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Lymphoedema

Lymphoedema

Lymphoedema may manifest as swelling of one or more limbs and may include the corresponding truncal area. Swelling may also affect other areas, eg. head, neck, breast or genitalia. Lymphoedema is the result of accumulation of fluid and other elements (eg. proteins) in the tissue spaces due to an imbalance between interstitial fluid production and transport. It arises from congenital malformation of the lymphatic system, or damage to lymphatic vessels and/or lymph nodes. Lymphoedema is a chronic condition that is not curable at present, but may be alleviated by appropriate management; if not treated it can progress and become difficult to manage. 

How many patients are affected?

At birth, around one person out of 6,000 will develop primary lymphoedema; the overall prevalence of lymphoedema/chronic oedema has been estimated as 0.13-2%. In developed countries, the main cause of lymphoedema is widely assumed to be treatment for cancer.

However, it appears that about a quarter to a half of affected patients suffer from other forms of lymphoedema, e.g primary lymphoedema and lymphoedema associated with poor venous function, trauma, limb dependency or cardiac disease. 

What are the risk factors?

The true risk factor profile for lymphoedema is not known. There may be many factors that predispose an individual to developing lymphoedema or that predict the progression, severity and outcome of the condition.

Classification of lymphoedema

Lymphoedema is classified as primary or secondary.

  • Primary lymphoedema is thought to be the result of a congenital abnormality of the lymph conducting system.
  • Secondary or acquired lymphoedema results from damage to the lymphatic vessels and/or lymph nodes, or from functional deficiency. Infections from insect bites, serious wounds or burns can cause lymphoedema when they damage or destroy lymphatics. Any type of surgery, serious injury, or radiation for cancer treatment can also cause the onset of the disease. It may also be the result of high output failure of the lymphatic circulation.

Treatment of lymphoedema

Lymphoedema has different stages of development. Compression garments can be used as prophylaxis or as part of intial management in patients who have mild lymphoedema. The main use of compression garments is in the long-term management of lymphoedema, usually following a period of intensive therapy. In general, the level of compression used to treat lymphoedema of the upper limb is lower than that required for lower limb lymphoedema. (1).

Some patients - especially those who are post breast cancer treatment - may wear a low compression armsleeve (14-18 mmHg) to minimise the risk of developing lymphoedema. This may be worn in "high risk" times such as during flying, exercise, or overuse of the arm. For those patients who have mild oedema, or well decongested extremities, an armsleeve of 20-25mmHg might be appropriate. For a patient experiencing a high level of oedema, there are several ways to achieve reduction by decongesting the limb, including manual lymphatic drainage and/or compression bandaging.

The result can be sustained by medical compression garments. Medical compression garments can be used as initial management in patients who have mild lymphoedema with minimal subcutaneaous tissue changes and shape distortion. Where there is considerable soft pitting oedema, multi layer lymphoedema bandaging will be required to reduce and stabilise the swelling prior to the application of medical compression garments.

Lower pressure compression garments also have a role to play in managing symptoms in a palliative context. 

How to minimise the risk of developing lymphoedema?

  • Take good care of skin and nails
  • Follow a balanced diet
  • Maintain optimal body weight
  • Avoid tight underwear, cloting, watches and jewellery
  • Wear comfortable supportive shoes
  • Undertake exercise/movement and limb elevation
  • Avoid exposure to extreme cold or heat
  • Use high factor sunscreen and insect repellent
  • Use mosquito nets in lymphathic filariasis endemic areas
  • Wear medical compression garments if prescribed or recommended

(1) Lymphoedema Framework: International Consensus. Best Practice for the Management of Lymphoedema. 2006, pages 19-39.

Download the Lymphoedema Framework Best Practice Guidelines. Lymphoedema Best Practice guidelines

Lymphoedema: SIGVARIS solutions

SIGVARIS provides several types of medical compression products to treat and relieve patients with lymphoedema. For lower limb lymphoedema, compression socks, stockings and tights are available at different compression levels. Speak with your clinician about treatment solutions.

To check our product catalogues for full details and ranges please click here. 

For example:

SIGVARIS ADVANCE® armsleeve is SIGVARIS' newest answer to the treatment of lymphoedema of the upper limb. This product has been designed with patients for patients.  The texture of SIGVARIS ADVANCE® is made of polyamide microfiber. Apart from its soft texture, this innovation microfiber incorporates a bacteriostatic additive. The non-organic agent contains silver ions that protects the skin and the knitting from bacteria multiplication. The non-bactericide agent keeps the natural saprophytic flora of the skin.

Therefore, SIGVARIS ADVANCE® contributes in maintaining a good skin hygiene of the arm suffering from lymphoedema. Similar to cotton, the thermoregulating viscose has the greater advantage of a better absorption of skin moisture which provides a new comfort highly appreciated by patients.

The choice of colours developed together with patients, the fine sewing reducing skin irritation, help patients with their concordance. In addition, SIGVARIS ADVANCE® armsleeve with handpiece is the only armsleeve product that matches the International Best Practice guidelines - the handpiece having the same compression level as the armsleeve.