How to Diagnose and Treatment For Lymphoedma?

1
How to Diagnose and Treatment of Lymphoedma?
http//muh.org.au/services-specialties/lymphoedema
-program/phases
2
Diagnosis
An accurate diagnosis of lymphedema is essential
for appropriate therapy. In most patients, the
diagnosis of lymphedema can be readily determined
from the clinical history and physical
examination. In other patients confounding
conditions such as morbid obesity, lipodystrophy,
endocrine dysfunction, venous insufficiency,
occult trauma, and repeated infection may
complicate the clinical picture.
3
Pathology
Lymphedema occurs from the accumulation of
interstitial and lymphatic fluid within the skin
and subcutaneous tissue. This then stimulates
fibroblasts, keratinocytes and adipocytes which
in turn result in deposition of collagen and
glycosaminoglycans within the skin and
subcutaneous tissue which could then lead to skin
hypertrophy and destruction of elastic fibres.
4
Imaging
Ddynamic images of both lymphatics and lymph
nodes in the peripheral and central system as
well as semiquantitative data on radiotracer
(lymph) transport, and it does not require dermal
injections of blue-dye (as often used for example
in axillary or groin sentinel node visualization
i.e., lymphadenoscintigraphy). Dye injection is
occasionally complicated by an allergic skin
reaction or serious anaphylaxis.
5
Lymphoscintigraphy
Lymphoscintigraphy is commonly used for
confirming the diagnosis of lymphedema and is a
reliable method for functional assessment of the
lymphatic system. It affords visualisation of the
major lymphatic trunks and lymph nodes as well as
evaluation of lymphatic function.
6
Magnetic Resonance Lymphography
Magnetic resonance lymphography (MRL) entails the
acquisition of high-resolution 3D datasets of the
entire limb. It is especially useful for
preoperative planning of lymphaticovenular
anastomosis (LVA) microsurgery, as it can
demonstrate individual lymphatic channels and
areas of dermal backflow.
7
Computed Tomography
CT can be used to localise oedema as subfascial
or epifascial and depict the characteristic
honeycomb pattern of subcutaneous oedema and skin
thickening. Its role in follow-up is diminishing,
though, owing to its inherent ionising radiation.
8
Treatment For Lymphoedma
Therapy of peripheral lymphedema is divided into
conservative (non-operative) and operative
methods. Applicable to both methods is an
understanding that meticulous skin hygiene and
care (cleansing, low pH lotions, emollients) is
of upmost importance to the success of virtually
all treatment approaches.
9
Treatment of Lymphoedma

• A. Non-operative Treatment
• Physical therapy and adjuvants
• Drug therapy
• Psychosocial rehabilitation
• B. Operative Treatment
• Microsurgical procedures
• Liposuction
• Surgical Resection
• Lymph Node Transplantation
• Special Considerations
• C. Treatment Assessment
• D. Molecular Therapy

10
Thank You
http//muh.org.au/services-specialties/lymphoedema
-program/phases
Reference http//www.u.arizona.edu/