I. Concept of lymphedema
Lymphedema is a series of pathological changes including tissue edema, chronic inflammation, and tissue fibrosis caused by the retention of lymphatic fluid in the interstitial space of tissues due to impaired lymphatic circulation. It is most common in the extremities, but can also occur in the face, neck and external genitalia. Lymphedema is a progressive disease that develops progressively. Early treatment and control is the key. The pathological changes caused by lymphedema are usually irreversible. The hazards of chronic lymphedema include: swelling and thickening, tissue fibrosis, fat deposition, limb or organ deformity, which may cause disability in the late stage; lymphangitis and inflammation of surrounding tissues, which may lead to life-threatening sepsis in severe cases; lymphedema limbs with combined venous disease may form chronic ulcers that are difficult to treat in the late stage; lymphedema in the late stage may also change from benign disease to malignant lesions.
II. Classification and staging of lymphedema
Lymphedema is divided into two types: primary and secondary. Secondary lymphedema refers to lymphedema caused by clear triggering factors such as radiotherapy, surgery, trauma, infection, malignant tumor, etc. Lymphedema can be divided into four stages according to the degree of clinical edema and fibrosis. Phase I: Reversible lymphedema. Characterized by localized indentation when the edema site is pressed with a finger. The edema is obvious in the afternoon or evening, and the swelling mostly subsides completely after resting overnight. Stage II: The edema does not subside on its own. As the connective tissue begins to proliferate, the texture of the tissue in the edematous area is no longer soft, the depressed edema gradually disappears, and the tissue becomes hard. Stage III: The volume of the swollen limb increases significantly, the tissue changes from soft to hard, fibrosis is evident, skin occurs in hyperkeratosis, and papilloma grows. Stage IV: also called elephantiasis, characteristic manifestation of late stage lower limb lymphedema, due to abnormal thickening of the limb, skin thickening, keratinization, roughness in the form of elephant leg-like changes, more obvious in the distal limb. Due to the abnormal enlargement and heaviness of the affected limb, as well as the obvious deformity of the shape, it affects the patient’s daily life and work.
III. Lymphedema treatment
Lymphedema treatment includes: pressure treatment, surgical treatment and conservative treatment. While surgical treatment often requires careful consideration, some people believe that lymphedema does not have absolute indications for surgery. Therefore, the more commonly used conservative treatment with pressure therapy is currently recognized as having significant effects. Manual lymphatic drainage was first introduced in France in 1932 by Dr. Vodder and his wife as a massage therapist who successfully treated enlarged lymphoedema and published the first article on manual lymphatic drainage in 1936.
The German doctors, Dr. and Mrs. Foldi, refined and developed a comprehensive decongestive treatment technique, which consisted of three parts, namely.
(1) Lymphatic drainage by manipulation, (2) Lymphatic drainage by elastic compression, and (3) Lymphatic drainage by compression.
(2) elastic compression bandaging.
(3) functional exercise
Fourth, the manipulation of massage drainage
Upper limb massage: applicable to breast cancer patients with axillary lymph nodes removed
Massage methods: 1.
1.Open the lymph nodes on the healthy side.
Firstly, use index finger, middle finger and ring finger to gently press the axillary lymph nodes on the healthy side by drawing circles with fixed points, about 5 to 7 times.
2.Cross the chest and drain the lymphatic fluid to the healthy side
The healthy side of the chest will be unblocked first, then from the affected side of the lymphatic fluid, across the chest to the healthy side of the lymph nodes. Massage the hands alternately plucked, do not interrupt.
3, then open the affected side of the lymph nodes
The same with the index finger, middle finger, ring finger drawing a circle to press the affected side of the axillary lymph nodes, about 5 to 7 times.
4.Three arm massage
The affected arm is divided into three segments: the first segment is the upper arm, from the shoulder to the elbow, the second segment is the lower arm, from the elbow to the wrist, the third segment is below the wrist to the fingers, each segment is pressed for about 5 minutes.
5.Upper arm massage
Fingers first from the bottom of the upper arm to the top of the paddle, so that the lymphatic fluid from large molecules into small molecules easy to flow, and then from the elbow to the shoulder for dredging.
6.Lower arm massage
Fingers from the bottom of the lower arm to the top, and then from the wrist to the elbow to open up.
7.Massage of palm and back of hand
From the palm of the hand to the back of the hand, then massage the back of the hand, the end of each fingertip can also be gently massage, and then from the fingertips to the wrist to unblock.
8.Final unblocking
Finally, from the affected fingertips all the way up to the healthy side of the lymph nodes, do not interrupt the action.
9.Massage time
The whole set of massage time, about 15 to 20 minutes.
Lower extremity massage: for patients with gynecological cancer who have removed lymph nodes in the groin
Massage method.
1.Open the lymph nodes in the groin
First, use the index finger, middle finger and ring finger to gently press under the lymph nodes in the groin in a fixed point and circle, about 5 to 7 times.
2.Three sections of the leg massage
The legs are divided into three sections for massage: the first section for the thigh, from the knee to the groin, the second section for the calf, from the ankle to the knee, the third section is below the ankle to the toes, each section is pressed for about 5 minutes.
3.Thigh massage
From the bottom of the thigh to the top of the paddle, so that the lymphatic fluid from large molecules into small molecules easy to flow, and then from the knee to the groin to unblock.
4.Calf massage
From the bottom of the calf to the top, then from the ankle to the knee to unblock.
5.Foot back massage
Massage from the palm of the foot to the back of the foot, and then from the toes to the ankle paddle, the end of each fingertip can be lightly rubbed.
6.Final unblocking
Finally from the toes all the way up to the groin lymph nodes, do not interrupt the action.