Lymphoedema is a chronic condition resulting from congenital defects or secondary damage caused by surgical disruption, radiation, or trauma to the lymphatic system. Lymphoedema is characterised by swelling (oedema) due to the build-up of lymph fluid in the tissues just under the skin. This swelling, seen most often in the arms or legs, may involve the face, neck, abdomen and genitals.
The lymphatic system is one of the three circulatory systems in the human body. A great deal is known about the arterial and venous system, but only recently has more attention been spent on understanding the lymphatic system, which plays a vital role in the balance of fluids in the body.
The lymphatic system functions to balance the tissue fluid pressures by reabsorbing protein-rich fluids and waste products that escape from the bloodstream into the interstitial space.
The normal lymphatic system is a one-way system in which tiny lymphatic capillaries start blind-ended in the tissues, where they are attached to the skin by anchoring filaments. These capillaries unite to form a network of wider vessels that act as a regional drainage system.
As these vessels become larger, they follow a similar path to veins, eventually emptying into the venous system through two large lymph-collecting vessels. 75% of lymph fluid is collected from the left side of the body and the right leg and lower abdomen and passes into the thoracic duct. The remaining 25% of the lymph fluid is collected from the right side of the head, neck, arm and chest and is passed into the lymphatic duct (Mei, 2009).
This vast lymph network contains lymph nodes, located in chains or clusters that filter and remove potentially harmful bacteria, viruses and cancer cells prior to entering the venous system. The lymph nodes also produce lymphocytes, white blood cells specially designed to protect us from disease.
Fluids in body tissues are normally kept in balance through complex interactions between the blood circulation mechanisms and the lymphatic system. Arterial blood flow brings nutrients and oxygen to the tissues and during this process fluids will pass through the capillary walls (filtration) into the tissue (interstitial) spaces. Waste products and fluids that have collected within the tissue spaces are then primarily reabsorbed back into the small, collecting veins that return the blood back to the heart.
The job of the lymphatic system is to remove any excess fluid, waste products, viruses and bacteria still trapped in the interstitial spaces, (reabsorption) where it’s ultimately returned to the venous circulation.
If an imbalance occurs between the fluids that accumulate in the tissue space and the rate of reabsorption, then oedema occurs. There are many causes that contribute to this tissue fluid imbalance, but if the lymphatic reabsorption is compromised, proteins are also trapped in the tissues increasing the concentration of the interstitial fluid. This accumulation of high protein fluids in the interstitial space is called lymphoedema.
Under normal conditions, healthy lymphatic flow is supported by rhythmic contractions of the lymphangions. These are the functional segments of lymph vessels with walls of smooth muscle cells and one-way valves that prevent back flow. These contractions generate enough pressures to move the fluid towards the heart. All other forces, such as muscular contractions, respiratory movements and arterial pulsations are secondary to the normal lymphatic contractions (Waldemar, 2002).
However, research has shown that when spontaneous lymph flow mechanisms are damaged, limb muscle contractions take over the job to stimulate lymphatic contractions, subsequently increasing lymph flow, or generating intralymphatic pressures that propel the lymph (Waldemar, 2008).
In this study, the benefit of compression bandaging was illustrated to support the limb muscle dynamics that supported lymph flow.
The ultimate goal of lymphoedema management is to stimulate lymphatic flow via alternative pathways so that lymph fluid is moved from the lymphoedematous regions, circumventing the damaged or obliterated normal pathways.
The traditional treatment methods will vary depending on the patient’s physical status and stage of condition. It’s widely accepted that compression therapy is an effective component of lymphoedema treatment.
Lymphoedema is treated by a physical or occupational therapist or other health care professional with specialised training. Treatment may be accomplished in specialised clinics, hospital or community settings. Lymphoedema management may be called complex decongestive therapy (CDT), decongestive lymphatic therapy (DLT) or complete decongestive physiotherapy (CDP). It includes skin care, education, movement/breathing exercises, manual lymphatic drainage (MLD) and compression therapy.
1. Mei R. Fu, PhD, RN, ACNS-BC, Sheila H. Ridner, PhD, RN, ACNP, Jane Armer, PhD, RN, FAAN. American Journal of Nursing July 2009; 109(7): 48–54
2. Waldemar L. Olszewski. Contractility Patterns of Normal and Pathologically Changed Human Lymphatics. Ann. N.Y. Acad. Sci. 2002; 979: 52–63
3. Waldemar L. Olszewski. Contractility Patterns of Human Leg Lymphatics in Various Stages of Obstructive lymphoedema. Ann. N.Y. Acad. Sci. 2008; 1131: 110–118