Editing Lymphedema (section)

==Treatment==
While there is no cure, treatment may improve outcomes.<ref name="Lymphedema Diagnostic workup" /> This commonly include compression therapy, good skin care, exercise, [[manual lymphatic drainage]] (MLD) and the use of an intermittent pneumatic compression pump, which together is known as combined decongestive therapy.<ref name="Lymphedema Diagnostic workup" /> MLD is most effective in mild to moderate disease.<ref name="Ezzo2015">{{cite journal | vauthors = Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D | title = Manual lymphatic drainage for lymphedema following breast cancer treatment | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD003475 | date = May 2015 | volume = 2015 | pmid = 25994425 | pmc = 4966288 | doi = 10.1002/14651858.CD003475.pub2}}</ref> In breast cancer-related lymphedema, MLD is safe and may offer added benefit to compression bandages for reducing swelling.<ref name="Ezzo2015" /> Most people with lymphedema can be medically managed with conservative treatment.<ref>{{cite journal | vauthors = Koul R, Dufan T, Russell C, Guenther W, Nugent Z, Sun X, Cooke AL | title = Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer | journal = International Journal of Radiation Oncology, Biology, Physics | volume = 67 | issue = 3 | pages = 841–846 | date = March 2007 | pmid = 17175115 | doi = 10.1016/j.ijrobp.2006.09.024}}</ref> Diuretics are not useful.<ref name="Lymphedema Diagnostic workup" /> Surgery is generally only used if symptoms are not improved by other measures.<ref name="Lymphedema Diagnostic workup" /><ref>{{Cite web |last=Rajaee Rizi |first=Farid |date=2022 |title=Towards Better Lymphedema Rehabilitation by Interdisciplinary Approach in the Elderly |url=https://en.civilica.com/doc/1858250/ |website=Civilica}}</ref>

===Compression===

====Garments====
[[File:Lymphedema Compression sleeve November 2106 Second Skin 016.jpg|thumb|right|200px|Lymphedema compression sleeve on a mannequin]]

Once a person is diagnosed with lymphedema, compression becomes imperative in the management of the condition. Garments are often intended to be worn all day but may be taken off for sleep, unless otherwise prescribed. [[Compression stockings|Elastic compression garments]] are worn on the affected limb following complete de-congestive therapy to maintain edema reduction. Inelastic garments provide containment and reduction.<ref name="Lymphedema Diagnostic workup" /> Available styles, options, and prices vary widely. A professional garment fitter or certified lymphedema therapist can help determine the best option for the patient.<ref>{{Cite web |title=Lymphoedema |url=https://www.physio-pedia.com/Lymphoedema |access-date=2025-03-17 |website=Physiopedia |language=en}}</ref>

====Bandaging====
Compression bandaging, also called wrapping, is the application of layers of padding and short-stretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the proper therapeutic tension necessary to safely reduce lymphedema and may produce a [[tourniquet]] effect. Compression bandages provide resistance that assists in pumping fluid out of the affected area during exercise. This counter-force results in increased lymphatic drainage and therefore a decrease in size of the swollen area.<ref name="tan-2019">{{cite journal | vauthors = Tan C, Wilson CM | title = Clinical Outcomes After Physical Therapy Treatment for Secondary Lymphedema After Breast Cancer | journal = Cureus | volume = 11 | issue = 5 | pages = e4779 | date = May 2019 | pmid = 31367497 | pmc = 6666846 | doi = 10.7759/cureus.4779| doi-access = free }}</ref>

