Lymphedema

What Is Lymphedema?
The lymphatic system plays a vital role in your immune system by circulating lymph fluid -- made up of bacteria-fighting white blood cells, proteins, and other substances -- throughout your body. Lymph fluid (also called interstitial fluid) that cannot flow freely may back up, which can cause pain and uncontrolled swelling (also called edema). Lymphedema can be treated but not cured. Left untreated, lymphedema can cause painful skin problems, disability, and life-threatening infections.

Types of Lymphedema
There are two types of lymphedema.

• Primary lymphedema is genetic and uncommon.
• Secondary lymphedema can result when the lymphatic system is altered due to injury, infection, or problems with major organs. It may occur after breast cancer treatment, including lymph node removal, radiation therapy, or chemotherapy. Lymphedema most often manifests in the arms and legs.

If your provider suspects lymphedema, you may be referred to a physical or occupational therapist. The following nonsurgical lymphedema treatments are known as complete decongestive therapy.

Lifestyle Changes and Exercise
A healthy diet and elevating your affected limbs can help your body to better circulate stagnant lymph fluid. Exercise helps the muscles become more efficient in pumping lymphatic fluid throughout the body.

Skin Care 
Lymphatic swelling can stretch your skin to the point of breaking, causing painful wounds and scarring. To help prevent skin damage and infections, our physical and occupational therapists teach you how to maintain good skin hygiene (using antibacterial soap, moisturizing, wearing sunscreen) and monitor skin lesions. They may also recommend using long-handle lotion applicators, and devices, and making other modifications to help you bathe and apply moisturizer. 

Compression 
Garments like compression socks and sleeves along with special fabrics, bandages, and wraps help promote the flow of fluid through lymph channels. Special compression devices apply pressure to irregularly shaped limbs. Our lymphedema therapists have been trained to use these devices effectively and will teach you and your family members how to use them correctly at home. 

Manual Lymphatic Drainage 
Certified lymphedema therapists perform this intensive massage technique that helps move lymph fluid out of congested areas and into decongested areas. 

Medications
Some medications are used to treat certain lymphedema symptoms. Topical steroids and antihistamines reduce skin inflammation and itching. Oral medications help reduce inflammation, thin lymphatic fluids, restore more normal vein function, and improve lymphatic flow.

Performed by vascular surgeons or plastic surgeons, lymphedema surgery is usually only recommended for people who have secondary lymphedema, aren’t seeing satisfactory improvement with other treatments, or have cosmetic concerns. Even after surgery, people with lymphedema will still need to wear compression garments or wraps, practice good skin hygiene, and continue other maintenance therapies. 

Lymphatic Anastomosis
During this minimally invasive procedure, also called lymphovenous bypass, a surgeon attaches lymph vessels to each other or to veins, bypassing damaged lymphatic tissue and allowing drainage elsewhere. You’ll go home the same day as your surgery. Before surgery, you may need to undergo a special type of imaging called lymphoscintigraphy. It helps your surgeon map out your lymphatic system and identify blockages. 

Lymph Node Transfer/Transplant
One or more healthy lymph nodes from another part of your body, usually the abdomen, are transplanted into the damaged region. This helps revitalize the lymphatic tissues and encourages new lymph node growth in that area. You’ll stay in the hospital for a few days after the surgery to recover. 

Debulking and Liposuction
Lymphedema can cause fatty deposits to accumulate in an area of the body, making it heavy and difficult to use or move. Removing these fatty deposits through surgery or liposuction can help reduce weight in that area and restore function.

Lymphedema Care for Everyone
Unlike some health systems, we have the ability to assess and treat anyone with lymphedema, not just people with cancer. Our team of providers are ready and willing to offer the right tests to determine whether your issue is lymphedema or another type of edema, and we’re trained to provide top-notch care. If your doctor is hesitant to refer you for a lymphedema evaluation, we encourage you to ask for a referral. The earlier you receive care, the better your results will be.

Certified Lymphedema Therapists
Duke’s certified lymphedema therapists have completed advanced lymphedema-specific training. In fact, our physical and occupational therapy department is training the next generation of certified lymphedema therapists through our residency education programs.

Inpatient Care
If you are hospitalized for another issue, our certified lymphedema therapists are available to assess you for lymphedema and make treatment recommendations.