A-Z of Injuries

A transport disorder of the lymphatic system: Lymphoedema (swelling) occurs when lymph flow is impaired. Either damage, obstruction or absence of vessels can lead to dysfunction of the lymphatic system. This can result in the accumulation and stagnation of lymph in the tissues. Most often limbs are affected, but lymph oedema can also occur in the face, neck, abdomen or genitals. Tissues with lymphoedema are at risk of infection and susceptible to progression. Lymphoedema is a treatable and manageable condition.

Types of Lymphoedema and Causes:

  1. Developmental (inherited) disturbance of the lymphatic system (primary lymphoedema)
  2. Acquired damage of lymphatic vessels and/or lymph nodes (secondary lymphoedema)
  1. Primary Lymphoedema occurs in women more often than men. In most cases it is found on one side and is pronounced more distal. If it occurs on both sides, there is normally and asymmetry. Primary lymphoedema can be further classified according to the type of occurrence (congenital: already manifest at birth – lymphoedema praecox: occurring before the age of 35 – lymphoedema tardum: occurring after the age of 35)
  2. Secondary Lymphoedema can occur following surgical removal of lymph nodes or radiation therapy in the treatment of cancer. Secondary lymphoedema can also occur as a result of the following:
  • Post-operative (e.g. after plastic or venous surgery).
  • Post-traumatic (e.g. trauma which leads to injury of large lymph collectors such as open fractures, burns, wounds).
  • Post-inflammatory (e.g. rheumatic diseases, sinusitis, recurrent phlebitis).
  • Post-infection (e.g. recurrent cellulitis, inflammation of the lymph vessels, inflammation of lymph nodes).

Treatment involves decongestive therapy:

Manual Lymph Drainage – Patients receive Manual Lymph Drainage (MLD) to remove excess fluid and protein from the tissues. The MLD is performed to open lymphatics in the unaffected regions so these can help to drain the affected area. MLD stimulates lymphangions to increase their activity, which results in a decompression and emptying of obstructed lymphatic channels.

Exercise – Effective lymph flow depends on sufficient muscle and joint activity, especially if the functionality of the lymphatic system is compromised. Decongestive exercises are most effective if performed while the patient wears compression garments or bandages, which are also essential components in lymphedema management.

Skin Care and Hygiene – Good skin care plays an essential part in the treatment of lymphoedema. Daily skin cleansing with antibacterial washes and neutral balanced pH lotions will help to eliminate possible bacterial and fungal growth and so minimise the possibility of repeated attacks of cellulitis or lymphangitis.

Breathing – The lymph transport in the Thoracic Duct (Ductus Thoracicus) is mainly caused by the action of breathing. Taking into consideration that this duct transports 4 litres of lymph per day explains the importance of diaphragmatic breathing to help increase transport of lymphatic fluid.

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