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278
lower extremity
decongestive exercises 219–221
do’s and don’ts 231–233
evaluation 67
lymphatic drainage 26–30, 28
deep layer 29–30
drainage areas 155
superficial layer 26–28
manual lymph drainage 155–157
anterior leg 155–156, 155
posterior leg 156–157, 156
self-MLD 224–228, 225–228
treatment sequences
bilateral primary lymphedema 167–169
bilateral secondary lymphedema 164–166, 16 4
unilateral primary lymphedema 166–167
unilateral secondary lymphedema 161–163, 162
venous dynamics 79–80, 79
lower leg collectors 28
lumbar area
drainage areas 150
manual lymph drainage 149–150
lumbar lymphatic trunks 9
lumpectomy 51
lymph 4–5, 264
formation 7
thickening of 13–14
lymph angion 8, 8
lymph nodes 12, 13–14, 13, 14 ,266
accessory 21
antecubital 25
axillary 22
dissection 50
functions 13–14
head 20
inguinal 26
deep 30
superficial 26–28
internal jugular 21
neck 20
occipital 19
parasternal (internal mammary) 22–23
parotid 18
pelvic 27, 27
popliteal 28, 29
deep 29
posterior auricular 18
sentinel lymph node biopsy 51–52
submandibular 18
submental 18
supraclavicular 21
trunk 24
lymph sacs 4
lymph time volume (LTV) 42
lymphadenitis 52, 264
lymphangiectasia 49, 264
lymphangiogram 264
lymphangiography 264
lymphangioma 264–265
lymphangiomotoricity 8, 59
lymphangiopathy 56
lymphangitis 52, 265
lymphatic cysts 61, 61
evaluation 69
genital 171, 171
lymphatic drainage 18–30, 19
lower extremity 26–30, 28
deep layer 29–30
superficial layer 26–28
mammary gland 22–23, 23
neck 19–21
anterior group 19
lateral group 21
scalp and face 18–19
trunk 21–23, 22, 23
upper extremity 24–26, 25
deep layer 26
superficial layer 24–26
see also drainage areas; lymph nodes
lymphatic fistula 61
evaluation 69
genital 171, 171
lymphatic loads 5–6
cells and particles 6
fatty acids 6
protein 5
water 5–6
lymphatic reflux 8
lymphatic return 5
, 9
lymphatic safety factor 8, 42–43, 43
, 59–60
lymphatic system 3–14, 10, 265
components 4–14
lymph fluid 4–5
tissues 11–14, 13
vessels 6–11, 13
development 4
discovery of 112
functional reserve (FR) 42, 42
insufficiencies 43–46
combined insufficiency 45–46, 45
dynamic insuf ficiency 43–44, 44,131
mechanical insufficiency 44–45, 45,131
physiology 42–43
topography 4
transport capacity (TC) 42
lymphatic territories 8–9, 16
lymphatic vessels 6–11, 13
capillaries 6–7, 6
collectors 8–9, 8
precollectors 7–8
trunks 9–11, 11
lymphatic watersheds 9, 14–17, 15, 16
between trunk and extremities 15–17
horizontal watershed 15
sagittal watershed 14–15
lymphedema 44–45, 48–78, 265–26 6
associated conditions 64
cardiac insufficiency 64–65
diabetes 66
obesity 65
Appendix
279
orthopedic problems 65
orthopedic venous insufficiencies 65–66, 65
avoidance mechanisms 59–61
collateral circulation 60
lymph vessels in adventitia of blood vessels 61
lympho-lymphatic anastomosis 60, 60
lympho-venous anastomosis 60
macrophages 61
safety factor 59–60
children see pediatric lymphedema
complications 61–66
congenital 50
definition 48
diagnosis 66
diagnostic imaging 72–73
documentation techniques 137–139, 140, 141
etiology 49–55, 49
primary lymphedema 49–50, 49, 51
secondary lymphedema 49, 50–55, 51
evaluation 66–69
form 245–246
genital see genital lymphedema
grading 58, 59
incidence 48–49
precipitating factors 59
stages of 55–58, 55, 74
stage 0 56
stage 1 56, 56
stage 2 56–57
stage 3 57–58, 58
therapy 41, 46, 73–78, 74
elevation 75
massage 75
medication 77–78
nutritional aspects 77
pneumatic compression pump 76–77
surgical 78
thermo therapy 75
