Lymphedema is swelling in the subcutaneous (under the skin) tissues with accumulation of lymph in the affected region. The swelling can occur in the arms, legs, face, head and neck, abdomen or genitals. Lymphedema most often occurs after lymph vessels or lymph nodes in the armpit or groin removed by surgery or damaged by radiation, impairing the normal drainage of lymphatic fluid. Lymphedema may also be due to a mass such as a tumor pressing on the lymphatic vessels.

At USC University Hospital, inpatient and outpatient treatment is provided for both primary and secondary lymphedema by therapists who are certified in what is called Complete Decongestion Therapy (CDT). This means that they not only are licensed occupational or physical therapists, but have met rigorous national standards of education, experience and clinical expertise in the specialty of CDT.

Who Benefits From Lymphedema Treatment

Patients who have the following types of lymphedema can benefit from the specialized treatment available at USC University Hospital:

• Primary congenital lymphedema
• Secondary lymphedema
• Phlebo-lymphedema - A combination of chronic venous insufficiency, (a condition in which veins do not channel the flow of blood adequately) and lymphostasis (obstruction of the normal flow of lymph)
• Post-surgical lymphedema - For example following head and neck cancer surgery
• Lipo-lymphedema (a combination form of lymphedema in which fat – lipo – as well as lymph accumulates in tissue)

Comprehensive Diagnostic & Treatment Resources

Treatment of lymphedema is a combination of a non-invasive technique called manual lymph drainage (MLD), compression bandaging, exercise, self-care and education. The aim of treatment is to reduce swelling, provide pain relief, reduce the risk of infection, and prevent the lymphedema from progressing to a more advanced stage. Treatment is provided in two phases:

• Phase I: Intensive Phase
  • Meticulous skin and nail care
  • Manual lymph drainage (MLD)
  • Compression bandaging and/or garments
  • Therapeutic exercises
  • Education in self-care techniques
  • Education in lymphedema self-management
• Phase II: Maintenance Phase (you perform these activities independently)
  • Putting on/taking off compression garment(s)
  • Continued skin care
  • Therapeutic exercises
  • Self MLD
  • Follow-up visits with lymphedema specialist to monitor your progress

Common Terms Used in Lymphedema Therapy

• Chronic venous insufficiency – A condition in which veins do not channel the flow of blood adequately. It is most often seen in the lower extremities (the legs).
• Compression bandaging/garments – Bandages and specially designed garments that provide pressure to a particular area of the body.
• Edema – An excessive accumulation of fluid.
• Fibrosis – Formation of scar-like tissue.
• Interstitial - Relating to or situated in the small, narrow spaces between tissues. The interstitium is where lymph accumulates in cases of lymphedema.
• Lymph – The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease.
• Lymphatic system – The tissues and organs that produce, store and carry white blood cells that fight infection and disease. This system includes the bone marrow, spleen, thymus, and lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body.
• Lymphostasis – Obstruction of the normal flow of lymph.
• Manual Lymph Drainage (MLD) – A massage technique that uses a gentle pumping technique to stimulate the lymphatic system and improve lymph drainage.
• Pitting edema – When pressed by the fingertips, the affected area indents and holds the indentation.
• Sclerotic – Hardened; tissue that is sclerotic is tissue that has hardened.

Frequently Asked Questions

Q: How long will my lymphedema treatment take?
A: It depends on the stage of your lymphedema, your overall health and how you respond to treatment. Because each person is unique, there is no single answer that applies to every patient.

Q: How does compression therapy work?
A: When a compression bandage is applied, it supports the tissues without "squeezing" when you are inactive. The stability of the bandage also resists stretching when pressure is applied through muscle contraction and joint movement. This soft "cast-like" environment prevents lymph fluid from “refilling” after drainage. Plus, the exercise regimen you are prescribed promotes further lymph removal. A compression garment liberates you from wearing bandages all the time and is an important, non-bulky part of daily home care.