====Intermittent pneumatic compression therapy====
Intermittent pneumatic compression therapy (IPC) utilizes a multi-chambered pneumatic sleeve with overlapping cells to promote movement of lymph fluid.<ref name="Lymphedema Diagnostic workup" /> Pump therapy should only be used in addition to other treatments such as compression bandaging and manual lymph drainage. Pump therapy has been used in the past to help with controlling lymphedema. In some cases, pump therapy helps soften fibrotic tissue and therefore potentially enable more efficient lymphatic drainage.<ref>{{cite journal | vauthors = Cheville AL, McGarvey CL, Petrek JA, Russo SA, Taylor ME, Thiadens SR | title = Lymphedema management | journal = Seminars in Radiation Oncology | volume = 13 | issue = 3 | pages = 290–301 | date = July 2003 | pmid = 12903017 | doi = 10.1016/S1053-4296(03)00035-3}}</ref> However, reports link pump therapy to increased incidence of edema proximal to the affected limb, such as genital edema arising after pump therapy in the lower limb.<ref>{{cite journal | vauthors = Boris M, Weindorf S, Lasinski BB | title = The risk of genital edema after external pump compression for lower limb lymphedema | journal = Lymphology | volume = 31 | issue = 1 | pages = 15–20 | date = March 1998 | pmid = 9561507}}</ref> Current literature has suggested the use of IPC treatment in conjunction with an [[elastic therapeutic tape]] is more effective in the overall reduction of lymphedema as well as increasing shoulder [[range of motion]] than the traditional treatment of IPC paired with complete decongestive therapy. The tape is an elastic cotton strip with an acrylic adhesive that is used commonly used to relieve the discomfort and disability associated with sports injuries, but in the context of lymphedema, this increases the space between the dermis and the muscle which increases the opportunity for lymphatic fluid to flow out naturally.<ref>{{Cite web |last=Robinson |first=Lauren |date=2024-04-22 |title=Lymphedema - Symptoms, Treatment, & Care at VIC Chattanooga |url=https://vascularinstituteofchattanooga.com/vein-clinic/venous-conditions/lymphedema/ |access-date=2025-04-21 |website=vascularinstituteofchattanooga.com |language=en-US |archive-date=2025-02-21 |archive-url=https://web.archive.org/web/20250221211040/https://vascularinstituteofchattanooga.com/vein-clinic/venous-conditions/lymphedema/ |url-status=live }}</ref><ref name="Effects of Kinesio Taping">{{cite journal | vauthors = Kasawara KT, Mapa JM, Ferreira V, Added MA, Shiwa SR, Carvas N, Batista PA | title = Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis in clinical trials | journal = Physiotherapy Theory and Practice | volume = 34 | issue = 5 | pages = 337–345 | date = May 2018 | pmid = 29308967 | doi = 10.1080/09593985.2017.1419522 | s2cid = 3351415}}</ref> The use of IPC treatments with tape, as well as subsequent lymphatic drainage, has proven to significantly reduce the circumference of lymphatic limbs in patients experiencing lymphedema secondary to breast cancer post-mastectomy.<ref name="Effects of Kinesio Taping" />

===Exercise===
In those with lymphedema or at risk of developing lymphedema, such as following breast cancer treatment, resistance training did not increase swelling and led to decreases in some, in addition to other potential beneficial effects on cardiovascular health.<ref>{{cite journal | vauthors = Furmaniak AC, Menig M, Markes MH | title = Exercise for women receiving adjuvant therapy for breast cancer | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 9 | pages = CD005001 | date = September 2016 | pmid = 27650122 | pmc = 6457768 | doi = 10.1002/14651858.CD005001.pub3}}</ref><ref>{{cite journal | vauthors = Schmitz KH, Ahmed RL, [[Andrea Troxel|Troxel A]], Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP | title = Weight lifting in women with breast-cancer-related lymphedema | journal = The New England Journal of Medicine | volume = 361 | issue = 7 | pages = 664–673 | date = August 2009 | pmid = 19675330 | doi = 10.1056/NEJMoa0810118 | s2cid = 3125299 | doi-access = free}}</ref> Moreover, resistance training and other forms of exercise were not associated with an increased risk of developing lymphedema in people who previously received breast cancer-related treatment. Compression garments should be worn during exercise.<ref>{{cite web |url=http://www.lymphnet.org/resources/position-paper-exercise |title=Position Paper: Exercise &#124; National Lymphedema Network |publisher=Lymphnet.org |access-date=2014-05-16 |url-status=dead |archive-url=https://web.archive.org/web/20140508025721/http://www.lymphnet.org/resources/position-paper-exercise |archive-date=2014-05-08}}</ref>

