COMPRESSION THERAPY FOR TREATMENT OF LYMPHEDEMA, VENOUS INSUFFICIENCY AND WOUND HEALING

Although Lymphedema has afflicted the population for centuries, little was understood about the disease. Only in the past ten to fifteen years have clinicians begun to seriously focus on its treatment.

Lymphedema is an accumulation of lymphatic fluid that causes swelling in the arms and legs. Edema occurs when venous and/or lymphatic vessels are impaired. When the impairment is so great that the lymph fluid exceeds the lymphatic transport capacity, an abnormal amount of protein fluid collects in the tissues of the extremity. Untreated, this stagnant, protein-rich fluid not only causes tissue channels to increase in size and number, but also reduces oxygen through the transport system, interferes with wound healing and provides a culture medium for bacteria that can result in various infections.

Lymphedema can occur from idiopathic or unknown causes. This is called Primary Lymphedema. Lymphedema can be present at birth, either idiopathically or associated with arterial-venous abnormalities, hemangioma, or lymphangioma.
Breast or abdominal surgery can result in Secondary Lymphedema. Surgical removal of a tumor and the adjacent lymph nodes and vessels can block lymph fluid from flowing naturally through its system. Other surgeries that require lymph node removal are those performed for skin cancer (melanoma), gynecological cancers, bladder or colon cancer and prostate or testicular cancer.
 

Radiation therapy used in the treatments of various cancers and some AIDS-related diseases, can damage otherwise healthy lymph nodes by causing scar tissue to form and thus, interrupt the normal pathway of the lymphatic fluid.

Lymphedema can occur secondary to an infection that interrupts normal lymphatic pathway function. A severe traumatic injury may also trigger the onset of lymphedema.
According to the World Health Organization, lymphedema affects 250 million people worldwide. Others estimate that one in every twenty-five will suffer from some form of lymphedema during their lifetime. The M.D. Anderson Hospital in Houston, Texas reports that approximately 15% of all women with breast cancer will develop lymphedema over the course of their lifetime and that lymphedema resulting from prostate cancer is on the rise.

Lymphedema is a chronic condition and often begins with a swelling in the hands or feet. Early diagnosis and treatment improves both the prognosis and the condition. Left untreated, the limbs become more edematous and the skin hardens, losing its elasticity (fibrosis). Moreover, untreated lymphedema leads to infection and sometimes, irreversible complications.

Compression must be applied to the limb to reduce the swelling. Surgical compression stockings or sleeves can apply compression. Manual Lymph Drainage (MLD) is performed by specially trained therapists, utilizing a gentle massaging technique in conjunction with a pumping motion. Some treatment centers use a special bandaging technique.
Increasingly, compression pumps are being used to treat lymphedema. The system consists of a pump and an appliance (sleeve) which fits over the extremity. Air pressure is applied to the appliance which in turn, applies pressure to the extremity. The basic pump applies a uniform pressure over the extremity. The better devices consist of a pump and appliance with three or more segment which sequentially apply pressure along the extremity, distally to proximally.

Since lymphatic pressure is greater distally than proximally, the preferred method of compression therapy would be to mimic the lymphatic system. This is accomplished by means of a pump that applies gradient pressure to the segmented appliance. This system mimics the lymphatic system wherein it applies gradual, gradient pressure distally to proximally, moving the accumulated fluid from the affected extremities back into the body where it can be naturally eliminated. It simulates a gentle massaging action. Pressure and the subsequent effectiveness can be gradually increased as the patient becomes more tolerant. These devices are low cost, lightweight, quiet, comfortable and easy to use for home therapy. Because of its comfort and ease of use, compliance is very high. It is the cost-effective way to treat lymphedema and venous insufficiency.
Compression therapy additionally, is extremely effective in curing decubitus ulcers and the lower of the extremities.