Drain Away Swelling and the
Risk of Infection from
Secondary Lymphedema

by Laura Goold, OTR/L, CLT, LANA

Lymphedema, the abnormal swelling of a limb or part of the body, results from the accumulation of lymphatic fluid. When the normally functioning lymphatic system is interrupted or disturbed, fluid in an area of the body is unable to follow its normal course into the venous system and swelling occurs. Causes of secondary lymphedema include trauma, radiation, venous insufficiencies and surgeries for cancer. Lymphedema may occur immediately or years later.

A swollen limb, trunk, neck or other part of the body causes physical and psychological discomfort and increases the risk of cellulitis or infection if left untreated. Lymphedema, at this time, has no cure but treatment and instruction in a home program will decrease edema and increase comfort. To be effective, he treatment regime requires the individual follow the prescribed program for life.

Prior to treatment the referring physician will evaluate each individual to rule out medical complications which would be contraindicated for hands-on care. The initial treatment needs to be given by a professional knowledgeable in lymphedema working in communication with the referring medical professionals.

The treatment program consists of proper skin care, manual lymph drainage, use of compression garments and bandages and recommended exercises.

Manual lymph drainage is a special gentle technique of moving and stretching the skin in the direction of the lymph flow out of a swollen area. Preparatory clearing of non-involved areas is completed prior to moving lymphatic fluid away from areas of trauma or interruption and into normal watersheds of lymph drainage.

Compression is used after therapy to prevent refilling of a cleared area. Specific short-stretch bandages may be worn initially between therapy sessions. Prescribed exercises are performed while wearing the compression to work the muscles of a limb against the resistance of a bandage. The gentle pressure applied between the muscles and the bandages assists the lymph fluid out of an affected limb.

Over a period of time with proper treatment, good skin care, use of compression and daily exercises the limb gradually decreases in size. The limb is then measured for a compression garment (i.e., a sleeve and glove or stocking) to be worn during the day in place of bandages. The compression fabric in the garment prevents swelling in the limb during the day and is more comfortable to wear under clothing than the bulkier compression bandages. For best long term results the garment is removed at night and compression bandages or a specific night compression device are worn for sleep.

A home program enables the individual to become independent in managing his or her lymphedema following the prescribed program. Family members are encouraged to participate in all therapy sessions to support ongoing success.

Laura Goold is an occupational therapist certified by the Dr. Vodder School of Lymphedema in 1999. She has also completed the national lymphedema examination. Laura has been assisting patients with lymphedema for the past ten years and her program of in-clinic treatments, skin care, compression, and daily exercises has helped many patients get back to work, play and everyday life.