A prospective study in detection of lower-limb lymphedema and evaluation of quality of life after vulvar cancer surgery.

Jul 2012

Novackova M, Halaska MJ, Robova H, Mala I, Pluta M, Chmel R, Rob L.

Source

Department of Obstetrics and Gynaecology, 2nd Medical Faculty of Charles University in Prague, Czech Republic. marta.novackova@seznam.cz

Abstract

BACKGROUND:

Lower-limb lymphedema is one of the most disabling adverse effects of vulvar cancer surgery. Multifrequency Bioelectrical Impedance Analysis (MFBIA) is a modern noninvasive method to detect lymphedema. The first aim of this study was to prospectively determine the prevalence of secondary lower-limb lymphedema after surgical treatment for vulvar cancer using objective methods, circumference measurements and MFBIA technique. The second aim was to compare quality of life (QoL) before and 6 months after vulvar surgery.

METHODS:

Twenty-nine patients underwent vulvar cancer surgery in our study: 17 underwent inguinofemoral lymphadenectomy (RAD), and 12 underwent sentinel lymph node biopsy (CONS). Patients were examined before and 6 months after vulvar surgery by measuring the circumference of the lower limbs and with MFBIA. A control group of 27 healthy women was also measured. To evaluate QoL, the European Organisation for Research and Treatment of Cancer (EORTC) QoL questionnaires (QLQ-C30 and QLQ-CX24) were administered to patients before and 6 months after surgery.

RESULTS:

Using circumference measurement, 9 lymphedemas (31%) were diagnosed: 3 (25%) in the CONS and 6 (37.5%) in the RAD group (P = 0.69). After vulvar surgery, patients in the RAD group reported more fatigue and worsening of physical and role functioning. When comparing both groups, the RAD group had significantly worse parameters in social functioning, fatigue, and dyspnea.

CONCLUSIONS:

Lower radicality in inguinofemoral lymphadenectomy shows a trend toward lower morbidity and significantly improves QoL. Multifrequency Bioelectrical Impedance Analysis was tested in these patients as a noninvasive, objective method for lymphedema detection. Detection of lymphedema based on subjective evaluations proved to have an unsatisfactory sensitivity. Less radical surgery showed objectively better results in QoL.

Lippincott, Wilkins, Williams

Lymphoscintigraphy in unilateral lower limb and scrotal lymphedema caused by filariasis.

Dec 2012

Subramanyam P, Palaniswamy SS.

Source

Department of Nuclear Medicine and PETCT, Amrita Institute of Medical Sciences, Cochin, Kerala, India.

Abstract

Lymphedema is the edema that results from chronic lymphatic insufficiency. Lymphatic filariasis is caused by the filarial nematodes Wuchereria bancrofti, Brugia malayi, and Brugia timori. Lymphatic filariasis is common in tropical and subtropical regions. Early diagnosis and prompt therapy can be implemented using lymphoscintigraphy. Our patient is a 15-year-old boy presenting with a 3-month history of hydrocele. The patient was referred to us to rule out any lower limb lymphatic obstruction as the patient is from an endemic area. Tc Sulfur colloid (filtered) lymphoscintigraphy showed abnormal tracer collection in the scrotum and penis. There is associated dermal backflow or stasis in the left thigh region extending just above the knee, suggesting partial obstruction of left inguinal lymphatic channels.

AJTMH

See also:

Leg Lymphedema

Lymphoscintigraphy

Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis.

2011

Yamamoto T, Narushima M, Kikuchi K, Yoshimatsu H, Todokoro T, Mihara M, Koshima I.

Source

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. tyamamoto-tky@umin.ac.jp

Abstract

BACKGROUND:

Lymphaticovenular anastomosis has become an increasingly common treatment for lymphedema. Supermicrosurgical techniques are essential for the successful performance of lymphaticovenular anastomosis. A positive correlation between the number of lymphaticovenular anastomoses performed and therapeutic efficacy has been reported, and in performing these anastomoses, the establishment of as many bypasses as possible is important.

METHODS: Forty limbs of 20 patients with lower extremity lymphedema who underwent lymphaticovenular anastomosis in our department were assessed. All cases were performed under local anesthesia using two to four surgical microscopes. A new method of anastomosis, lambda-shaped anastomosis assisted by intravascular stenting, was chosen in required cases.

