Treatment of lymphoedema is conservative or surgical.
Manual Lymph Drainage
This is a hands on treatment performed by a certified lymphoedema therapist. It does not equate to a standard lymphatic massage. A certified lymphoedema therapist is a qualified nurse, occupational therapist or physiotherapist who has specialised in lymphoedema management, and a AHPCSA therapeutic massage therapist who has extended their scope of practice. They prepare the body from the neck down opening up lymphatic channels and enhancing flow. This technique stimulates the lymphatic system to function optimally by facilitating enhancing flow and thus removal of waste products and toxins. It does this by increasing the rate of contraction of lymphangion’s which are little pumps within the smooth muscle wall of lymph vessels, drawing lymph more effectively towards lymph nodes and onwards. This gentle treatment is done in a rhythmical, systematic way, starting centrally in the neck area, and working towards the peripheries. It includes deep abdominal breathing which further enhances the drawing of waste products towards the thoracic duct and terminus where most lymph fluid enters the bloodstream.
Compression Multi Layered Bandaging
This technique helps to effectively remove lymph fluid from the limb leaving only adipose tissue. This needs to be done daily for 1—14 days and then a custom made garment applied for maintenance of the limb.
These garments need to be chosen by a lymphoedema therapist in order to fit the patient correctly. An illfitting garment can do more harm than good, so these need to be properly measured and the correct strength of compression determined.
Lymphatic Pneumatic Compression
This is a machine that uses sequential pressure to drive lymph out of a limb. It is a unique lymphatic pump machine which has compression pumps which force air in sleeves with multiple chambers which house overlapping cells. The pump forces air into the cells which encourage lymph fluid to continue moving and not pool. Lymphedema pumps are not just a reactive treatment but in many cases, they aid in softening fibrotic tissues which will create an environment for higher efficiency lymphatic drainage. The OptiVein Centre has such a machine and sessions can be booked on request.
Lymphatic Lifestyle Modification
This refers to meticulous skin and nail care, an education on correct eating for lymphatic stimulation, breathing and posture to help the movement of lymph, exercises for enhanced lymph flow and other techniques that can be implemented at home to optimise lymph drainage such as dry brushing.
The recommended treatment for lymphoedema is called Complete Decongestive Therapy (CDT). This is a combination of the above mentioned treatments performed by a certified lymphoedema therapist working actively with the patient and aims to reduce swelling, then maintain the optimal size and health of the limb with well-fitting, carefully selected compression garments.
Lymphoedema may be advanced and although drainage is always necessary to move lymph fluid, if it has been there for many years, adipose tissue has built up and no conservative management nor microsurgical technique can reverse this process. Microsurgical techniques, such as lymph node transfers and lympho-venous anastomosis are done by some plastic surgeons, Although this will help lymph drainage, it does not decrease limb volume.
Dr Hakan Brorson in Sweden, is internationally renowned for firstly dedicating his career to understanding lymphoedema and proving that additional adipose tissue forms. Thereafter he developed a specialised technique of debulking liposuction specifically for lymphoedema patients with excellent outcomes. Dr Redman went to train in Sweden under Dr Hakan Brorson with Suzi Davey (lymphoedema therapist) and they have bought it into South Africa.
This treatment is done by a team working closely with the patients’ lymphoedema therapist. The pre-operative preparation is intense and a patient needs to be dedicated and work with the entire team. The surgery is not considered cosmetic but rather a functional debulking using specialised equipment from Europe and cannulas designed by Dr Brorson himself for lymphoedema type tissue. Patients need to be compliant lymphoedema patients as use of compression garments and lymph drainage will need to be continued strictly thereafter in order to prevent recurrence.