two-phase approach 133–137
see also complete decongestive therapy (CDT);
manual lymph drainage (MLD); treatment
sequences
lymphedema clinic 238–240
equipment 239
marketing issues 239–240
personnel 238
space required 238–239
lymphedema praecox 50
lymphedema program 240–241
lymphedema tarda 50
lympho-lymphatic anastomoses 60
lympho-venous anastomoses 60
lymphocele 266
lymphocytes 13, 266
lymphography
direct 73
indirect 73
isotope 73
lymphoma 266–267
lymphorrhea 267
lymphoscintigraphy 73
lymphostasis 267
lymphostatic elephantiasis 57–58
lymphostatic fibrosis 57, 58, 58
M
macromolecule 267
macrophages 61, 98–99, 267–268
magnetic resonance imaging (MRI) 73
malignant lymphangiosis 63, 64
malignant tumors 53, 54,63
mammary gland lymphatic drainage 22–23, 23
manual lymph drainage (MLD) 69, 114–122,
134–135, 144–157
abdomen 151–153
deep abdominal treatment 152–153, 15 3
superficial abdominal treatment 152
basic strokes 115–118
pump 115, 116
rotary 117–118, 118
scoop 115–117, 117
stationary circles 115, 116
contraindications 121–122
cyclic idiopathic edema 105
deep abdominal technique 118–119
development of 113
edema technique 119, 119 , 120
effects of 114–115
face 147–148
fibrosis technique 119–120, 120
genital area 171–172
lower extremity 155–157, 224–228, 225–228
anterior leg 155–156, 155
posterior leg 156–157, 156
lumbar area 149–150
neck 145–147
abbreviated neck sequence 146
lateral neck and submandibular area 145–146,
145 , 146
posterior neck and occipital area 146–147
pediatric lymphedema 178
reflex sympathetic dystrophy 104
self-manual lymph drainage 137
self-MLD 221–228
lower extremity 224–228, 225–228
upper extremity 221–224, 221–224
manual lymph drainage (MLD)
thorax
anterior 150–151, 151
posterior 148–149, 149
traumatic edema 100–101
upper extremity 153–155, 15 4, 221–224, 221–224
vasa vasorum technique 121, 121
marketing issues, lymphedema clinic 239–240
massage 75
mastectomy 51
materials
compression therapy 179–181, 188
lymphedema program 240–241
Index
280
measuring board 13 9
mechanical insufficiency 44–45, 45,131
management 45
medial upper arm territory 25–26
median forearm territory 25
medication 77–78
medium-risk activities 230, 231
megalymphatics 49
Meige’s disease 176–177
melanoma 268–269
mesothenar territory 25
Milroy’s disease 176
modified radical mastectomy 51
monocyte 269
N
nail care 133, 134, 136
National Lymphedema Network 239
neck
exercises 218
lymph nodes 12, 20
lymphatic drainage 19–21, 176
anterior group 19
drainage areas 146, 147
lateral group 21
manual lymph drainage 145–147
abbreviated neck sequence 146
lateral neck and submandibular area 145–146,
145 , 146
posterior neck and occipital area 146–147
neck straps 207, 208
treatment sequences 175–176
necrosis 89
wounds 91–92
negative-pressure therapy 94, 95
nephrotic syndrome 269
net filtration pressure 40
net reabsorption pressure 40
Noonan’s syndrome 177
nutritional aspects 77, 230, 232
O
obesity 65
occipital lymph nodes 19
open junction 7
‘orange peel’ skin 96
orthopedic problems 65
osmosis 37–38, 37, 269
colloid 38
osmotic pressure 37–38
colloid 38
P
padding materials 180
lower extremity 190, 191–192, 197–19 8, 197–198
foot 191–192, 197
self-bandaging 214, 214
lymphedema program supply requirements 240
upper extremity 182–183, 184–185,187,188, 18 9
self-bandaging 210–211, 211
palliative care 270
pannus 102
pantyhose, measurements for 202–204, 203
custom-made pantyhose 204
standard-size pantyhose 204
papillomas 69, 270
paralysis 63–64
parasternal (internal mammary) lymph nodes