RESULTS: Lymphaticovenular anastomoses resulted in 186 anastomoses on 20 patients with lower extremity lymphedema; the average number of anastomoses per case was 9.3 (range, five to 18). The number of surgical microscopes used ranged from two to four (average, 3.3), and the duration of the operation ranged from 3 to 5 hours (average, 4.1). In the cases of lambda-shaped anastomosis (n = 11), the number of anastomoses was significantly greater than in the cases without lambda-shaped anastomosis (n = 9; 10.2 ± 2.3 versus 8.2 ± 1.4; p < 0.05).

CONCLUSIONS:

Lambda-shaped anastomosis assisted by intravascular stenting is a safe and relatively easy method that can be performed by surgeons with less than 1 year of experience in microsurgery. This in turn allows efficient lymphaticovenular anastomoses to be performed simultaneously by a team of surgeons, resulting in an increased number of bypasses.

Lippincott, Williams & Wilkins


*Editor's Note: Article is for information only and is NOT to be construed as an endorsement of the procedure, nor as a position of opposing the procedure.

The efficacy of complex decongestive physiotherapy (CDP) and predictive factors of response to CDP in lower limb lymphedema (LLL) after pelvic cancer treatment.

June 2012

Liao SF, Li SH, Huang HY.

Source

Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan. sueliao3@gmail.com

Abstract

OBJECTIVE:

The aim of this study was to estimate the efficacy of an intensive CDP program, as well as to identify the predictors associated with lymphedema severity and response to CDP in lower limb lymphedema (LLL) after pelvic cancer therapy.

METHODS:

We performed a retrospective review of post-pelvic cancer LLL patients that were treated with a CDP program between January 2004 and March 2011.

RESULTS:

Twenty-seven of the total 44 patients had cervical cancer, 9 had endometrial cancer, and 8  had ovarian cancer. The mean age was 62.2 years, 18  patients received radiotherapy and a mean of 12.6 sessions of daily CDP, and mean lymphedema duration was 34.8 months. The interval from pelvic cancer treatment to LLL development was 63.4 months. Lymphedema severity, baseline and post-CDP percentage of excess volume (PEV) were thirty-two percent plus-minus eighteen point four percent and eighteen point eight percent plus-minus sixteen point seven. Baseline PEV was not correlated with duration of lymphedema, number of CDP sessions, age or radiotherapy, and was significantly different to post-CDP PEV . CDP efficacy, percentage reduction of excess volume PREV, was minus fifty-five point one percent, and was correlated with baseline PEV, but not with the number of CDP sessions, duration of lymphedema, or age. PEV ) was the only predictive factor for CDP efficacy.

CONCLUSIONS:

The key to predicting successful lymphedema treatment of LLL is the initial PEV. The intensive CDP program was effective and successful. We should encourage and refer patients to undergo treatment for LLL, even when the LLL is mild.

Elsevier

The Prevalence of Lymphedema Symptoms Among Survivors of Long-term Cancer with or at Risk for Lower Limb Lymphedema.

The Prevalence of Lymphedema Symptoms Among Survivors of Long-term Cancer with or at Risk for Lower Limb Lymphedema.

Oct 2012

Brown JC, Chu CS, Cheville AL, Schmitz KH.

Source

From the Department of Clinical Epidemiology and Biostatistics (JCB, KHS) and the Department of Gynecologic Oncology (CSC), Perelman School of Medicine, and Abramson Cancer Center (CSC, KHS), University of Pennsylvania, Philadelphia; and the Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota (ALC).

Abstract

OBJECTIVE:
The aim of this study was to identify commonly reported symptoms in the lower limbs among those with or at risk for developing lower limb lymphedema (LLL).

DESIGN:
The authors surveyed survivors of long-term cancer using the Pennsylvania State Cancer Registry. They inquired about demographics, cancer treatment history, knowledge about LLL, and symptoms experienced since completing cancer treatment. They invited all participants for an in-person clinical assessment to better identify and characterize the symptoms associated with LLL.

