LYMPHEDEMA

6.2 LYMPHEDEMA

ETIOLOGY

Is usually due to obstruction or destruction of normal  lymphatic

channels.

Congenital  lymphedema  is  due to  hypoplasia  or  aplasia  (non

development)  of lymphatics. Obstruction of lymphatics  may  also

occur   because  of  tumours,  repeated  infection  or   prasitic

infestation. The number of lymphatic channel and lymph glands  is

in adequate for draining lymphatic fluid.

Excision  of  lymphatic nodes as during  radical  mastectomy  and

radical groin dissection and radiation therapy may also result im

lymphedema

This edema increases during the day and decreased overnight.

The main complaints are fatigue, and cosmetic defect

Elephantiasis   (thickened   skin)is  a  complication   seen   in

filariasis (Discussed in chapter)

PHYSICAL FINDINGS

*  In early stages the lymphedema, pitting is possible

*  The lymphedema is firm rubbery and non-pitting at later stage.

   There may be small blisters in the skin.

DIFFERENTIAL DIAGNOSIS

Unilateral  lymphedema  needs  to be  differentiated  from  soft,

pitting, bilateral edema seen in heart failure and renal failure

Treatment

Conservative measures include elevation of the limbs and  control

of infection.

Surgical Treatment

Silk threads; strips of fascia and pedicle grafts have been tried

to provide alternative passage for fluid

Alternatively  excision of all the skin and  subcutaneous  tissue

followed  by  application of split-thickness  has  also  relieved

symptom of heavy limb.

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