Physical therapy for patients with lymphedema may include [[Myofascial trigger point|trigger point]] release, soft tissue massage, postural improvement, patient education on condition management, strengthening, and stretching exercises. Exercises may increase in intensity and difficulty over time, beginning with passive movements to increase range of motion and progressing towards using external weights and resistance in various postures.<ref name="tan-2019" />

=== Surgery ===
The treatment of lymphedema is usually conservative, however the use of surgery is proposed for some cases.<ref>{{cite journal | vauthors = Carl HM, Walia G, Bello R, Clarke-Pearson E, Hassanein AH, Cho B, Pedreira R, Sacks JM | title = Systematic Review of the Surgical Treatment of Extremity Lymphedema | journal = Journal of Reconstructive Microsurgery | volume = 33 | issue = 6 | pages = 412–425 | date = July 2017 | pmid = 28235214 | doi = 10.1055/s-0037-1599100 | s2cid = 7791985}}</ref>

Suction assisted lipectomy (SAL), also known as [[liposuction]] for lymphedema, may help improve chronic non pitting edema.<ref name="Granzow2013" /> The procedure removes fat and protein and is done alongside continued compression therapy.<ref name="Granzow2013">{{cite journal | vauthors = Granzow JW, Soderberg JM, Kaji AH, Dauphine C | title = Review of current surgical treatments for lymphedema | journal = Annals of Surgical Oncology | volume = 21 | issue = 4 | pages = 1195–1201 | date = April 2014 | pmid = 24558061 | doi = 10.1245/s10434-014-3518-8 | doi-access = free}}</ref>

Vascularized lymph node transfers (VLNT) and lymphovenous bypass are supported by tentative evidence {{as of|2017|lc=y}} but are associated with a number of complications.<ref name="Lymphedema Diagnostic workup" />{{Example needed|date=September 2023}}

===Laser therapy===
[[Low-level laser therapy]] (LLLT) was cleared by the [[Food and Drug Administration (United States)|US Food and Drug Administration]] (FDA) for the treatment of lymphedema in November 2006.<ref>[http://www.dotmed.com/news/story/3067/ dotmed.com December 27, 2006] {{webarchive|url=https://web.archive.org/web/20100107145043/http://www.dotmed.com/news/story/3067 |date=January 7, 2010}} ''Low Level Laser FDA Cleared for the Treatment of Lymphedema''. (accessed 9 November 09)</ref> According to the US [[National Cancer Institute]], LLLT may be effective in reducing lymphedema in some women. Two cycles of laser treatment were found to reduce the volume of the affected arm in approximately one-third of people with post-mastectomy lymphedema at three months post-treatment.<ref>[http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/HealthProfessional/page3#Section_68 National Cancer Institute: Low-level laser therapy] {{webarchive|url=https://web.archive.org/web/20090924235935/http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/HealthProfessional/page3 |date=2009-09-24}} accessed 9 November 09</ref><ref>{{cite journal | vauthors = Carati CJ, Anderson SN, Gannon BJ, Piller NB | title = Treatment of postmastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled trial | journal = Cancer | volume = 98 | issue = 6 | pages = 1114–1122 | date = September 2003 | pmid = 12973834 | doi = 10.1002/cncr.11641 | s2cid = 7043788 | doi-access = free}}</ref>

A new therapeutic approach involving the drug QBX258 has shown promising results in the treatment of lymphedema. Although it did not reach statistical significance, QBX258 treatment modestly decreased periostin expression and the number of CD4+ and CD4+IL4+ cells in lymphoedematous skin. Notably, QBX258 significantly reduced the expression of Th2-inducing cytokines, improving physical and social quality-of-life measures for patients. However, psychological improvements were not observed.<ref name=":1" />