RESULTS:
The response rate to the study survey was 57.2%. Among the 107 participants who answered the study survey, 37 (34.5%) reported one or more symptoms associated with LLL. Many reported a combination of symptoms that included difficulty walking (n = 37; 100%), aching (n = 32; 86%), puffiness (n = 28; 76%), and pain (n = 27; 73%) on one side of the body since cancer treatment. The in-person clinical assessment among a subsample of 17 participants revealed 10 participants with no evidence of LLL and 5 and 2 participants with grade 1 and 2 LLL, respectively. The in-person clinical assessment identified three cases of previously undiagnosed LLL.

CONCLUSIONS:
One third of the survivors of cancer surveyed reported experiencing new symptoms in the lower limbs since cancer treatment. Cases of symptomatic, undiagnosed LLL may exist in the population.

PubMed

Technical note: MRI lymphangiography of the lower limb in secondary lymphedema.

2011

Kamble RB, Shetty R, Diwakar N, Madhusudan G.

Source

Department of Radiology, BGS Global Hospital, Bangalore, India.

Abstract

We would like to describe a case of MRI lymphangiography of the left leg, performed by subcutaneous injection of gadopentetate in the foot, followed by serial acquisitions of images, in a 52-year-old female, who presented to us with progressive leg swelling following total hysterectomy and radiation therapy. Successful demonstration of lymphatic channels, along with faint visualization of the venous system, was achieved. This technique allows excellent visualization of lymphatic channels.

Introduction

The credit for the first description of lymphatic channels goes to the Italian anatomist Gasparo Asellius who saw these milky white channels in a dog. However, Kinmonth et al. were the first to demonstrate lymphatics after injecting a blue dye subcutaneously. Since then, there have been various advances in the imaging techniques for identifying and visualizing the lymphatic system and its diseases. Techniques described in the past include lymphangiography and lymphoscintigraphy. We describe an MRI lymphangiography (MRL) technique in a case of secondary lymphedema following surgery and radiation for endometrial carcinoma.

Case Report

A 52-year-old lady presented to us with progressive, huge, swelling of her left leg of 5 year’s duration and swelling of her right leg for the past 1 year. She had been diagnosed to have endometrial carcinoma in 2002 and had undergone radical hysterectomy and pelvic lymph node dissection, followed by 35 fractions of radiotherapy. She had been asymptomatic till 2005.

Doppler study for both legs showed a normal venous system. MRI angiography of both legs showed a normal arterial system. A CT scan of the abdomen done 7 months back had shown no tumor recurrence or metastases.

MRL of the left leg was performed on a 1.5-T (Wipro GE, Milwaukee, WI, USA) machine after obtaining informed consent. Following painting and draping of her left foot, 0.5 ml of 2% lignocaine was injected subcutaneously into the interdigital web spaces and between the first and second proximal metatarsal space with a 24-G needle. 

Following this, 1 ml of meglumine gadopentetate (Magnevist, Bayer Schering Pharma, Berlin, Germany) was injected into each of these five sites at the recommended dose (for intravenous use) of 0.1 mmol/kg body weight. The injected sites were massaged for 1 min. Imaging was performed using a 3D spoiled gradient-echo sequence (LAVA-XV) with the following parameters (TR-4, TE-1.9, TI-7, bandwidth 62.5 kHz, matrix 320 × 192, NEX-0.73, thickness 4 mm with 0 interslice gap, FOV 48 × 43.2, and scan time of 28 s). The scan was performed with an eight-channel body array coil. The acquisition was done at 5, 15, 25, 35, 45, and 55 mi. Dilated lymphatic channels were first visualized at 5 min followed by 15 min, 35 min  and by 55 min, lymphatics up to the groin could be seen. 

There was excellent visualization of multiple lymphatic channels on the superomedial aspect of the leg and, in addition, there was also faint visualization of the veins. Dermal backflow was noted in the medial aspect of the lower leg at the ulcer site. No dilated lymphatics were noted in the lateral and posterior aspects of the leg. The patient was kept on antibiotics after the procedure. 

There was no pain at the puncture site and no other complications were noted.