22–23
parasternal trunk 11
paresis 63–64
Parkes Weber syndrome (PWS) 177
parotid lymph nodes 18
patient education 209–235
decongestive exercises 216–221
lower extremity 219–221
upper extremity 217–219
information of lymphedema 253–254
precautions 228–233
lower extremity 231–233
upper extremity 229–231
self-bandaging 209–216
lower extremity 213–216, 214–217
upper extremity 210–213, 211–213
self-manual lymph drainage 221–228
lower extremity 224–228, 225–228
upper extremity 221–224, 221–224
patient information form 244
pediatric lymphedema 176–179
compression therapy 178
home care 179
manual lymph drainage 178
pelvic lymph nodes 27, 27
penis, compression bandaging 199, 199
pericervical lymphatic circle 18–19
perometer 138, 13 8
personnel requirements, lymphedema clinic 238
phlebolymphodynamic insufficiency 81
phlebolymphostatic edema 172–173
phlebolymphostatic insufficiency 81
photography release form 251
physical evaluation form 247
pneumatic compression pumps 76–77
lipedema 97
popliteal lymph nodes 28, 29
deep 29
post-thrombotic syndrome (PTS) 79
posterior auricular lymph nodes 18
posterior axillo-axillary (PAA) anastomosis 18
posterior inter-inguinal (PII) anastomosis 18
precapillary sphincters 35, 40
precollectors 7–8
pressure changes 59
prestage 56
privacy rules consent form 252
progress notes form 250
protein 270
Appendix
281
lymphatic load 5
lymphatic return 5, 5
pulmonary circulation 32, 32, 33–34
pulmonary edema 271
pulmonary embolism (PE) 82, 83
pump stroke 115, 116
see also manual lymph drainage
pyoderma gangrenosum (PG) 88–89
R
radial forarm territory 25
radial hand territory 25
radiation fibrosis 61–62, 62
radiation therapy
secondary lymphedema and 50, 52
skin changes 89–90
radical mastectomy 51
reabsorption 38–41, 39
increased net reabsorption 41
net reabsorption pressure 40
reception area, lymphedema clinic 239
rectum, lymphatic drainage 9
reflex sympathetic dystrophy (RSD) 103–104, 271
definition 103–104
lymphatic involvement 104
pathology and stages 104
therapeutic approach 104
reflux 61
reimbursements 241–242
reversible stage 56
rheumatoid arthritis (RA) 101–103
definition 101
effects on lymphatic system 102–103
pathophysiology 101–102
therapeutic approach 103
right lymphatic duct 11
rotary stroke 117–118, 118
see also manual lymph drainage
S
safety factor 8, 42–43, 43, 59–60
sagittal watershed 14–15
scalp lymphatic drainage 18–19
scars 62–63
evaluation 69
scoop stroke 115–117, 117
see also manual lymph drainage
scrotum, compression bandaging 198, 200–201,
200–202
sebaceous 272
self-bandaging techniques 135
self-induced lymphedema 53–55, 55
self-management 136–137
sentinel lymph node biopsy 51–52
sequential intermittent pneumatic compression
(SIPC) 76
serum sickness 272
short-stretch bandages 181
lower extremity 190–195, 192–196
self-bandaging 214–216, 215–217
lymphedema program supply requirements 240
upper extremity 184–187, 185–188
self-bandaging 211–213, 212–213
wide-width short-stretch bandages 181
shoulder exercises 218
shower requirements, lymphedema clinic 239
sickle-cell anemia 89
skin care 133, 134, 136, 230, 232
skin lesions 84–95
avoidance 229–230, 231
types associated with lymphedema 85–91
failed surgical sites 91
radiation-related skin changes 89–90
tears/excoriations 90–91
ulcerations 85–89
see also wounds
skin traction 71, 71
soft ball exercises 219, 220–221
space requirements, lymphedema clinic 238–239
spontaneously irreversible lymphedema 56
Starling, Ernest Henry 38
stationary circles technique 115, 116
