February 24, 2015
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Lymph edema is a swelling in the limb, which is precipitated by surgery of the draining lymph nodes or radiation or infection. Protein-rich fluid, fat globules and debris accumulate in the subcutaneous tissue. Persistent accumulation leads to brawny swelling. Infection along these vessels can give rise to redness, pain and accompanying fever.
Lymph edema is known to occur in 15-25 % of women who undergo removal of lymph nodes from the armpit during surgery for breast cancer. This can occur weeks, months or years after the surgery.
Few points to keep in mind to prevent lymph edema
- Avoid pricks and needles on the operated side of the arm
- Never measure the blood pressure on the side of surgery.
- One should not lift heavy weights (more than 5 kgs) with the operated arm.
- Cuts, stings, insect bite should be avoided.
- Tight garments, bracelets and rings should not be worn on the affected side.
- Be careful while paring (cutting) your nails. Avoid waxing of the arm on the affected side.
- In case of any accidental cuts, wash the wound carefully and apply antiseptic ointment immediately.
- If there is redness or swelling in the arm, report back immediately to your treating physician.
- If you wish to undertake a trip by flight, kindly ensure you have an arm sleeve (custom made) for the arm on the operated side during the duration of the flight.
The measures to deal with lymph edema
- Post operative exercises with isotonic exercise as an integral part to be initiated and continued for lifelong as a habit.
- Isotonic exercises improves the lymphatic circulation
- Over exertion is not recommended.
- External compression aids the muscle in pumping action to drain the lymph out of the limb.
- External compression can be achieved by multilayer bandaging or compression garments. A combination of both yields better results
Multilayer bandaging technique
- It is advisable not to do bandaging if there is any vascular compromise in the limb or neuropathic problem. It is also to be avoided in case of active infection.
- Redo the bandage after about 6 hours as it tends to loosen over time.
- Compression sleeve is best worn during the day.
- Graduated compression, maximum distally, allows for the lymph to be drained towards the heart.
- These garments are best custom made and should be replaced every six months.
Pneumatic compression ( Lymphapress)
- Pneumatic compression is delivered using a sleeve connected to a motor driven pump with the intention of assisting in lymphatic fluid return. It is best used in combination with a compression sleeve or bandaging.
- It is important to take care of the skin of the arm.
- Ensure there are no cuts, pricks or tight clothing or jewelry on the arm.
- The skin should be kept clean and moist to prevent cracks or fissures from developing.
- Nails should be pared with care. In case of injury or cut, please apply an antiseptic lotion or ointment and cover the wound. If, however, redness, pain or fever develops, then one would need to be put on antibiotics and anti-inflammatory drugs.
- Any infection will only cause the lymphedema to worsen.
Manual or self-lymphatic drainage
- Gentle massage of the arm starting distally and moving proximally allows for displacement of fluid in the desired direction.
- The massage should be gentle so as to stimulate the skin lymphatics to play an effective role in draining the fluid
- While a physiotherapist may perform a massage over 45 minutes to an hour, one can do it by self for about 20 minutes and get similar results.
Early intervention is the best way to deal with it. And better still is prevention!