Discussion

The incidence of symptomatic lymphedema in a single lower extremity after surgery for uterine corpus malignancy has been found to be 69%, while bilateral lymphedema occurs in 31% of cases. Lymphedema develops after a median time of 5.3 months after the initial surgery. This development of lower extremity lymphedema is associated with the removal of 10 or more lymph nodes during surgery.

Lymphovenous anastomosis is often performed to treat lymphedema. For this, prior visualisation of the lymphatic channels is important. The more the number of lymphovenous anastomoses performed, the better are the results.

Initially, invasive techniques of the exploration of lymphatic vessels and injection of oil-based dyes were used for the assessment of the lymphatic drainage, but these are no longer used due to technical difficulties, the nonavailability of the contrast medium, and associated risks like pulmonary embolism. Lymphoscintigraphy is another technique that detects peripheral lymphatics and can yield quantitative flow information but has limited use in the evaluation of mild lymphedema. It suffers from poor spatial and temporal resolution.

With the development of new MRI sequences, it is now feasible to demonstrate lymphatic channels with MRL and thus help the surgeons plan adequate surgery. This can be achieved with or without the use of contrast. Laor et al. have demonstrated lymphatic channels noninvasively in children and infants with lymphatic pathologies, but in a few cases they were unable to suppress signals from veins. Excellent visualization of dilated lymphatic channels is possible with intracutaneous injection of gadodiamide or gadolinium-DTPA, without much venous contamination.

We have modified the technique by using a subcutaneous injection of 1 ml of meglumine gadopentetate in each interdigital web space as well as between the first and second metatarsals after first injecting the sites with 0.5 ml of 2% lignocaine. We were able to clearly demonstrate the lymphatic channels and also faintly visualize the venous system.

Indian Journal of Radiology and Imaging

Lower limb lymphedema treated with lymphatico-venous anastomosis based on pre- and intraoperative icg lymphography and non-contact vein visualization: A case report.

Mar 2012

Mihara M, Hara H, Narushima M, Hayashi Y, Yamamoto T, Oshima A, Kikuchi K, Murai N, Koshima I.

Source

Department of Plastic and Reconstructive Surgery, University of Tokyo, Japan. mihara@keiseigeka.name

Abstract

Lymphatico-venous anastomosis (LVA) is used to resolve lymph retention in lymphedema. However, the postoperative outcome of lower limb lymphedema is poorer than that for upper limb lymphedema, because of the location lower than the heart level. Improvement of the therapeutic outcome requires application of as many anastomoses as possible in a limited operation time, particularly since there is a positive correlation between the number of anastomoses and the therapeutic effect of LVA. In this case, we described a method to increase the efficiency of lymphatico-venous anastomosis for bilateral severe lower limb lymphedema through efficient identification of lymph vessels and veins suitable for anastomosis using indocyanine green (ICG) contrast imaging and AccuVein, a noncontact vein visualization system, respectively. Ten LVAs were succeeded at seven incisions, and the operation time was 3 hours and 5 minutes. Accuvein can be used for identification of subcutaneous venules with a diameter of about 0.5-1.0 mm. We used this approach in surgery for a case of bilateral lower limb lymphedema, with a resultant improvement in the surgical outcome.

Wiley Online

The efficacy of complex decongestive physiotherapy (CDP) and predictive factors of response to CDP in lower limb lymphedema (LLL) after pelvic cancer treatment.

June 2012

Liao SF, Li SH, Huang HY.

Source

Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan. sueliao3@gmail.com

Abstract

OBJECTIVE:

The aim of this study was to estimate the efficacy of an intensive CDP program, as well as to identify the predictors associated with lymphedema severity and response to CDP in lower limb lymphedema (LLL) after pelvic cancer therapy.

METHODS:

We performed a retrospective review of post-pelvic cancer LLL patients that were treated with a CDP program between January 2004 and March 2011.

