Lymphedema is a chronic pathology and its treatment is becoming an issue very discussed in scientific field, considering the scientific knowledge increase and the more and more effective cures. Lymphedema is not more an incurable disease but it can be treated in different ways thanks to continuous increase of scientific developments. A brief description of Lymphatic System is necessary in order to know all pathology aspects.
LYMPHATIC SYSTEM PHYSIOLOGY
In the human body blood is transported by two big systems: arterial and venous system. The two systems meet in the periphery, in a place called microcirculatory unit, that is composed of arterial capillary, venous capillary and interstice. In particular the interstice is characterized by a cells and fibres tridimensional net and it’s placed between the blood and lymphatic vessels. Interstitial liquid flows inside the interstice and it is composed of water, proteins, mineral salts, different kinds of cells like virus, bacteria etc. Arterial blood goes into microcirculatory unit through the capillaries in order to release nutritional substances to the tissues; then the venous system removes waste substances from tissues through the venous capillary. Lymphatic System is a drainage system and it works like the venous system, in particular its main function is the drainage of interstitial fluids that flow into the peripheral connective tissue. It’s clear therefore that it’s very important consider the lymphatic system functioning and its ability to maintain the equilibrium in the microcirculatory unit. For example if interstitial fluid increase the lymphatic system maintain the equilibrium within physiological limits. When the lymphatic system is not able to maintain this physiological equilibrium it appears a disease called “OEDEMA”.
Oedema is usually defined as a fluid retention in the interstitial space of the organism. There are different kinds of oedemas, for example physiological oedemas or pathological oedemas that are caused by organs pathologies. Physiological oedemas are characterised by a transitory dysfunction due to an overload: fist of all the hydrostatic oedema that happens when a person stand upright or remained seated for a long time. In these conditions the lymphatic system is not able to balance the venous flow difficulties. Then there are the premenstrual oedema and the pregnant oedema (within defined limits). Among pathological oedemas there are kidney oedema, cardiac oedema, hepatic oedema or in specific pathologies: myxoedema, rheumatic oedema, phleboedema, lypoedema, lymphedema.
Lymphedema is an oedema with an high interstitial proteins concentration and it’s due to a reduction in transport ability of the lymphatic system. It’s typically an expression of lymphatic pathology. The proteins concentration increment is a specific characteristic of lymphedema that is classified in two categories: primary and secondary lymphedema. Primary lymphedema appears in the first months of life or during teenage years so it is caused by structural alterations of lymphatic system already present at birth. Secondary lymphedema, on the contrary, is due to different reasons like for example lymph node stations removal, after an oncologic chirurgic surgery, lymph node stations degeneration after radiotherapy, traumatic or infective events, parasite diseases.
DIAGNOSIS (clinical and instrumental)
Lymphedema diagnosis is an essential procedure in order to do the best treatment. Lymphedema is diagnosed by clinical way with also instrumental exams to confirm the diagnostic result.
Lymphedema disease can be treated in different ways: manual lymphodrainage, pneumatic pressotherapy, respiratory physiotherapy, hydrokinesitherapy, diet, pharmacological therapy, physical therapy (electrostimulation etc.), microsurgical derivative procedure. Here below we’ll make reference to the therapies connected with our medical devices.
Pneumatic pressotherapy consists in mechanic compression of limb through a compression chambers system (pumped in a sequential way) controlled by a computer. Oedema is reduced thanks to the lymphatic flux increment caused by distal-proximal limb compression. The pressure supplied in each chamber is constant, although the effective pressure is decreasing in distal-proximal direction due to the increase of limb radius of curvature in according to Laplace law. The device is composed of a compressor connected to an armband or a legging characterized by pneumatic sacs that are inflated by the computer activated pumps according to a pre-adjusted program. Sacs number is between 4 and 12 in order to obtain the best oedema fragmentation. Moreover the device is designed so that the different chambers swell up and deflate consecutively in a distal-proximal way (from down to up ; foot>groin). The issue concerning the working pressures is actually very discussed anyway working pressures have to be adjusted in according to tissues conditions: more fibrosclerosis = more pressure; less fibrosclerosis = less pressure, taking into account that the device works on superficial lymphatic system so the pressures have to be lower than 30/40 mmHg. In fact high pressure in the initial state of lymphedema can provoke irreversible damages in the lymphatic system, on the contrary low pressures don’t release any effect in the fibrosclerosis because of the irreversible alterations of lymphatic system. Which are the drainage effects of this therapy? First of all there is venous and lymphatic flux increase, then the release of substances with antithrombotic, pro-fibrinolytic and vasodilatory action. Moreover this therapy causes a bigger interstitial pressure so a lower filtration and a bigger capillary reabsorption and finally an interstitial lymphatic load reduction. This effect provokes an increase in lymphatic capacity with a consequent reduction in oedema. The therapy contraindications are the acute venous thrombosis and the cardiac insufficiency. Besides these absolute contraindications there are a number of contraindications concerning the local and general infective conditions etc. After the pressotherapy treatment we recommend to do a bandage in order to maintain the good pressotherapy effects for a short time or a compressive sheath to maintain the therapy results for a long time.