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Lymphostasis

Lymphostasis

Lymphostasis is a disease that manifests itself as a dysfunction of the lymph outflow. With lymphostasis, there is a difficulty in the outflow of lymph through the lymphatic capillaries and vessels of various organs (usually from the legs or arms) to the main lymphatic collector and the thoracic duct. Lymphostasis can be acquired or congenital in origin in a patient.

With lymphostasis in the skin and subcutaneous tissue, patients develop temporary or chronic stagnation of tissue fluid (lymph). Such an impaired lymph outflow is a consequence of trauma to the lymphatic vessels themselves, as well as various inflammatory processes.

With a disease of lymphostasis, there are several types of its course:

  • lymphedema
  • lymphocele
  • lymphorrhea
  • elephantiasis

Several factors contribute to the onset of lymphostasis in humans:

  • the presence of overweight and obesity (disturbance in the work of the cardiovascular system)
  • tumor diseases of the pelvic organs (creates a mechanical obstacle to the outflow of lymph)
  • erysipelas of the lower extremities
  • undergone operations for oncological diseases with the removal of regional lymph nodes and ducts (breast cancer, tumors of the chest organs, etc.)

Anatomy of the human lymphatic system, showing the cleansing of lymph through the lymph node.

 

Stages and symptoms of lymphostasis

1st stage of lymphostasis

At the beginning of its development, lymphatic edema (lymphedema) is barely noticeable. Patients have a small, barely noticeable progressive edema to which they get used and which they do not notice. No pain occurs. At this stage, the alertness of patients is important, since the timely start of treatment of lymphostasis that is beginning to form allows to stop the progression of the disease and the development of complications. With further progression of lymphostasis, lymphatic edema (lymphedema) becomes noticeable to the patient. You can press on the area of lymphatic edema with your finger, after which a small fossa will remain. The patient notices an increase in the volume of the limb. The skin above the area of lymphatic edema becomes edematous, its pattern is smoothed. This type of lymphatic edema is noticeably reduced in a horizontal position and can disappear for a while on vacation, after physical activity (swimming, exercise bike). At this stage of lymphostasis, a qualified surgeon is required. Such patients are given outpatient courses of lymphostasis treatment, which necessarily include manual lymphatic drainage massage, compression hosiery, and physiotherapy exercises. From medications, drugs can be prescribed to improve venous and lymphatic outflow. Subsequently, after the main course of outpatient treatment, sanatorium treatment can be recommended.

Anatomy of the human lymphatic system, showing the flow of lymph through the thoracic duct and the thoracic duct cistern.

 

2nd stage of lymphostasis

At this stage of lymphostasis, the patient begins to harden the integument of the skin due to the growth of connective tissues. At the 2nd stage of lymphostasis, the edema will no longer be soft. When you press the swollen tissue with your finger, a deep fossa remains. Elasticly stretched skin is already felt by the patient himself, and with stronger tension, pain may occur. The patient may have a general increase in body weight. Lymphatic edema does not decrease (does not subside) after a night's rest. At this stage of lymphostasis, indications for surgical treatment may arise. Lymphovenous anastomoses may be required to improve lymphatic drainage. Long courses of spa treatment, followed by the selection of compression hosiery, contribute to the reverse development of the pathological process and improve the patient's quality of life at the 2nd stage of lymphostasis.

Lymphostasis causes swelling of the limb (foot) with depressions from clothing and shoes.

 

3rd stage of lymphostasis (stage of irreversible changes)

The leg, subject to lymphedema, loses its normal contour. This occurs due to the growth of altered soft tissues of the limb, which leads to "elephantiasis". In a patient with lymphostasis in the stage of irreversible changes, the bodyweight increases due to the limb, which limits his mobility. Due to the increased volume of the limb segments, joint stiffness (ankylosis) develops and the patient stops walking. This leads to even greater weight gain for him. Accumulations of lymph in the subcutaneous tissue (lymphocele), gross fibrosis (proliferation of connective tissue), and disfiguring limb deformities develop. At this stage of lymphostasis, the patient often develops infectious, fungal complications and trophic ulcers. Lymphatic edema (lymphedema) worsens the general condition of the body and is a life-threatening disease. At this stage, the treatment is very difficult. Conservative correction of lymph outflow is required using lymphatic drainage massage, hardware pneumocompression. After a decrease in the volume of a limb, a patient with lymphostasis is prescribed surgical operations. A resection operation is performed - removal of altered skin and subcutaneous tissue. Subsequently, to improve the lymphatic outflow, lymphatic-venous anastomoses are surgically formed. Hard elastic compression (compression stockings) is required.

The cause of lymphostasis on the arm in women is the removal of the axillary lymph nodes during a mastectomy operation for breast cancer.

 

Lymphostasis treatment

When treating a disease such as lymphostasis, first of all, it is necessary to reduce the volume of the affected limb to a minimum. Also, to prevent it during the treatment of lymphostasis, it is necessary to prevent its possible subsequent increase in volume in the future. This can be achieved by undergoing specialized conservative treatment of lymphostasis in the outpatient clinic of our clinic. Treatment of patients with lymphostasis is carried out using modern medical technologies, which leads to a decrease in the volume of the limb, the necessary recommendations are given for changing the way of life.

Lymphostasis of the lower extremities of 1-2 degrees is very effectively treated with the help of massage, methods of active physiotherapy (magnetotherapy, laser therapy, physiotherapy exercises). In the presence of severe fibrosis (proliferation of connective tissue) and deforming lymphatic sacs on the limbs, it is necessary to consider the issue of surgical treatment by performing liposuction surgery.

Treatment and prevention of lymphostasis using physiotherapy methods (vacuum massage).

It must be remembered that lymphostasis treatment is a rather difficult task. The difficulty in treating lymphostasis as a pathological condition depends on the stage at which this disease is in the patient. To assess the effect of the treatment and the results of the preventive procedures used, the patient is measured by the volume of the limb in dynamics. This method can also be used during elective surgery and to detect lymphedema at an early stage. This allows the patient to start on time the necessary course of treatment and prevention of complications of lymphostasis. During the treatment started, it will prevent the development of severe complications of lymphedema, and will also preserve the ability of the limb to function normally.

Lymphostasis treatment not started in time can lead to stagnation of lymph and further progression of the disease. This is fraught with various serious complications for the patient, threatening disability, the development of all kinds of infections and the appearance of trophic ulcers.

In the treatment of lymphostasis, wearing compression underwear after outpatient procedures is mandatory.