Therapeutic Options in Lymphedema

Abstract

Lymphedema of limbs characteristically means increase in the volume of extremity caused by accumulation of tissue fluid, proliferation of fibroblasts and adipocytes, and excessive production of collagen. There is also increase in infiltrating immune cell mass. Bacterial colonization ensues as the result of lack of lymphatic transport away of microbes penetrating the foot and palm skin. Under physiological conditions capillary filtrate-tissue fluid flows into the lymphatics and is transported via the collecting lymphatic trunks to the blood circulation. The transported calculated volume for one lower limb ranges from 20 to over 200 ml in some cases during 24 h [1]. Obliteration of the transport lymphatic channels and sinuses of regional lymph nodes causes stasis of intercellular water, proteins, and migrating immune cells. Contractility of the lymphatics disappears. Tissue changes are hyperkeratosis, fibrosis, and accumulation of tissue fluid/lymph under the epidermis with occasional lymphorrhea [2]. The most common complication of tissue fluid stasis is bacterial dermato-lymphangio-adenitis (DLA) [3]. For a long time, there was no awareness of the progressive tissue changes leading to the development of elephantiasis, and accumulation of mobile fluid was considered as the main event in increased volume of the limb.