What are the treatment options for chronic lymphedema? Treatment principles vary according to the stage of lymphedema. In the early stages, the aim is to drain accumulated stagnant lymph fluid and prevent the regeneration of lymphatic fluid. In the late stages, the goal is either surgical removal of irreparable damaged tissues or shunt surgery to treat localized lymphatic obstruction.
The treatment of chronic lymphedema includes non-surgical treatments like Hongbing therapy and various surgical treatments.
1. Hongbing Therapy
Hongbing therapy is a treatment method that draws on the medical heritage of traditional Chinese medicine. The principle of treatment is to use continuous radiant heat to dilate the blood vessels in the skin of the affected limb, induce heavy sweating, and return the fluid in the local tissue spaces back into the bloodstream, thereby improving lymphatic circulation. For cases where lymphedema has not yet caused severe overgrowth of the limb skin, Hongbing therapy can be selected. There are two methods: electric radiation heat treatment and heating with a baking furnace. The temperature is controlled between 80-100 degrees Celsius, once daily, each session lasting one hour, with 20 sessions constituting one course of treatment. There should be a gap of 1-2 weeks between each course. After each treatment, external elastic bandage wrapping should be applied. Based on clinical observation, after 1-2 courses of treatment, the affected limb's tissue becomes softer, the limb gradually shrinks, and especially the number of erysipelas-like episodes significantly decreases or stops altogether.
2. Surgical Treatment
Most cases of lymphedema do not require surgical intervention. Approximately 15% of primary lymphedema cases eventually need lower limb plastic surgery. Current surgical methods, except for amputation, cannot cure lymphedema but can significantly improve symptoms.
(1) Indications for surgery: ① Impairment of limb function: due to bulky limbs causing easy fatigue and restricted joint movement. ② Excessive swelling accompanied by pain. ③ Repeated episodes of cellulitis and lymphangitis unresponsive to internal medicine treatment. ④ Lymphangiosarcoma: the malignant and fatal cause of long-term lymphedema. ⑤ Cosmetic reasons: most patients with primary lymphedema are young women. For those with significant swelling and cosmetic requirements, surgery can be considered, but the focus should be on improving function rather than cosmetics; otherwise, the results may not be satisfactory.
(2) Preoperative preparation and postoperative management: Includes: ① Bed rest with elevation of the affected limb: reducing limb edema to the minimum extent possible. Methods include elevation of the lower limb, suspension of the lower limb, and bone traction; elevating the lower limb at 60 degrees is ideal. ② Control of infection: for repeated episodes of acute cellulitis and acute lymphangitis, sensitive drugs should be administered intravenously or intramuscularly before and during surgery to reduce the risk of postoperative flap infections. ③ Clean the skin: to achieve healing of ulcers or control of local infections. ④ Maintain postoperative drainage: separated rough surfaces can lead to persistent capillary bleeding. Negative pressure drainage must be placed to ensure no accumulation of blood or fluid under the flap, reducing factors affecting flap blood supply, preventing flap necrosis and infection, and lowering the rate of surgical failure. ⑤ Continue to elevate the affected limb postoperatively to reduce edema, which benefits venous and lymphatic return.
(3) Types of surgery: Lymphedema surgeries can be divided into two categories: ① Extensive resection of diseased tissue. ② Reconstruction of lymphatic flow. According to experimental and clinical evidence, the good effects of the latter, in part or in whole, are actually achieved on the basis of extensive resection of diseased tissue. Simply reconstructing lymphatic flow, although requiring very fine surgical techniques, yields minimal therapeutic effect. Since secondary lymphedema has intact lymphatic system functions both proximally and distally near the blockage point, surgical reconstruction of regional lymphatic flow could potentially yield good results. On the other hand, most primary lymphedemas have developmental abnormalities in both proximal and distal lymphatics, so reconstructive lymphatic flow surgery does not improve symptoms.
What are the treatment options for chronic lymphedema? The above is a detailed introduction by experts on the treatment options for chronic lymphedema. It is hoped that this will help you. If you have more questions, you can consult online with the experts from Shanxi Yikang Peripheral Vascular Hospital. Finally, wishing you good health.
For more details, please visit the lymphedema section of Shanxi Yikang Peripheral Vascular Hospital: http://www.sxykmgy.com/linbashuizhong/ or consult the experts free of charge, who will provide detailed answers based on the patient's specific situation.
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