Lymphedema

In order to define this disease, first of all remember that the circulatory system is made up of arteries, veins and lymphatic vessels.

The mission of the lymphatic vessels is to absorb excess fluid from the tissues, as well as proteins and other particles, returning them to the general circulation. During its transit through the lymphatic vessels, its content is called lymph.

When the lymphatic system fails, the fluid stays in the tissues, the affected limb increases in size and when you put your finger on it, a footprint is left, which is called the fovea.

Why is it produced?

To understand the mechanism of production, one must know the classification of lymphedema:

Primary

It is the one that occurs due to lack of development or malformation of the lymphatic vessels. It can be: congenital (which appears shortly after birth), precocious (which appears at puberty) or late (which begins after the age of 35)

Secondary

They account for more than 50% of lymphedema cases. It is produced by injury or obstruction of lymphatic channels that were previously normal. Its causes are as follows:

• Recurrent local infections (bacterial lymphangitis) mainly due to streptococcus (erysipelas) or fungi. Those with leg ulcers or chronic eczema are most at risk . Worldwide, the most common cause of secondary lymphedema is filariasis (infection with a parasite, Filaria bancrofti).
• Postphlebitic lymphedema: the one that occurs after the inflammation of a vein, especially in the territory of the femoral artery.
• Nodal diseases , such as tuberculosis , Hogkin’s disease, or lymphosarcomas.
• Tumors: Prostate cancer and lymphomas can block lymphatic vessels. Also uterine and vulvar cancer.
• After surgical and radiotherapy treatment of breast cancer

Lymphedema symptoms

It usually occurs mainly in women and is a purely aesthetic problem, since it does not cause pain and does alter the shape and diameter of the limb.

It originally affects the foot or ankle, which swell, increasing inflammation with heat, fatigue and in premenstrual days.

It progresses and affects even the other limb and produces heaviness and fatigue in the limb. Finally it stabilizes and the entire leg is edematous. First, the edema is soft and when pressing with the finger, it leaves an imprint (fovea).

As it becomes more chronic, the tissues become fibrosed and stiff, the edema becomes hard and does not leave fovea when pressed. Over time complications arise, such as yellow nails , skin roughness, heaviness, and sometimes elephantiasis with lymphangitis (infection) and frequent ulcers.

How is it diagnosed?

The diagnosis is verified by the signs and symptoms that the patient presents and must be completed with the search for the cause that originates it.

In the event that a tumor is the cause, the battery of tests necessary to discover it must be performed, sometimes including an ultrasound or a scan of the abdomen and pelvis.

Specific tests of the lymphatic vessels are lymphoscintigraphy and lymphangiography, which are sometimes helpful in distinguishing primary from secondary lymphedema.

Lymphedema treatment

To treat primary lymphedema (due to non-formation or malformation of the lymphatic vessels from birth) a series of recommendations must be made to the patient, such as taking maximum care of the hygiene of the feet to avoid infections, avoid dryness with moisturizing creams, Raise the legs frequently, exercise, wear gradual compression stockings, avoid standing for a long time, or massage the limb.

In some cases where there is a higher risk of infection, antibiotics can be used prophylactically (penicillin, erythromycin). Intermittent pneumatic compression devices at home have also been used to reduce edema. Diuretics should not be used in this condition. If the lymphedema is secondary, its cause must be treated if possible (tuberculosis, lymphoma)

If the lymph node obstruction is due to a tumor, radiotherapy can be used to produce a transient improvement. The newest treatment consists of microsurgery with union of the lymphatic vessels to the veins to overcome the obstruction.

Avoiding disease

As we have already explained previously, careful hygiene of the feet and legs, physical exercise and frequent elevation of the legs, helps reduce lymphedema and prevents it from becoming complicated.