The Clinician’s Role in Compression
March 17, 2008
Susan Gallagher Camden, RN, MSN, WOCN, PhD
Tere Sigler, PT, CWS, CLT
Lymphedema, a disorder of the lymphatic system, affects at least 3 million Americans.1 The lymphatic system plays a role in both immune function and circulation. The system is comprised of lymphatic vessels located just under the skin and lymph nodes in areas around the neck, axilla, and groin. As the vessels transport fluid away from the tissues, waste products, bacteria, and large protein molecules are collected. The fluid is carried to the lymph nodes where the water products are degraded and eliminated, while the remaining protein-rich fluid is transported to the heart and back into circulation.2
When the normal lymphatic channels are disrupted, abnormal amounts of protein-rich lymphatic fluid collects in the interstitial tissue and causes swelling, most often in the arm and/or legs, and occasionally in other parts of the body. When the disruption becomes profound, the volume of lymphatic fluid exceeds the lymphatic transport capacity, leading to lymphedema.
Primary lymphedema is caused by connatal malformations of the lymphatic system, such as missing or impaired lymphatic vessels. This can affect any or all parts of the body but is usually seen in the legs. Secondary lymphedema, sometimes referred to as acquired lymphedema, occurs when lymphatic vessels are damaged or lymph nodes are removed. The lymphatic vessels can become damaged as a result of trauma, surgery, radiation, severe chronic venous insufficiency, morbid obesity, or infection. Without appropriate intervention, the protein-rich fluid increases the size and number of the tissue channels. This contributes to a reduction in the oxygen availability in the transport system, which interferes with wound healing and provides a culture medium for bacteria. This increased bacterial load can result in lymphangitis. When lymphedema continues unchecked, the protein-rich fluid continues to accumulate, swelling increases, and tissue becomes fibrotic. Untreated lymphedema can lead to a decrease or loss of limb function, skin breakdown, or chronic infections.
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