It consists of synthetic cotton wool containing 25% polyester and 15% polyolefin. It is used for paddings, under castings and adhesive bandages. This specific padding material or other types of padding are recommended when applying bandages on lymphedema patients, in order to prevent iatrogenic lesions caused by the bandages, which could worsen the patient’s clinical situation and nullify the bandage draining action.
PAIN IN LYMPHOLOGY
Lymphedema patients often complain about pain in the affected extremity. Theoretically, chronic lymphatic stasis is not painful, however lymphedema, due to its volume, may press against vascular-nervous bundles causing mechanical distress. Also, osteo-muscular structures can be stressed by the mere weight of the limb, which in some cases has more than doubled, thus causing widespread pain. As a matter of fact, concurrent homolateral periarthritis humeroscapularis is often present in patients with chronic edema of the upper limb.
Abnormal skin sensation felt by the patient without any apparent stimulus often reported as a sensation of skin numbness. This symptom is quite common in patients affected by edema, and it is most likely due to an increased pressure in subcutaneous and deep tissues, with direct repercussions on nerve endings and sensory receptors.
PERSEQ (PERISTALTIC-SEQUENTIAL LYMPHATIC DRAINAGE)
Mechanic lymphatic drainage, featuring a device with sleeves for the legs or the arms, or preferably overlapping bandages, and different pneumatic chambers with alternated sequences of compression-decompression cycles starting from the most distal to the most proximal region.
Figure: The device employed by us for mechanical peristaltic-sequential lymphatic drainage.
Edema resulting from venous insufficiency.
Inflammation of one or more veins. It may have different etiology, and its onset may be concurrent with a thrombotic episode (trombophlebitis). lnflammation often spreads to the vascular-nervous bundle structures. For this reason, in addition to pain, concurrent truncular lymphangitis often accompanies phlebitis, which is due to the involvement of lymphatic trunks close to the affected venous branches.
Radiographic examination with contrast medium, aimed at displaying the peripheral venous tree, and, in particular, the actual anatomy of venous branches, the presence of communicating vessels, and of pathologic thromboses or stenoses.
Edema caused by concurrent venous and lymphatic circulation insufficiency. Many, especially secondary, lymphedemas are due to concurrent venous circulation dysfunctions, therefore they are divided into three groups, depending on their respective clinical manifestations and timeframe:
- venous disorder with lymphatic involvement (lymphophlebedema);
- lymphatic disorder with venous involvement (phlebolymphedema proper);
- phlebolymphedema ab initio.
PHYSICAL EXERCISE IN LYMPHOLOGY
Lymphatic circulation has a peripheral origin and, unlike the blood, does not have any upstream pump – like the heart – moving the lymph forward. Inside larger lymphatic vessels, a minor smooth muscle component allows for just enough peristalsis to push on the lymph. However, the muscular system is the actual peripheral drive allowing for a healthy and quick lymph flow through the lymphatic collectors. With its physiological and periodic contractions, the muscular system acts as an external pump moving the lymph forward. For this reason, in all lymphedema patients, moderate, non traumatic, physical exercise is recommended, which is useful to a physiological activation of this centripetal function. Swimming is the best type of sport recommended for this group of patients, since this exercise is the best in meeting drainage needs. Conversely, as mentioned above, no other sport involving excessive muscle fatigue, which is likely to cause peripheral lymph overproduction, nor sports causing repeated traumas and likely to damage already insufficient lymphatic structures, should be recommended.