2 Indications and current treatments
2.1 Lymphoedema is the abnormal accumulation of subcutaneous fat and fluid in body tissue. It leads to chronic swelling that can cause disability, pain and cosmetic issues. Any part of the body can be affected, but the condition is most common in the arms and legs. Lymphoedema can be complicated by recurrent infection (cellulitis), which further damages the lymphatic vessels and aggravates the condition. Primary lymphoedema results from a congenital inadequacy and gradual occlusion of lymphatics. Secondary lymphoedema results from damage to the lymphatic system or removal of lymph nodes by surgery, radiation, infection or injury. In the UK, one of the most common types of chronic lymphoedema is secondary lymphoedema of the arm after breast cancer or its treatment.
2.2 Current conservative treatments for lymphoedema include manual lymph drainage (MLD), which stimulates the movement of lymph away from the affected limb, and decongestive lymphatic therapy (DLT). DLT combines MLD massage techniques with compressive bandaging, skin care and decongestive exercises. Once DLT sessions are stopped the patient is fitted with a custom-made compression garment, which is worn every day. These techniques aim to reduce the pain and discomfort associated with lymphoedema. In very severe cases, surgical treatment can be used to reduce the size of the limb or to restore lymphatic flow. Repeated debulking procedures to excise skin and subcutaneous tissue may be needed. Procedures to restore lymphatic flow from the limb include constructing an alternative lymph drainage pathway via lymphovenous anastomosis.