The Chronic Lymphedema

chronic Lymphedema

The lymphatic system is an important drainage and transport system of our body and plays a central role in our disease resistance. The most important task of the lymphatic system consists in the removal of the tissue fluid. Approximately 2 liters of tissue fluids are supplied to the venous system per day. The lymphatic system runs through the whole body and consists of a network of lymph nodes and lymph vessels. A human being has approximately 600 lymph nodes, located particularly in the neck, armpits, groin and along the gastrointestinal tract.

1. What is a chronic lymphedema?

2. What are the causes of chronic lymphedema?

3. How is a chronic lymphedema diagnosed?

4. Which stages of chronic lymphedema can be distinguished?

5. Which therapies are applied at a chronic lymphedema?

6. How does the Complete Decongestive Therapy (CDT) work?

7. Which surgical therapies can be applied?

8. How does the procedure of SENTINEL LIFE differ from existing therapies?

9. What problems arise from the chronic lymphedema?

chronic lymphedema, lymph system

1. What is a chronic lymphedema?

Under untreated conditions, the chronic lymphedema is a progressive disease, which appears due to primary or secondary damages of the lymphatic drain system. This results in an unsufficient removal by the lymphatic system. The accumulation of tissue fluid leads to an increase in volume at the affected site. With increasing severity of the disease, the tissue changes and hardens (fibrosis).


2. What are the causes of chronic lymphedema?

A distinction is made between congenital (primary) and acquired (secondary) lymphedema. Primary lymphedema are attributed to a genetic predisposition. They are inherited or caused by a spontaneous gene mutation and appear often in young adulthood. Secondary lymphedema occur as a result of various diseases, injuries and therapies. Cancer therapies are the most common cause of secondary lymphedema. In the course of cancer therapy, lymph nodes are often surgically removed and irradiation is applied in addition, which leads to a damage to the lymphatic system. The incidence of secondary lymphedema after malicious diseases (usually in the chest and pelvic area) is often observed years after the therapy.


3. How is a chronic lymphedema diagnosed?

A chronic lymphedema is diagnosed by the attending physician who performs a detailed anamnesis, examination and palpation. As part of the diagnostic, the Stemmer‘s Sign plays an important role: The physician tries to pinch and lift a skinfold at the base of the second toe or middle finger. If it is not possible to pinch and lift the skin, the Stemmer‘s sign is positive and a lymphedema exists. In addition to the clinical examination, other diagnostic methods can be applied, i.e. indirect isotopic lymphography and fluorescence microlymphography.


4. Which stages of chronic lymphedema can be distinguished?

Depending on the severity of chronic lymphedema 4 stages can be distinguished:

  • Stage 0 - no swelling; known damages to the lymphatic system
  • Stage 1 - edema of soft consistency; elevating reduces swelling
  • Stage 2 - edema with hardened connective tissue; elevating without effect
  • Stage 3 - edema with extreme increase in volume; hardened connective tissue and skin; frequent skin diseases (so-called elephantiasis)


5. Which therapies are applied at a chronic lymphedema?

Most of the patients are treated conservatively with the Complete Decongestive Therapy (CDT) as the gold standard of treatment. In addition there are a number of surgical operations, none of which has become a standard yet. The treatment of chronic lymphedema with medications is currently not available.


6. How does the Complete Decongestive Therapy (CDT) work?

The Complete Decongestive Therapy (CDT) consists of the following components, applied as needed:

  • manual lymphatic drainage
  • compression therapy with compression bandaging and stockings
  • decongestive and breathing exercises
  • skincare

The treatment is carried out in 2 phases. In Phase I, the accummulated, protein-rich insterstitial fluid is mobilized. As a result the increase of the connective tissue is reduced. In Phase II, the therapeutic success is optimized and preserved. The Complete Decongestive Therapy (CDT) is usually done by specially trained physiotherapists as outpatient treatment. Inpatient treatments in specialist clinics for lymphology are only required in severe cases. The disadvantage of this method is the purely symptomatic therapy, which requires lifelong commitment.


7. Which surgical therapies can be applied?

The surgical procedures are divided into reconstructive and ablative procedures. Reconstructive surgery is trying to eliminate the cause of the disease, whereas the ablative surgery only alleviates the symptoms.

Reconstructive procedures:

  • autologous lymph node transplantation
  • autologous lymph vessel transplantation
  • lymphovenous anastomosis (connection of lymphatic and venous system)

Ablative procedures:

  • liposuction
  • tissue resection (removal of tissue)

In recent years the autologous lymph node transplantation has emerged as the most promising surgical procedures. Nevertheless, none of the above methods of operation has become standard practice.


8. How does the procedure of SENTINEL LIFE differ from existing therapies?

Based on the existing techniques of the lymph node transplantation, the use of advanced biomaterials should lead to significant higher treatment outcomes and reduce the treatment risks at the same time.  

Please note that the procedure of SENTINEL LIFE is still in a research stage. First patients are expected to be treated within a clinical trial in 2018.


9. What problems arise from the chronic lymphedema?

The patients suffer particularly from the increased volume, deviate appearance, restrictions on the range of motion, pain and considerable effort of conservative therapies. In addition, many patients complain about skin tensions and weather sensitivity. Approximately 75% of patients complain about an impaired quality of life to a (very) severe degree.