What is lymphedema?
Lymphedema is a pathological condition in which fluid is retained between cells in a part of the body, when a problem with the lymphatic system is responsible. Its aetiology varies from congenital anomaly of conformation to acquired from parasitic infection to secondary after surgery or other medical treatments to the lymph nodes.
What is the lymphatic system?
Did you know that in addition to arteries and veins, there is a third system of blood vessels in our body: the lymphatic system? It consists of lymphatic vessels and lymph nodes, inside which there is a fluid called lymph.
Lemphaglomerate
They are tiny vessels that spread throughout the body and carry fluids and other contents of the space between cells to the lymph nodes that filter them and eventually drop them into the large veins before the heart.
Lymph nodes
As mentioned above, lymph nodes are intermediate filters that are inserted into the lymphatic vessels of the lymphatic system. Any infections can pass through the lymphatic vessels and reach the lymph nodes causing lymph node swelling. In a similar way malignant tumours can metastasise to the lymph nodes that filter the tumour area. They are arranged in groups within the body and the group we are interested in is the axillary lymph nodes. These are usually around 20 (with a range of 5-30) and are responsible for filtering the lymph of the adjacent breast and upper limb.
They are responsible for the lymph nodes and the upper and lower limbs.
Upper limb lymphedema
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It is the swelling of the upper limb due to lymph pooling caused by damage to the lymphatic vessels and lymph nodes of the axilla. In relation to breast cancer the causes of lymphatic system dysfunction are as follows:
Interventions in the axillary lymph nodes and lymphedema
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As we have seen on the related page, there are two main surgical procedures on the axillary lymph nodes, sentinel lymph node biopsy – axillary lymph node sampling and complete axillary lymph node cleansing. Both of these procedures injure the axillary lymph nodes, but the consequences of lymph node cleansing are much greater. Upper limb lymphedema may develop in 5-10% of women who have had a sentinel lymph node biopsy, whereas the rate after lymph node cleansing is 20-40%.
Armpit radiotherapy and lymphedema
Minor damage to lymph node function is also caused by radiotherapy to the axilla, but much less than lymph node cleansing. Modern treatment protocols replace lymph node cleansing with axillary radiotherapy in selected patients with a subsequent large reduction in the likelihood of developing lymphedema.
Symptoms of upper limb lymphedema
Lymphedema starts in the early stages with painless swelling and as it becomes more severe, pain, heaviness and even skin changes such as hyperplasia of the skin and hyperkeratosis occur. Women with lymphedema have an increased chance of infections such as cellulitis and should take special precautions to avoid injuries, stings and burns to the upper extremity. Also, vigorous muscular activity of the affected limb is best avoided.
Treatment of upper limb lymphedema
- Upper limb physiotherapy. It is a specialized form of physical therapy that uses specific types of massage and dressings to achieve lymphatic decongestion.
- Compression bandaging and compression garments. Using elastic bandages or special elastic sleeves and gloves increases the pressure on the upper limb to stop lymph production.
- Specialized microsurgical treatments. Various types of microsurgery have been used in very difficult situations, but they are very difficult and relatively ineffective.
Life and air travel
During airplane travel, the pressure in the cabin is lower than the usual pressure at low altitudes. As a result, women who have already developed upper limb lymphedema and those who are at high risk (after lymphatic cleansing) are more likely to worsen or develop lymphedema respectively. In addition to low pressure, a long air journey presents other risks: carrying cargo, long periods of immobility, multiple pressure changes on a journey with stopovers.
Consequently, women with lymphoedema must – and for those at high risk it is recommended – wear a sleeve and glove during the journey.
- The sleeve should be low pressure (20mm Hg) and comfortable to wear.
- The sleeve must be purchased and worn prior to travel to ensure comfort in fit during a long journey.
- The sleeve should be worn before boarding and removed 2-3 hours after disembarking the plane.
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