Detailed Information of lymphoedema treatments offered.

Manual Lymphatic Drainage (MLD): Both Clinical Nurse Specialists are qualified in Leduc and Casely-Smith MLD and incorporate both techniques depending upon the patient’s presentation of lymphoedema.

The principles of MLD are; to increase activity in normal lymphatics and improve their function, aid lymph drainage from congested areas and encourage lymph fluid to flow along alternative drainage routes.  MLD is not an effective mode of treatment on its own with arm and leg oedema; it has to be incorporated alongside compression hosiery to stop rebound of oedema.


Intermittent Pneumatic Compression
(IPC): we currently use ArjoHuntleigh FlowTron Hydroven 12, for arm and leg oedema.

The principles of IPC: expels venous blood from the lower extremities which increases velocity of venous return, reduces stasis, improves arterial profusion, increases pressure in the extracellular space forcing the excess fluid back into the circulation.  Again IPC is not an effective single mode of treatment and needs to be incorporated with compression hosiery.

 

Graduated Compression Hosiery; Compression hosiery is imperative for lymphoedema management and it must be measured correctly to avoid a tourniquet effect.  Hosiery used in our clinic ranges from Class 1 to Class 3, using RAL German classification. 

RAL    Class 1 = 18-21mmHg

Class 2 = 23-32mmHg

Class 3 = 34-46mmHg

Within each classification there are different types of materials used with differing rigidity exerted (stiffness/firmness).  To fit the correct mmHg and rigidity a precise assessment is undertaken to determine skin texture and by square rooting 4cm measurements in both arms then the Excess Limb Volume (ELV) can be established. 

Hosiery is manufactured using circular knit and flat knit (made to measure) each are very specific on how and when they can be used, this is determined by the CNS after taking a detailed examination.  If using compression hosiery on the lower limb, then a Doppler must be performed prior to fitting to establish the patients Ankle Brachial Pressure Index (ABPI).

The principles of graduated compression hosiery are:

  • Increases interstitial pressure – this affects fluid exchange from the blood into the interstitium and prevents fluid accumulation. 
  • Improves tissue fluid drainage – by aiding movement of lymph. 
  • Stimulates lymphatic contraction – lymphatic drainage is dependant upon spontaneous contraction of valved lymph vessels which create a pump, with compression there is a constant pressure for the lymph vessels to work against.
  • Break down fibrosclerotic tissue – this works in conjunction with other modalities of treatments.


Kinesio Taping
:  increases absorption of lymph in underlying tissues by removing congestion.  Kinesio taping is beneficial for head/neck and breast lymphoedema.

 

Lymph Pad: this reduces fibrotic tissues.

 

Multi-layer Lymphoedema Bandaging (MLLB): – Maybe considered where there are significant shape distortion and skin folds.  Traditional MLLB is undertaken a minimum of 3 times a week for 3 weeks.