Lymphoedema Treatment

What medical therapies are there?

Manual lymphatic drainage (MLD) is a specialised form of therapy which is gentle and rhythmic. It is a technique which was developed in Europe in the 1930s by Emil Vodder. The method has now been adapted by medical professionals around the world to treat lymphoedema and there are a number of schools of MLD (including Asdonk and Földi in Germany, Casley-Smith in Australia, LeDuc in Belgium and Vodder in Austria).

The aim is to encourage protein reabsorption and stimulate lymphatic flow to improve drainage away from congested areas.

How does MLD work?

Manual lymphatic drainage (MLD) is a specialised form of therapy which is designed to improve the functions of the lymphatic system. The specific movements used in MLD treatments allow the superficial lymph vessels to reabsorb excess fluid, metabolic waste, large protein molecules and foreign substances from the tissues. The lymphatic fluid is then encouraged to empty into the deep lymphatic vessels and filtered through a series of lymph nodes along its route before it is returned to the blood circulatory system in the neck area.
All patients with lymphoedema or at risk of developing it (for example after breast cancer surgery or after radiotherapy to the pelvis) can benefit from MLD.

What are the benefits of treating lymphoedema?

Apart from the relief or reduction in swelling and therefore improved comfort and quality of life, there is evidence that treatment also reduces the number of infective episodes and cellulitis. In addition, the skin and subcutaneous tissues often feel much softer after MLD.

Treatment protocols

Intensive Therapy comprises:

• A course of 10 to 15 MLD treatments over a period of 2 to 3 weeks.
• Exercises
• Compression hosiery
• This is followed by maintenance therapy.

Complex decongestive therapy involves 2 to 4 weeks of:

• Multilayer bandaging
• Pneumatic compression therapy
• Manual lymphatic drainage
• Exercises
• This is followed by maintenance therapy.

Maintenance therapy comprises:

• Exercise
• Manual lymphatic drainage
• Self lymphatic drainage
• Compression hosiery
• Skin and nail care and careful chiropody
• Occasionally prophylactic antibiotics can reduce the number of episodes of cellulitis

Testing for Lymphoedema

The Perometer is a very fast and easy way of measuring the volume of the limb. Within seconds the Perometer ring is slid up over the limb, and the exact dimensions are captured by the computer. This information not only allows us to keep an eye on how effective treatments are, but also to provide the most accurate way of getting the right stockings and bandages for our patients.

Sometimes tests would be performed to exclude other causes of leg swelling, for example, a scan of the veins in the leg (a duplex scan). Blood tests may be helpful in excluding other causes.

Often an isotope lymphogram or ‘lymphoscintography’ is used to confirm the diagnosis of lymphoedema. This test does not, however, show what type of abnormality is present, for example, too few lymphatics or a normal number of poorly functioning ones, but often this does not alter the management.

Very occasionally it is important to obtain a more detailed view of the lymphatics and this can be achieved with an operative lymphangiogram. A CT scan or pelvic ultrasound is sometimes performed when it is important to exclude a mass or lump in the pelvis or abdomen.

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