It can be defined as the accumulation of protein-rich fluid as a result of impaired lymphatic circulation due to congenital or subsequent causes. For example, it is one of the most distressing complications that occurs as a result of removal of the axillary lymph nodes after breast cancer surgery. type may develop after surgery or radiotherapy (radiation therapy). However, it develops especially after breast, prostate and lower abdominal region cancers. Minor injuries such as blow to the arm, graze-cut, insect bite and infection may cause lymphedema.
Lymphedema can be primary or secondary depending on the underlying cause.
Primary Lymphedema: It occurs as a result of developmental abnormalities in the lymphatic system, it can be congenital or inherited.
Hereditary Lymphedema Medicine1A (Milroy's Disease): Developmental anomaly of lymphatic vessels in the womb occurs in the first 2 years of life. Often the lower part of the body is affected and there is bilateral involvement, intestinal lymphangiectasia and cholestasis may accompany. Edema is usually on the back of the foot. Hydrocele (swelling in the scrotum) in men
Hereditary Lymphedema Type2 Precox (Meige's Disease): It constitutes 65-80% of primary lymphedema. Women are more affected. The clinical picture occurs before the age of 35 and mostly in adolescence.
Lymphedema Tarda: It occurs after the age of 35. There is lymphatic valve dysfunction (lymphatic valve disorder). It constitutes 10% of primary lymphedema cases.
Secondary Lymphedema: The developmentally normal lymphatic system occurs as a result of being affected by a cause. The most common cause of secondary lephedema is filariasis. In developed countries, the most common cause is postmastectomy lymphedema seen in patients with breast cancer.
Filariasis: It is an endemic disease seen in the southern regions. The larvae carried by the mosquitoes pass into the lymphatic system with the bite of the fly. In lymphatic filariasis, the lower part of the body, breast and external genitalia are mostly affected. .
Breast Cancer-Associated Lymphedema: Removal of axillary lymph nodes in breast cancer-related lymphedema, radiotherapy , having a high body mass index (BMI) and advanced age are risk factors.
Stages of Lymphedema What are they?
Stage 0 (Subclinical Stage): The patient has undergone surgery or trauma and has not yet started lymphedema, but is at risk of lymphedema. There is no clinical swelling, but the patient may describe a feeling of heaviness.
Stage 1 (Reversible Stage): Swelling occurs clinically at this stage. The swelling is still soft, the pitting is positive and there is no induration yet. Swelling in the limb with lymphedema; It decreases in the morning by moving it up and down or after resting at night. If appropriate and timely treatment is applied at this stage, it is possible to bring the limb to normal dimensions.
Stage 2 (Spontaneous Iversible Stage): Tissue growth and hardening begin at this stage. Over time, the tissue hardens, cupping becomes difficult, and the Stemmer sign is positive. (Stemmer's sign, when the skin is held at the level of the fingers with two fingers and the skin is not inlaid when trying to lift it) At this stage, with the increase in volume, regional immune protection mechanisms begin to deteriorate and infections such as lymphangitis and cellulitis are common.
Stage 3 (Lymphostatic Elephantiasis): There is an increase in the volume of lymphatic edema and tissue changes. Growth of connective tissue cells, increase in collagen fibers, increase in fat deposits and hardening occur. The tissue tightens and hardens. Stemmer sign becomes more pronounced. Skin changes; papillomas, cysts, fistulas, hyperkeratosis, hyperpigmentation, lymphorrhea, nail-skin fungal infections and ulcerations are common.
WHEN IT DEVELOPS?
* Slight swelling may occur immediately after surgery. The swelling heals quickly.
* The type that develops 6-8 weeks after surgery-radiotherapy heals more slowly.
* The most common is the type that develops slowly over months or years.
risk of surgical removal causes snoring. The point to remember is; Even if treatment is planned with a biopsy of the armpit gland (sentinel node biopsy), there is a risk of swelling. Swelling may occur or swelling may increase during radiotherapy.
WHAT ARE THE SYMPTOMS?
A feeling of tightness or fullness in the arm, pain, heaviness, tingling, swelling and redness, Difficulty in movement in the arm, hand and wrist, squeezing of the watch, ring or bracelet, feeling of tightness in the skin, discomfort and restlessness. When it is noticed visually, the difference in diameter may have reached the level that needs to be treated.
HOW SHOULD LYMPHODEMA TREATMENT BE?
Compliance with the treatment planned by your physical therapy doctor affects the success of the treatment. Treatment can sometimes take less than 1 week, sometimes longer than 1 month. If the correct application is not made, success cannot be achieved.
The aim of the treatment is to reduce the swelling and try to prevent its recurrence.
1. Correct skin care (moisturizer suitable for the arm should be applied from bottom to top in one direction, the skin should not be dry) (2 times / day)
2. Self-massage and manual lymph drainage (it should be applied by experienced people who have been trained in this subject, you can be taught the simple way. Please do not have it done by inexperienced people, your swelling may increase!)
3. Pressure cuff / bandaging (exercises It must be used during the operation)
If the difference in diameter is large (2-2.5 cm between the two arms), bandage treatment is started. The bandage treatment and the material used are special. A multi-layered application is made with a short stretch bandage. It should be performed by an experienced physical therapy and rehabilitation physician. When the diameter is reduced to different desired limits, the pressure cuff is switched. Relatives of patients can be taught about bandaging.
4. Pressure pumps
5. Exercises
The arm diameter measured by the doctor is important in the treatment. All or some of these treatments are applied according to the diameter differences.
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