Lymphedema

Lymphatic swelling (lymphedema, Latin: lymphedema) is a chronic pathological condition resulting from impaired drainage of lymph from tissues to the lymphatic system. This results in the accumulation of protein-rich fluid in the intercellular space, which leads to a permanent increase in the volume of a limb or another area of the body. Lymphedema can be primary (genetically determined) or secondary (acquired, most often after damage to lymphatic vessels). The condition is progressive and, without proper treatment, leads to tissue fibrosis and the deterioration of skin and immune system functions.

Lymphedema – causes

The pathogenesis of lymphedema is based on an imbalance between lymph production and drainage. The lymphatic system performs drainage and immunological functions, and its insufficiency leads to chronic stasis of interstitial fluid.

The most important causes of lymphatic swelling include:

1. Primary lymphedema (congenital):

developmental defects of lymphatic vessels (hypoplasia, aplasia, or dysplasia),
genetic mutations affecting the development of the lymphatic system,
onset of symptoms in childhood, adolescence, or adulthood.

2. Secondary lymphedema (acquired):

removal or damage of lymph nodes (e.g., in oncological treatment),
radiotherapy leading to fibrosis of tissues and lymphatic vessels,
mechanical injuries and surgical procedures,
chronic inflammatory states (e.g., recurrent infections of the skin and subcutaneous tissue),
parasitic diseases (e.g., filariasis in tropical countries),
chronic venous insufficiency coexisting with lymphatic insufficiency.

An important mechanism is the increase in pressure in the interstitial space and the accumulation of plasma proteins, which initiates inflammatory processes and fibrosis. Over time, skin thickening and loss of its elasticity occur.

Lymphedema – occurrence

Lymphedema can affect various areas of the body, however, its location remains closely related to the cause of its development and the course of the lymphatic vessels.

Most common locations:

lower limbs – especially in primary forms of the disease,
upper limbs – typically after breast cancer treatment (after mastectomy and lymphadenectomy),
face and neck area – after oncological procedures or radiotherapy,
genitals – in the course of advanced lymphedema.

Characteristic clinical features include:

asymmetrical increase in limb circumference,
feeling of heaviness and tissue tension,
skin hardening (in later stages),
positive Stemmer sign (inability to pinch a skin fold at the base of the digits).

Several stages are distinguished in the course of the disease:

stage 0 (latent) – no visible swelling, but impaired lymph transport,
stage I – reversible edema, decreasing after limb elevation,
stage II – persistent edema, unresponsive to rest,
stage III (elephantiasis) – advanced fibrosis, deformations, and skin changes.

It is worth emphasizing that chronic lymph stasis promotes bacterial infections (e.g., erysipelas), and can also lead to oncological complications, such as rare lymphangiosarcoma (angiosarcoma).

Lymphedema – treatment

Lymphedema treatment is comprehensive and long-term. Its goal is to reduce swelling, improve lymph drainage, and prevent complications. There is no single causal method – therapy focuses on symptom control and improving the patient's quality of life.

1. Complex Decongestive Therapy (CDT):

The basic standard of treatment includes:

manual lymphatic drainage (MLD) – a specialized massage technique improving lymph flow,
compression therapy – the use of bandages or compression garments,
physical exercises – activating the muscle pump and supporting drainage,
skin care – preventing infections and epidermal damage.

2. Physiotherapy and supporting technologies:

pressotherapy (mechanical lymphatic drainage),
low-energy shock wave therapy,
treatments improving microcirculation and tissue metabolism.

3. Pharmacological treatment:

Pharmacotherapy has a supportive role:

phlebotropic and anti-edema drugs,
antibiotics in case of infection,
preparations improving vascular endothelial function.

4. Surgical treatment (in selected cases):

microsurgical lymphovenous anastomoses,
lymph node transplants,
liposuktion in advanced stages with adipose tissue predominance.

Modern aesthetic and regenerative medicine supports lymphedema therapy through procedures improving microcirculation and tissue function:

drainage and lymphatic treatments,
therapies stimulating regeneration of the skin and subcutaneous tissue,
technologies supporting edema reduction and improvement of tissue tension.

The consistency of therapy and patient education in the field of prevention are of key importance:

avoiding injuries and pressure,
weight control,
regular physical activity,
proper skin hygiene.

Untreated lymphatic swelling leads to progressive fibrosis, limb deformation, and a significant reduction in the quality of life. Early implementation of therapy allows for effective limitation of disease progression and maintenance of tissue functionality.