RESULTS:

Twenty-seven (61.4%) of the total 44 patients had cervical cancer, 9 (20.5%) had endometrial cancer, and 8 (18.2%) had ovarian cancer. The mean age was 62.2 years, 18 (40.9%) patients received radiotherapy and a mean of 12.6 sessions of daily CDP, and mean lymphedema duration was 34.8 months. The interval from pelvic cancer treatment to LLL development was 63.4 months. Lymphedema severity, baseline and post-CDP percentage of excess volume (PEV) were 32.9% ± 18.4% and 18.8%± 16.7%. Baseline PEV was not correlated with duration of lymphedema, number of CDP sessions, age or radiotherapy, and was significantly different to post-CDP PEV, CDP efficacy, percentage reduction of excess volume, was minus fifty-five percent and was correlated with baseline PEV, but not with the number of CDP sessions, duration of lympheema, or age.  PEV was the only predictive factor for CDP efficacy.

CONCLUSIONS:

The key to predicting successful lymphedema treatment of LLL is the initial PEV. The intensive CDP program was effective and successful. We should encourage and refer patients to undergo treatment for LLL, even when the LLL is mild.

Elsevier

Another older article from 2002, that discusses CT staging of leg (lower limb) lymphedema.

Doctors have long maintained that these radiography scans can be valuable in assesing the stages of lymphedema and in understand the physiology of a lymphedematous leg. However, this remain tremendously difficult for several reasons.

First, not many doctors appear to be well trained to interpret these scans in as much as lymphedema is concerned.

Secondly, even if a doctor was able to interpret a CT scan, there really is no specific diagnostic criteria for such a diagnoses or staging.

Notice too, in the study, the comments regarding the difference between the description of a primary lymphedema thigh versus a secondary one.

The abstract follows:

Lymphedema of the lower limbs: CT staging].

[Article in French]

Marotel M, Cluzan RV, Pascot M, Alliot F, Lasry JL.

Source

Hôpital Saint-Michel, 33, rue Olivier-de-Serres, 75015 Paris, France. martine.marotel@hopital-saint-michel.org

Abstract

Routinely performed, CT is useful and reliable for staging lower limb lymphedema. We describe methods we utilized. We found in frequency order: skin thickening, subcutaneous tissues area increase in regard the safe limb, perimuscular aponevrosis thickening, fat infiltration: lines parallel to the skin, edematous areas along perimuscular aponevrosis, lines perpendicular to the skin. The lowest fat density is increased on the pathologic side. Subfascial compartment is slightly fattened. We found huge differences between primary and secondary lymphedema for the thigh. Same images may be generated by old or young lymphedema. Rarely useful for positive diagnosis, CT is indispensable for secondarylymphedema staging (initial staging or after a recent increase). It seems us indispensable for any pretherapeutic staging (whole objectively disorders, exact upper limit, infraclinic bilaterality).

PubMed

Combined edema reducing therapy in the treatment of advanced lower limb lymphedema

Combined edema reducing therapy in the treatment of advanced lower limb lymphedema
Wiad Lek. 2008

Gabriel M, Sawlewicz P, Krüger A, Pawlaczyk K, Stanisić M, Majewski W.
Kliniki Chirurgii Ogólnej i Naczyń Uniwersytetu Medycznego w Poznaniu. mgabriel@pro.onet.pl

Combined edema reducing therapy is a recognized method of lymphedema treatment. However such therapy can be difficult to implement from methodological and logistic point of view in cases of advanced forms of lymphedema. The aim of the study was the presentation and discussion of intensive phase of combined treatment in patient with advanced primary lymphedema.

MATERIAL AND METHODS: Therapy was conducted on 19 patients (27 limbs) with edema reducing therapy program. Procedures were conducted daily for 4-6 weeks in out-patient and in-wards conditions.

RESULTS: Intensive phase of treatment succeeded in 3870-15 330 ml edema reduction, consisting of 48-65% of initial status. Chronic leg ulcers were healed completely in 2 patients. Ten patients underwent minor adverse events (AE), such as superficial skin ulceration (n = 2), popliteal fossa skin maceration (n = 2), neuropathic foot pain (n = 3) and skin scratches (n = 3). Modification of the treatment allowed the complete healing of AEs within 2-7 days, but it produced significant delay in achievement of desired therapeutic result, In 2 cases it prolonged hospital stay for 7 days.

CONCLUSIONS: 1. Combined edema reducing therapy is very efficient form of treatment in advanced primary lymphedema. 2. Intensive, 4-6 week, phase of the treatment allows 3.8 to 15.3 1 edema reduction. 3. In our opinion this phase should be conducted only in specialized centers for proper final results achievement with adverse events minimization. 4. The main point of the therapy is a combination of appropriate forms of available treatment.

