The lymphatic system is a system, also known as the lymphatic system, that cleanses waste products from the intercellular fluid. A normal person has about ¼ of their body weight in lymph fluid. This fluid is transported through the lymph vessels and delivered to the lymph nodes. If the lymph nodes or lymph vessels are damaged due to disease or surgery, a condition called lymphedema develops.

Lymphedema may not develop immediately; sometimes it appears years after injury to the lymphatic system. Symptoms first appear on the back of the hands and feet. The skin is tight and hard. Sensory disturbances and joint stiffness may be seen in the hands and feet. Resistance to infection may decrease. Symptoms may include a feeling of fullness in the arm or leg, skin tightness, decreased mobility of the wrist or ankle and fingers, and tightness and marks left by items such as bracelets, watches, rings, shoes, and socks.

Lymphedema is divided into three stages, and untreated patients progress from stage 1 to stage 3:

Stage 1: Reversible lymphedema. Temporary swelling is seen. The skin is tight and shiny. The edema gradually increases during the day and disappears after resting at night.

Stage 2: Chronic, non-reversible, hard edema. It is accompanied by constant swelling, decreased sensation, pain, burning, and limited movement.

Stage 3: Lymphostatic Elephantiasis (Elephant Disease). Over time, there is increasing limb deformation, significant restriction of movement and function, and severe pain.

Treatment: There are two types of treatment for lymphedema: physical therapy and surgery. It is performed using a pneumatic compression device, manual lymphatic drainage, compression bandages, and exercise. Manual lymphatic drainage is a special massage technique applied by hand, the purpose of which is to remove lymph fluid from the edematous area and ensure its flow to other parts of the body. Manual lymphatic drainage is performed by applying light pressure to the superficial lymph vessels just under the skin. At the end of the treatment, the patient is given compression garments with appropriate pressure. This treatment reduces the volume of the affected arm or leg and promotes lymph circulation. The free flow of lymph fluid blocked in the lymphatic system is achieved through the manual lymphatic drainage technique. Manual lymphatic drainage should not be confused with other massage techniques that have no effect on lymph circulation. Other massage techniques are not only ineffective for lymphedema but can also be harmful. Bandaging is different from other types of bandaging and must be applied with care. Compression stockings are materials that must be worn during the follow-up period after treatment and should be customized for each individual. Recommendations for patients with lymphedema: Care and protection of the arm or leg at risk of lymphedema or affected by lymphedema is very important. The patient must pay attention to the following points for the treatment to remain successful:

• The skin should be kept clean and thoroughly dried, not left moist.
• Pay attention to skin care and elasticity; use moisturizers with very low oil content.
• Avoid cat and dog scratches and blows, as these can lead to infection and damage to the lymphatic vessels.
• Manicures and injections should not be performed on the affected arm. Calluses on the affected foot should not be cut; they should be protected with softening creams. Care should be taken not to cut the skin when cutting the nails.
• Avoid hot water, hot springs, and sunbathing; instead, take care to keep the swollen arm or leg cool.
• Repeated, strenuous movements can worsen the swelling.
• Excess weight, poor nutrition, insufficient or excessive exercise, excessive exposure of the limb to heat, traveling, carrying heavy objects, and constriction of the affected arm or leg (e.g., blood pressure measurement, tight watches, tight clothing) trigger and increase lymphedema.
• Razors should not be used; unwanted hair should be removed with an electric shaver.
• Gloves must be worn to protect against cuts when working in the kitchen or garden.
• Sunburn should be avoided; high SPF sunscreen should be used when sunbathing, and the limb should never be exposed to the sun for long periods.
• The most ideal sports are swimming and diving.
• Bras, underwear, other clothing, and jewelry should not be tight. Redness caused by these garments on the skin means that lymph circulation is blocked.
• Due to pressure drops during air travel, compression stockings and compression bandages must be used.
• Care should be taken not to lie on the affected arm while sleeping at night.
• A balanced diet should be maintained, excessive salt should be avoided but salt should never be eliminated, and plenty of water should be consumed.
• Excess weight should be avoided.
  
  20.09.2022
  Uzm. Dr. Semiha VURGUN