Non-Compression Treatment for Lymphedema

Complete decongestive therapy (manual lymph drainage):

As the name of the treatment suggests, the treatment, in addition to using short stretch compression bandages, therapeutic exercises, and skin care, also uses manual ways to manipulate the lymphatic ducts.

The Complete decongestive therapy or CDT is one of the main tools used for in lymphedema management

Developed in the 1930’s by Emil Vodder, this technique was first used in the treatment of chronic sinusitis and other immune disorders.

To reduce lymphedema, as per CDT procedure, the patient has to initially make numerous and frequent visits to a certified therapist accompanied by a doctor's prescription.

When reduction in lymphedema is achieved, the use of elastic compression and non-elastic directional flow foam garments is then started. In all of this, it is necessary that the patient is in no way reluctant and there is increased participation from the patient. This is necessary because for proper ongoing care.

The process to manually manipulate the lymphatic ducts includes gentle massaging of the skin of the affected area. This stimulates flow of lymph back into the blood stream.

Once the extra lymph has entered into the blood stream and the blood passes through the patient’s kidneys, the excessive lymph is then strained out and removed via urination, from the body.

This is not a surgical procedure and is rather quite gentle. Normally one sitting will include drainage of lymph from the neck first then the trunk and finally the involved extremity. This specific order is necessary. The sitting lasts for around 40 to 60 minutes.

This process is usually found useful on non-fibrotic lymphedema.

Surgical techniques:

It should be noted here that surgical treatment for lymphedema in no way cures a person of the disease. It does not even finish the need for CDT.

Surgical treatment is used when a case reaches levels of extremity and there is immediate need to reduce the affected limb’s weight. Surgery also helps in minimizing the frequency of inflammatory attacks, improves cosmesis, and has the potential to reduce risk of secondary angiosarcoma.

Surgery clearly reduces lymhpedema in the short run. However, there is very little evidence to show that it also works in the long-term.

Surgical techniques include:
- Circumferential excision of the lymphedematous tissue followed by skin grafting
- Lympholymphatic anastomosis
- Modified liposuction to remove adipose tissue associated with long term lymphedema

Recently, Low level laser therapy has been given the go ahead by the FDA for treatment of lymphedema as certain studies have suggested that low level laser therapy could be effective in reducing lymphedema.

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