at least 1 year.

Results from a randomized, single blind, controlled trial have suggested that in trying to prevent arm lymphedema, manual lymph drainage with instructional guidelines and an exercise program does not provide significantly better results than an exercise program and guidelines alone after axillary lymph node dissection for breast cancer. Researchers reported triple therapy (manual drainage, guidelines, exercise) was not likely to produce medium-to-large effects in reducing lymphedema of the arm in the short term.
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