cardiovascular disorders
Lymphedema
Treatment of Lymphedema
Sometimes surgical soft-tissue reduction and reconstruction for primary lymphedema Mobilizing fluid (eg, by elevation and compression, massage, pressure bandages, intermittent pneumatic compression) Treatment of primary lymphedema may include surgical soft-tissue reduction (removal of subcutaneous fat and fibrous tissue) and reconstruction if quality of life is significantly reduced. Treatment of secondary lymphedema involves managing its cause. For lymphedema itself, several interventions to mobilize fluid (complex decongestive therapy) can be used. They include. Manual lymphatic drainage, in which the limb is elevated and compressed (“milked”) toward the heart Gradient pressure bandages or sleeves Limb exercises Limb massage, including intermittent pneumatic compression Surgical soft-tissue reduction, lymphatic reanastomoses, and formation of drainage channels are sometimes tried but have not been rigorously studied. Preventive measuresinclude avoiding heat, vigorous exercise, and constrictive garments (including blood pressure cuffs) around the affected limb. Skin and nail care require meticulous attention; vaccination, phlebotomy, and IV catheterization in the affected limb should be avoided. Avoid vaccination, phlebotomy, and IV catheterization in limbs affected by lymphedema. Cellulitis and lymphangitis are treated with beta-lactamase–resistant antibiotics that are effective against gram-positive organisms (eg,dicloxacillin). 