Lymphedema refers to the soft tissue fluid caused by the obstruction of lymphatic flow in certain parts of the body after repeated infections on the surface of the body, subcutaneous fibro-connective tissue proliferation, fat sclerosis, thickening if the limb, and later skin thickening, roughness, toughness like elephant skin, also known as “elephantiasis”.
Etiology
1.Primary lymphedema
(1) Congenital Monogenic.
(2) Early onset Primary lymphedema can be classified as follows.
(1) Lymphatic dysplasia with subcutaneous lymphatic agenesis;
(2) Hypolymphatic development with small and few lymph nodes and lymphatic vessels;
(3) Lymphatic hyperplasia with large and numerous lymph nodes and lymphatic vessels, sometimes with distortion and varicosity.
2.Secondary lymphedema
(1) Infectious Parasites, bacteria, fungi, etc.
(2)Injurious Surgery, radiotherapy, burns, etc.
(3)Malignant tumor Primary tumor, secondary tumor.
(4) Other systemic diseases, pregnancy, etc.
Clinical manifestations
Skin and subcutaneous tissue proliferation, skin wrinkles deepen, skin thickening and hardening roughness, and may have spines and warty protrusions, appearance like elephant skin. In the early stage, the affected limb is swollen and can be reduced after elevation. In the late stage, the affected limb is obviously swollen, the surface is roughly keratinized and rubber-like swelling. A few may have skin fissures, ulcers, or warty growths.
Examination
1.Diagnostic puncture tissue fluid analysis
2.Lymphangiography
3.Isotope lymphangiography
Treatment
Lymphedema has different treatment principles depending on the early and late stages of the disease. In the early stage, the aim is to remove the stagnant lymphatic fluid and prevent the regeneration of lymphatic fluid, while in the late stage, the aim is to surgically remove the irrecoverable diseased tissue or treat the limited lymphatic obstruction by shunt.
1.Acute stage lymphedema
(1)Drainage in body position;
(2) Compression bandage;
(3) Restrict sodium intake and use diuretics;
(4)Prevent infection.
2.Chronic lymphedema
(1) Baking therapy;
(2) Surgical treatment. Some of the lymphedema that is not effective by conservative treatment eventually need to perform surgery. It can significantly improve the symptoms.