PubMed

HELPFUL POINTS WHEN APPLYING YOUR LYMHPEDEMA LEG GARMENT

HELPFUL POINTS WHEN APPLYING YOUR LYMHPEDEMA LEG GARMENT
The use of rubber gloves

Using common household rubber gloves simplifies the procedure of applying your garment. Rubber gloves allow you to smooth out the fabric with a minimum effort and grip the material. Rubber gloves also protect the fabric from runs/snags caused by fingernails.

The use of slip on aids

Sometimes garments slide down the arm or leg. Sliding or rolling of the fabric can reduce the effectiveness of the compression garment and be bothersome to you. This problem can be eliminated with the use of adhesive lotion. If this is a problem with you, talk to your therapist.

To use adhesive lotion, put the garment on and turn the top of the border over and apply the adhesive lotion to the area where the garment ends. Allow 3-4 minutes for the lotion to become tacky. Then turn the garment border back over.

Proper fit and garment distribution

It is important to notice that the fabric is woven in straight lines, after application of the garment, make sure seams and stitches run vertically. If this is not the case, use your rubber gloves to straighten the fabric. It is a common mistake to over-stretch the garment while applying it. This leads to a loss of support (compression) in your garment. If the garment is constantly bunching up behind the knee, it is most likely over-stretched. To correct this, simply work the fabric downward towards the calf.

The use of adhesive lotion

Sometimes garments slide down the arm or leg. Sliding or rolling of the fabric can reduce the effectiveness of the compression garment and be bothersome to you. This problem can be eliminated with the use of adhesive lotion. If this is a problem with you, talk to your therapist. To use adhesive lotion, put the garment on and turn the top of the border over and apply the adhesive lotion to the area where the garment ends. Allow 3-4 minutes for the lotion to become tacky. Then turn the garment border back over.

ProRehab, PC has certified fitters for Juzo, Jobst & CircAid.

Self Manual Lymph Drainage for the Lower Extremity

Self Manual Lymph Drainage for the Lower Extremity

Rules for MLD:

The strokes should be made with arcing motions or half circle motions.

Do not slide over your skin, but rather, keep your fingers in contact with your skin and stretch it gently over the underlying tissues.

You should have NO PAIN.

Each stroke should be done 10-15 times SLOWLY, taking about 2 seconds for each stroke.

If redness occurs, you are pressing too hard.

For lymphedema of BOTH legs, perform all moves on both sides.
The best position to be in for this is seated reclined, or lying down and propped up slightly.

Make sure you can make skin-to-skin contact for all of these strokes. They won't work when done over clothing.

1. Neck: Place the flats of your fingers on your opposite shoulder, in the triangular part just above the collarbone and next to your neck. Move your hand in an arcing motion stretching the skin forward and down towards your chest. Repeat this on the other side.

2. Armpit: Raise your arm (on the same side as the leg in which you have lymphedema), bend you elbow, and place the hand behind your head. Place the flat of your opposite hand in your armpit. Stretch the skin in an arcing motion up towards the neck.

3. Above the waist: Place the flat of your opposite hand on the side of your body (on the side on which you have lymphedema) below the breast, but above the waist. Move your hand upwards in an arcing motion in the direction of your armpit, stretching your skin.

4. Below the waist: Place the flat of your opposite hand on the side of your body (on the side on which you have lymphedema) on or just below the waist, but above your hip. Move your hand upwards in an arcing motion in the direction of your armpit, stretching your skin.

5. Deep (diaphragmatic) breathing: Place both open palms on top of each other below the belly button. Take a slow breath in and feel your belly rise up into your hands as it expands to take in the air. Then breath out and feel your belly sink in as the breath leaves you. As you get better at this you can use your hands to resist your stomach slightly as you breath in, and press in slightly with your hands as you breath out. Don’t get dizzy. Start with only 2 or 3 breaths and work up to 10 as you get stronger.

6. Groin: Place the flat of your hand on the front of your groin, right where your underwear falls. Make a scooping motion in the groin, rolling your hand from the thumb to the little finger. Imagine that your hands are the bottom of a water wheel.

