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Advanced Lymphoedema — Decongestive Protocol Detailed

Complex Decongestive Therapy (CDT) is the gold standard for advanced lymphoedema; combining intensive and maintenance phase is essential.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Fizik Tedavi ve Rehabilitasyon department. Book Appointment →

What is Advanced Lymphoedema — Decongestive Protocol Detailed?

Lymphoedema is the situation in which lymph fluid does not return because of insufficient transport capacity of the lymphatic system; protein-rich fluid accumulates in the interstitial space.

Primary (congenital) and secondary (post-mastectomy, radiotherapy, infection, filariasis) classification.

Stages 0–3 according to ISL classification; advanced stage (II-III) is fibrosis-associated and rehabilitation is more difficult.

Symptoms

Asymmetrical extremity volume increase (>2 cm)
Stemmer sign positivity (skinfold of toe)
Skin thickening, peau d'orange appearance
Heaviness, tension and discomfort
Cellulitis recurrence (yearly multiple)
Limitation of joint motion
Psychosocial impact (body image, depression)

Risk Factors

Post-breast cancer surgery and radiotherapy
Lymph node dissection (axillary, inguinal)
Genetic predisposition (Milroy, Meige)
Filariasis (lymphatic filariasis, tropical region)
Recurrent cellulitis history
Obesity (BMI >30) and immobility
Trauma and surgical intervention to the extremity

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Asymmetrical extremity swelling must be evaluated for lymphoedema
  • Cellulitis (redness-fever-pain) is a medical emergency, antibiotic must be started
  • Severe fibrosis or skin damage requires lymphatic surgery (LVA, VLNT)
  • Annual maintenance phase follow-up should be done with a CLT-LANA certified therapist

Treatment Methods

01
Phase 1 (intensive): manual lymph drainage (MLD) 60 min/day, 4–6 weeks
02
Multilayer short-stretch compression bandage
03
Decongestive exercise (pumping mechanism)
04
Skin care and infection prevention
05
Phase 2 (maintenance): grade 2-3 compression sleeve
06
Severe case: pneumatic pump and lymphatic surgery (LVA, VLNT)

Which Department to Visit?

You can visit our Fizik Tedavi ve Rehabilitasyon department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Fizik Tedavi ve Rehabilitasyon Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.