Lymphedema is a lifelong condition that requires expert care, which you can find at Duke Health. Our certified lymphedema therapists and surgeons have been specially trained to offer the latest treatments for lymphedema, whether it is mild or severe. We strive to reduce the quality-of-life issues and serious complications that lymphedema can cause. People with unexplained swelling should seek medical care as soon as possible to rule out dangerous blood clots or other emergency conditions.
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 could occur, for example, after surgery, radiation therapy, or chemotherapy to treat and prevent the spread of cancer. Lymphedema most often manifests in the arms and legs.
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It's important to test carefully for lymphedema, since it can be confused with other types of swelling/edema. During your initial evaluation, your lymphedema provider will discuss your medical history and perform a detailed physical exam. The provider will assess the condition of your skin and how it reacts to prodding, evaluate how well the affected body part moves, and test your general strength and balance. You may also need one or more of the following tests:
Genetic Testing and Counseling
Blood tests can identify certain genes or abnormalities that can cause primary lymphedema. Genetic counselors help you understand how these findings may affect family members.
Measuring the affected body part provides information about the extent of your swelling. If lymphedema is present in an arm or leg, measurements from your affected limb will be compared with measurements from your unaffected limb.
Ultrasound, MRI, CT scans, X-rays, and other imaging tests can assess vessel health and identify blockages or other conditions that could be contributing to fluid buildup in the body.
Bioimpedence Spectroscopy (BIS)
A machine sends painless electrical currents through the swollen body part to measure the level of resistance. Lower resistance indicates higher levels of fluid accumulation.
This imaging option shows how fluid moves through the lymphatic system over time. Although it is considered the “gold standard” for confirming a lymphedema diagnosis, it’s reserved for select people and surgery planning because it requires injecting a radioactive dye into an already overloaded lymphatic system.
Nonsurgical Lymphedema Treatment
If your provider suspects lymphedema, you may be referred to a physical or occupational therapist. Together, the nonsurgical lymphedema treatments listed below 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.
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, devices, and making other modifications to help you bathe and apply moisturizer.
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.
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.
Surgical Options for Lymphedema
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.
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.
Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2020–2021.
Why Choose Duke
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.
If you are hospitalized for another issue, our certified lymphedema therapists are available to assess you for lymphedema and make treatment recommendations.