• #12-3. Treatment knowhow of lymphedema




    Key symptoms of lymphedema is the chronic swelling of the limbs. Swelling progresses without pain and shows partial pitting in the early phase. Swollen tissues gradually turn non-pitting in the chronic phase where the secondary fibrosis of the skin and fascia make the tissues harden.

    Lower limb swelling develops in the ankle which progressively resembles a tree trunk or elephant leg. The foot of a lymphedema patient eventually gets deformed.

    - Positive Stemmer sign (The skin of the dorsal foot is tight and cannot be pinched.).

    - Mounds on the ventral hand or foot.

    - In the later stages, toes swell up in sausage-like shapes.

    - Deep dents and wrinkles form around the ankle and achilles tendon.

    - Creases of the hand deepen.

    Mobility decreases due to heaviness of the limbs and loss of function and worsens the hyperemia and lymphedema. Serious aesthetic and psychological problems, severe skin infection and inflammation, skin complications, and malignant transformation, etc. can follow.

    -Normal or pale skin color.

    -Cellulitis, erysipelas, lipodermosclerosis.

    -Skin papilloma, microbial eczema, myosis, pyoderma, lymphorrhea, keratosis, hemangioma, etc.

    -Pain develops when swelling suddenly worsens but disappears in a few days.

    Most patients present localized swelling limited to the distal or medial parts of upper or lower extremities. If lymphedema is under-treated or is left untreated, it could develop into Stewart-Treve syndrome which is can be fatal.


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    Early signs


    Heaviness or pain in one leg or arm, and unexplained throbbing pain can be felt in the early stage. Prickling sensation can be felt. Tightness of the hands or feet is accompanied by noticeable swelling in the arm, leg, hand and foot. In some cases, swelling affects fingers, shoulder and chest.

    In the early phase, swelling develops in the areas of blunt trauma and cut injury or areas of exercise injury or sunburn. It could also develop after inflammation of the cancer therapy area and after taking a three-hour flight. The swelling can be temporary and its cause cannot be easily explained.

    The fingers, wrist, and ankle stiffen and do not bend easily. Patients notice that shirts or pants that used to fit well are now too tight. Rings, bracelets or shoes in particular do not fit anymore. When pressing the skin with fingers, the skin is tight and a deep dent is formed. The skin is shiny without wrinkles and prone to inflammation.


    Signs of inflammation


    The patient may experience chills, shivers, high fever of at least 38℃, rash, pain, softness, redness, and swelling etc. Wounds do not heal easily and red sores are hot to the touch and produce discharge. The patient may experience pain in swallowing, a runny nose, congested nose, headache, and pain when pressed with fingers on the cheekbone.

    Dry or wet coughs persist over two days and the oral mucosa or tongue have white coating. Nausea, vomiting, diarrhea, flu symptoms, or discomfort, etc. may be experienced along with frequent or difficult urination or burning pain during urination.


    -To be continued-

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