7. Back of knee: Place the flat fingers of both hands behind your knee. Perform a scooping motion up towards the body.

8. Repeat steps 3, 4 and 6 (waist and groin areas)

A very special Thanks to Katy from

LymphedemaTherapists · Lymphedema Therapists

Preventative Steps for Leg Lymphedema

Preventative Steps for Leg Lymphedema

For the patient who is at risk of developing Lymphedema, and for the patient who has developed Lymphedema.

Who is at risk?

At risk is anyone who has had gynecological, melanoma, prostate or kidney cancer in combination with inguinal node dissection and/or radiation therapy. Lymphedema can occur immediately postoperatively, within a few months, a couple of years, or 20 years or more after cancer therapy. With proper education and care, Lymphedema can be avoided or, if it develops, kept under control. (For information regarding other causes of lower extremity Lymphedema, see What is Lymphedema?) The following instructions should be reviewed carefully pre-operatively and discussed with your physician or therapist.

1. Absolutely do not ignore any slight increase of swelling in the toes, foot, ankle, leg, abdomen, genitals (consult with your doctor immediately).

2. Never allow an injection or a blood drawing in the affected leg(s). Wear a LYMPHEDEMA ALERT Necklace.

3. Keep the edemic or at-risk leg spotlessly clean. Use lotion (Eucerin, Lymphoderm, Curel, whatever works best for you) after bathing. When drying it, be gentle, but thorough. Make sure it is dry in any creases and between the toes.

4. Avoid vigorous, repetitive movements against resistance with the affected legs.

5. Do not wear socks, stockings or undergarments with tight elastic bands.

6. Avoid extreme temperature changes when bathing or sunbathing (no saunas or hottubs). Keep the leg(s) protected from the sun.

7. Try to avoid any type of trauma, such as bruising, cuts, sunburn or other burns, sports injuries, insect bites, cat scratches. (Watch for subsequent signs of infection.)

8. When manicuring your toenails, avoid cutting your cuticles (inform your pedicurist).

9. Exercise is important, but consult with your therapist. Do not overtire a leg at risk; if it starts to ache, lie down and elevate it. Recommended exercises: walking, swimming, light aerobics, bike riding, and yoga.

10. When travelling by air, patients with Lymphedema and those at-risk should wear a well-fitted compression stocking. For those with Lymphedema, additional bandages may be required to maintain compression on a long flight. Increase fluid intake while in the air.

11. Use an electric razor to remove hair from legs. Maintain electric razor, properly replacing heads as needed.

12. Patients who have Lymphedema should wear a well-fitted compression stocking during all waking hours. At least every 4-6 months, see your therapist for follow-up. If the stocking is too loose, most likely the leg circumference has reduced or the stocking is worn.

13. Warning: If you notice a rash, itching, redness, pain, increase of temperature or fever, see your physician immediately. An inflammation or infection in the affected leg could be the beginning or a worsening of Lymphedema.

14. Maintain your ideal weight through a well-balanced, low sodium, high-fiber diet. Avoid smoking and alcohol. Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid; rather, this may weaken the connective tissue and worsen the condition. The diet should contain easily-digested protein such as chicken, fish or tofu.

15. Always wear closed shoes (high tops or well-fitted boots are highly recommended). No sandals, slippers or going barefoot. Dry feet carefully after swimming.

16. See a podiatrist once a year as prophylaxis (to check for and treat fungi, ingrown toenails, calluses, pressure areas, athelete's foot).

17. Wear clean socks & hosiery at all times.

18. Use talcum powder on feet, especially if you perspire a great deal; talcum will make it easier to pull on compression stockings. Be sure to wear rubber gloves, as well, when pulling on stockings. Powder behind the knee often helps, preventing rubbing and irritation.

Unfortunately, prevention is not a cure. But, as a cancer and/or Lymphedema patient, you are in control of your ongoing cancer checkups and the continued maintenance of your Lymphedema.

Revised © January 2001 National Lymphedema Network. Permission to print out and duplicate this page in its entirety for educational purposes only, not for sale. All other rights reserved. For more information, contact the NLN: 1-800-541-3259.