Friday, February 24, 2012

Multidisciplinary Lymphedema Treatment Program.

I have long been a proponent of a lymphedema treatment "team." This is a team of medical professionals that would be involved in a patients lymphedema management program.

For example, in my own team I have:

Primary Care Physician

Infectious Disease Doctor


Pulmonary doctor (due to lymphedema related pulmonary complications)

Certified lymphedema therapist

At times, this team has expanded to include a home health nurse, physical therapist, and an occupational therapist.

As you can see from the article others might include a vascular surgeon, physiotherapist, dietitician, dermatologist, and even a psychologist.

A team approach is designed around the patients very specific medical needs and their very specfic medical situation. This way, there is a "complete" patient care focus.

The study:

Multidisciplinary Lymhpedema Treatment Program

February 2012


Lymphedema is an underrecognized and undertreated condition that requires a multidisciplinary approach in an individualized program that will address the special needs of each patient. In an ideal setting of an outpatient management program the team should be composed of a vascular surgeon, a dermatologist, a physiotherapist, a dietician, a psychologist, a social worker, and an office employee, working together in the assessment and management of all aspects of lymphedema. All treatment strategies and actions taken should ultimately focus on the improvement of the quality of life of patients suffering from lymphedema and on the prevention of lymphedema in high-risk patients.

Development and use of guideline-derived quality indicators for community lymphoedema.

Development and use of guideline-derived quality indicators for community lymphoedema.

Feb 2012


Background  Treatment of lymphoedema is complex and needs specific skills. There are no standards for the evaluation of quality of care.


Development and application of indicators for the measurement of quality of care in lymphoedema.


In a three-step process including a national Delphi expert consensus, quality indicators were derived from national and international guidelines. In a cross-sectional study involving a large spectrum of care providers, the quality of lymphoedema care in the community was assessed by transforming the indicators to one unweighted quality index (QI).


A total of 12 quality indicators were identified and applied to n = 348 patients with lymphoedema and lipolymphoedema of any origin in the metropolitan area of Hamburg (90.8% female, mean age 57, SD 14.5 years). On average, 55% of the quality indicators were met, and 64.8% of the patients were satisfied with lymphoedema care.

There was a significant correlation between QI and satisfaction.


The quality indicators and the QI are feasible and valid for the evaluation of quality of care. They can support optimizing lymphoedema care.

Wiley Online Library

Thursday, February 16, 2012

Management of limb lymphedema

Management of limb lymphedema.

Jan. 2012

[Article in French]


Unité de lymphologie, centre national de référence des maladies vasculaires rares, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.


Keywords: Lymphedema, Treatment, Physiotherapy, Low Stretch bandage, compression

Lymphedema results from impaired lymphatic transport with increased limb volume. Cellulitis is the main complication, but psychological or functional discomfort may occur throughout the course of lymphedema. Lymphedema management is based on complete decongestive physiotherapy (multilayer low stretch bandage, manual lymph drainage, skin care, exercises). First phase of treatment leads to a reduction of lymphedema volume. The second phase stabilizes the volume and is based on elastic compression. Resection surgery is a useful tool in external genitalia lymphedema.


Monday, February 13, 2012

Lymphangiogenesis: A Potential New Therapy for Lymphedema?

Lymphangiogenesis: A Potential New Therapy for Lymphedema?

2012 Jan

Cooke JP.


Stanford Cardiovascular Institute, Stanford, CA.


At the level of the capillaries, the systemic circulation loses about 2-4 liters of fluid and about 100g of protein into the interstitium daily. This ultrafiltrate of the systemic capillaries is returned to the circulatory system by the lymphatics. The lymphatic vasculature is highly specialized to perform this service, beginning with the blind-ended lymphatic capillaries. These vessels are highly permeable to protein, fluid and even cells, due to fenestrations in their basement membrane, and discontinuous button-like junctions rather than tight intercellular junctions as observed in the systemic capillaries(1). The lymphatic capillaries merge into collectors and larger lymphatic conduits that are invested with vascular smooth muscle (capable of contracting and propelling lymph forward) and valves for unidirectional flow. These conduits merge at lymph nodes, delivering antigens to the immune cells and serving as an early warning system of pathogen invasion. The lymph nodes drain into conduits that ultimately merge into the thoracic duct which empties into the left subclavian vein.

Lymphedema Genetics

When I originally became active in online groups, blogs, and websites, there were only two genes identified as being involved with causing hereditary lymphedema.

Now, eight specific genes have been identified as causing several hereditary lymphedema syndromes and associated syndromes with lymphatic malformations or dysplasia.

At our main webste, Lymphedema People, we have complete information pages on each one:

Thursday, February 09, 2012

Lymphedema Family Study - Financial Crises

Family members, last Fall, I wrote about the desperate financial situation of the Lymphedema Family Study at the University of Pittsburg and I also wanted to share it with you.

When I got active online back in 2003, there was only one confirmed lymphedema gene - VEGFC - and one suspected FOXC2.

Now, a few years later there are eight confirmed genes responsible for hereditary lymphedema and the syndromes associated with it.

We always complain about the medical world not caring, and I wish I could convey Dr. Finegold's dedication to lymphedema genetic studies. You'll never find anyone more committed to the lymphedema world then he is.

This is our chance to stand up and be counted - and - to show that we believe our lives to be worth being cured. If there is anything, anything you can do, please follow the link to the study and help.

Here is an excerpt from his note:

"I'm in a situation where I need to reach out to people in the lymphedema community.

I believe we have identified an opportunity to significantly affect wound healing by stimulating lymphangeogenesis in preparations of adipocyte stem cells or a mesenchymal stromal fraction prepared from adipocytes.

I believe this may also possibly be an avenue to the effective treatment of lymhepdema.

At this point in time, we don't haave sufficient funding to do the experiments for proof of principle. I need to identify a commercial or foundation entity who might be willing to seed us for six months or so to solidify our preliminary data.


David (Dr. Finegold)