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Lymphoedema is the swelling seen in a part of the body, resulting from a defective lymphatic system. The main function of the lymphatic system is to transport immune cells, tissue fluid and many other chemicals within the body. The lymphatic system is made up of hundreds of very small channels which usually run alongside the venous system.
Lymphoedema usually occurs when the number of functional lymphatic channels is less than that required to drain excess fluid from the tissues. In certain patients, this deficiency is congenitally determined. In others, the deficiency is acquired following repeated infections, surgery or radiation damage to the affected part. Whilst lymphoedema most commonly affects the legs, other parts of the body such as the arms can also he affected. The main feature of the disease is diffuse swelling which is worse following prolonged dependency. In a minority of patients, the skin of the affected limb becomes very thickened leading to folding, fissuring and huge increase in size.
The diagnosis of lymphoedema is usually made after excluding commoner causes of limb swelling such as venous insufficiency, heart failure, pelvic tumours, etc. The diagnosis is then confirmed radiologically by "lymphoscintigraphy". This is an investigation where a radio isotope is injected under the skin and its transit time measured. Delayed transit time is diagnostic of lymphoedema.
Unfortunately, there is no definitive treatment for lymphoedema. Regular use of compression stockings together with skin care provide the only reasonably effective treatment. When the skin swelling is such that it becomes disabling, surgical skin volume reduction is carried out. These procedures, however, are fraught with complications and are no substitute to complex physiotherapy. |
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Right leg lymphoedema. Note the discrepancy in size between the two legs. |
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