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Advice to patients with Lymphoedema

  1. What is lymphoedema? It is swelling which is due to a build-up of fluid(lymph) in the leg. Normally this fluid drains out of the leg via a network of tiny tubes called lymphatics. In your case fluid is not draining out properly. At first, the swelling often builds up during the day and goes down at night. However, unless treated properly, the swelling later becomes fixed in the leg permanently.
  2. What causes lymphoedema? The most common cause of lymphoedema is to be born without enough lymphatics. If there are very few lymphatics, then the swelling may start as a teenager or even earlier. This type of lymphoedema is called ”Milroy’s Disease”. One leg is often more swollen than the other and sometimes only one leg is affected. In less severe cases, the lymphatics may be able to cope initially and only start to fail when you are older; this kind is sometimes called “Lymphoedema Tarda”
  3. Are there any other causes?  Lymphoedema can also be caused if the lymphatics of the arm or leg are damaged by surgery or radiotherapy, often for the treatment of cancer. This is often unavoidable if the cancer is to be cures. Infections in a limb can also block lymphatics. Finally, there are some rare tropical parasites (Filariasis) that invade and block the lymphatics, though these are not found in Britain.
  4. What effects does lymphoedema have? Apart from the uncomfortable and unsightly swelling lymphoedema can cause other problems if it is not kept under control. There is an increased risk of infections under the skin (cellulitis) and repeated infections lead to further lymphatic damage. Rarely, this vicious circle may eventually lead to severe infections, ulcers and even amputation in extreme cases.
  5. What is the treatment? Lymphoedema cannot be cured but it can usually be controlled so that complications do not occur later. The mainstays of treatment are compression bandages or stockings, elevation of the limb and intermittent pneumatic compression (IPC). Whenever the leg is elevated, fluid will tend to drain out of it. Put your legs up whenever you can and as high as you are able- the arm of a sofa is good. Also, elevate the foot of your bed 6 inches. Compression is required to squeeze the fluid out of your legs. Bandages may be required at first to remove the worst of the swelling before stockings can be used. These stockings need to be specially fitted and are much stronger than ordinary “support tights”. If the swelling only affects the lower leg, then you can wear a below-knee stocking. The usual strength of stocking used is Class II, but sometimes a stronger Class III is required. If you have difficulty putting on your stockings, then you can buy a special stocking applicator. Despite compression stockings, many people find that some swelling accumulates by the end of the day. IPC is a special boot that inflates and deflates to squeeze fluid out of the leg. It is normally used in the evening to get rid of any fluid that has built up. If your doctor thinks you need IPC therapy, a trial of the device will normally be arranged so that you can decide whether it is worth buying one(the cost is around £600)
  6. What about surgery? Many operations have been tried to cure lymphoedema, but none have been successful. Surgery to reduce the size of the lower leg (Homan’s Reduction) may be suggested if your leg remains very swollen despite compression therapy.
  7. How can I help myself? By following the rules below:
    • Wear your compression stockings every day from morning to night.
    • Elevate your legs whenever possible.
    • Take plenty of exercise and don’t put on weight.
    • Keep the skin in good condition by using plenty of moisturizing cream to prevent dryness.




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