see also manual lymph drainage
Stemmer sign 56, 57,69
stent 272
Stewart-Treves syndrome 58, 63, 84
stockinettes 179–180
lower extremity 190, 190
self-bandaging 213, 214
lymphedema program supply requirements 240
upper extremity 182, 183
self-bandaging 210
stockings, measurements for 202–204, 203
custom-made knee-high stockings 203
custom-made thigh-high stockings 204
standard-size knee-high stockings 203
standard-size thigh-high stockings 204
storage room, lymphedema clinic 239
stretched-pore phenomenon 80
subclavian trunk 11
subclinical stage 56
submandibular lymph nodes 18
submental lymph nodes 18
superficial inguinal lymph nodes 26–27
supraclavicular lymph nodes 21
supraclavicular trunk 11
surgery
debulking 78
liposuction 78
lymphedema therapy 78
secondary lymphedema and 48–49, 50–51, 59
synovial joint anatomy 101, 102
systemic circulation 2–4, 32
Index
282
T
telangiectasia 61, 62
thermo therapy 75
thigh collectors 28
thoracic duct 9–11
thorax
drainage areas 148, 150
manual lymph drainage
anterior thorax 150–151, 151
posterior thorax 148–149, 14 9
thrombophlebitis 82–83, 272
deep veins 82–83
superficial veins 82
thymus 272–273
tight junction 7
toe bandages 190, 191
self-bandaging 213–214
transport capacity (TC) 42
reduced 50
trauma 52, 59
traumatic edema 98–101
definition 98
inflammation ef fects 99
pathophysiology 98, 99
therapeutic approach 100–101
travel precautions 230, 232
air travel 232–233
treatment see specific types of treatment
treatment rooms 238–239
treatment sequences, lymphedema management
157–176
bilateral primary lower extremity 167–169
bilateral secondary lower extremity 164–166,
164
bilateral secondary upper extremity 159–161, 16 0
genital lymphedema 171–172
head and neck lymphedema 175–176
lipolymphedema 173–174
phlebolymphostatic edema 172–173
unilateral primary lower extremity 166–167
unilateral secondary lower extremity 161–163,
162
unilateral secondary upper extremity 157–159,
158
tributary areas 8
trophic 273
trunk
lymph nodes 24
lymphatic drainage 21–23, 22, 23
Turner’s syndrome 177
U
ulcerations 83, 85–89
arterial 86–88
fungating wound/malignant ulcerations 89
inflammatory 88–89
vascular 85–86
venous 86
ulnar forearm territory 25
ulnar hand territory 25
ultrafiltration 273
upper extremity
circumferential measurement chart 140 , 248
compression bandaging 182–189, 183–189
self-bandaging 210–213, 211–213
decongestive exercises 217–219
do’s and don’ts 229–231
evaluation 67
lymphatic drainage 24–26, 25
deep layer 26
drainage areas 154
superficial layer 24–26
manual lymph drainage 153–155, 154
self-MLD 221–224, 221–224
treatment sequences
bilateral secondary lymphedema 159–161, 160
unilateral secondary lymphedema 157–159, 158
urticaria 273
V
vasa vasorum technique, manual lymphatic
drainage 121, 121
vasculitis 88
vasodilation 35, 40, 41
active 59
passive 35, 41,59
veins 2, 3, 32–33
valves 3, 33
venous dynamics in lower extremities 79–80, 79
see also venous insufficiencies
venous Doppler imaging 73
venous insufficiencies 65–66, 65
phlebolymphostatic edema and 172
see also chronic venous insufficiency (CVI)
venous ulcerations 86
ventromedial territory 28, 29
venules 3
vests, compression 207, 209
measurements for 207
W
water, lymphatic load 5–6
watersheds see lymphatic watersheds
Web site listings, lymphedema clinic 239
weight gain fluctuation 59
wounds
types associated with lymphedema 85–91, 85
wound bed preparation 91–95
bacterial control 92–93
moisture balance 94–95, 94
wound necrosis 91–92
see also skin lesions
Appendix