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Physiotherapy, Rehabilitation and Sport medicine

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Lymphatic drainage

LYMPHATIC DRAINAGE

Lymphatic drainage or lymph drainage is a specific rehabilitation method with great potential and applications in various fields of medicine.
In essence, any form of edema, and even more specifically edemas due to lymphatic and/or venous insufficiency, can lead to temporary and more or less extensive situations of “flooding” of the interstitial tissue. The edema of the limbs generated by a true deficiency of the venous system (phlebitis with oedema) and especially those from diseases of the lymphatic system (lymphedema), or both (phlebolymphedema), constitute the best indications for therapy with manual and mechanical lymphatic drainage.
By acting on the accumulation of fluid (water and proteins) stagnating in the interstitial space, lymphatic drainage allows absorption and routing to appropriate locations (the reference lymph node and ultimately the blood stream). This specific technique also favours the opening or the increase in functionality of new collateral lymphatic pathways, of lymph-lymphatic and venous-lymphatic anastomosis.

Within phlebology and lymphology this manual technique has a series of important indications:
Venous diseases with lower limb edema and, more rarely, upper limb edema; in all these cases it is objectively useful to apply the manual lymphatic drainage to achieve a reduction in stasis.
Particularly in phlebology, there are a number of indicated situations for treatment with manual and mechanical lymphatic drainage: the main one among them is undoubtedly post-thrombotic syndrome, with all the clinical conditions of variously intersected chronic venous insufficiency, consisting of phlebolymphedema, dermo-hypodermitis stasis, skin dystrophies such as lipodermatosclerosis and venous ulcer.

In varicose vein surgery (stripping and/or phlebectomies) this method is very useful in the preparation of the limb (if edematous or lypodystrophic) and especially in the management of patients during the postoperative period.
In the lymphatic pathology, and specifically in all cases of lymphedema, it can be said that the manual lymphatic drainage is the cornerstone of any therapeutic treatment protocol, which must be in any case comprehensive and integrated.

The lower limb lymphedemas, of the primitive type (early or late congenital) or of the secondary type (post-lymphangitic, neoplastic infiltration, parasitic infections, surgical wounds, radiation therapy, post-traumatic, due to bones, joints and muscular limitations etc.), are routinely treated with this method.

In oncology:
a major role is given to manual lymph drainage in case of upper limb lymphedema, mainly in post-mastectomy; in this specific pathology, on the basis of anatomical and lesion data (sometimes through a lymphoscintigraphy assessment), this manual technique is performed according to specific rules and in view of the activation of the residual and alternative pathways.

In urological patients and/or patients affected by abdominal neoplastic diseases who have undergone lymphadenectomy with lymphedema, that ate sometimes impotent and fibrosis complication of the lower limbs, (manual and mechanical) lymphatic drainage is the only practicable therapy with a good chance of improvement of the condition, if not a resolution.

  • There are also chronic and recurrent lymphedema conditions where this method is used as a normal physical and therapeutic rehabilitative treatment: an example of this are the sequences of orthopaedic surgery, hip or knee replacement, shoulder operations, etc. where lymphatic drainage significantly shortens the functional recovery time of the limbs.
  • In the neurological field, they reduce the risk of trophic lesions in paraplegic patients, etc.
  • Even aesthetic medicine can make use of manual lymph drainage in the treatment of Fibro Sclerotic Edematous Panniculitis (or “cellulitis”), as well as other related conditions of the skin and the superficial subcutaneous layer.