Advances and controversies in the contemporary management of chronic lymphedema

Abstract

The lymphatic system is essential for normal body function, as its role is to recover fluid passed to the interstitial tissue from capillaries and to carry it back to the systemic circulation. This review presents briefly the magnitude of the problem first and then focuses on recent key advances and controversies in contemporary management. Lymphedema touches millions of individuals and generates considerable financial burden for the healthcare system. This frequently debilitating disease requires lifelong treatments in most of the cases. Lymphedema can be significantly improved with comprehensive management including always decongestive physiotherapy, compression pumps, and garments. Drug therapy and surgical treatment are optional. Surgical interventions can be reconstructive or excisional. Therapeutic strategies often combine several methods and should be adapted to each patient. At all times, the patient's values and quality of life should be considered. Although nonperfect and in majority of cases noncurative, the therapeutic options are available and they are efficient. Future research efforts should bring better solutions and will improve patients' evaluation and management.

Keywords

• Complete decongestive therapy
• compression
• elephantiasis
• excisional surgery
• filariasis
• intermittent pneumatic compression
• liposuction
• lymph node transplantation
• lymphatic grafting
• lymphedema
• lymphovenous anastomosis
• manual lymph drainage