I have seen three lymphoedema patients today consecutively (and rather randomly booked) in clinic. It is a pretty challanging case that so far has no proper cure for.
My advice consists currently of the following components (ref. uptodate May 2015) –
1- The term complete decongestive therapy (CDT, also called complex decongestive therapy, complex decongestive physiotherapy, or decongestive lymphatic therapy) refers to an empirically derived, multicomponent technique that is designed to reduce the degree of lymphedema and to maintain the health of the skin and supporting structures [14,21,28].
2- CDT generally consists of a two-phase treatment program that can be used in both adults and children [14,21,28]. Success is dependent in part upon the availability of physicians, nurses, and physical therapists that are trained in these techniques.
●The first phase (treatment phase) includes meticulous skin and nail care to prevent infection, therapeutic exercise, a massage-like technique called manual lymph drainage (MLD), and limb compression using repetitively applied, multilayered padding materials and short-stretch bandages. The patients receive daily therapy five days per week, with circumference and volume measurements weekly to see if improvement is continuing or the patient has plateaued [21]. The usual duration of the first stage is two to four weeks.
●The second phase (maintenance phase) is intended to conserve and optimize the benefit attained in the first phase. It consists of compression garments worn during waking hours and, if necessary, self-compression bandaging at night, skin care, continued exercises, and, as necessary, self-MLD. Limb circumference and volume measurements should be monitored every six months or sooner if necessary [21].
3- Efficacy of CDT has been suggested in observational studies, which demonstrated a reduction in limb volume with improved pain, cosmesis, and/or function [35-39]. In these studies, the reduction in limb volume ranged from 33 to 68 percent. However, patient compliance is required for long-term success. In one study, at least 90 percent of the lymphedema reduction was maintained in compliant patients at an average follow-up of nine months, while noncompliant patients lost approximately one-third of the initial benefit [35]. The benefit of CDT was shown in a small phase III trial in which 53 patients with lymphedema after breast cancer treatment were randomly assigned to CDT (lymph drainage, multilayer compression bandaging, elevation, remedial exercise, and skin care) versus standard physiotherapy (bandages, elevation, head-neck and shoulder exercises, and skin care) [40]. The group receiving CDT had a significantly greater improvement in edema as measured by circumferential and volumetric measurements.