Primary lymphoedema is a congenital change in the lymphatic system. Secondary lymphoedema, on the other hand, is “acquired” and can develop after lymph node removal or radiotherapy for cancer, for example
Lymphoedema occurs when the lymph fluid cannot be removed sufficiently and accumulates in the tissue. The accumulation of fluid and proteins in the tissue leads to remodeling processes over time, especially in the case of untreated edema, which can lead to fibrosis (proliferation of connective tissue) and sclerosis (hardening of tissue).
At the USZ, specialized physiotherapists treat patients with lymphoedema in lymphological physiotherapy, also known as complex physical decongestive therapy (CDT).
The aim of physiotherapeutic treatment of newly occurring lymphoedema is to reduce the oedema. We apply compression bandages and promote lymph drainage using manual techniques such as lymphatic drainage. During the course, patients learn how to bandage themselves and a custom-made compression garment is made by a bandaging specialist.
Therapy
Physiotherapy for lymphoedema is carried out in 2 phases:
Intensive phase
The intensive phase lasts 2-3 weeks, with 2-4 appointments per week. The aim is to achieve the best possible decongestion during this time. At the end of the intensive phase, a flat-knit compression stocking/flat-knit compression garment made to measure is fitted.
Maintenance phase
At the end of the intensive phase, the patient wears the compression garment during the day, applies bandages if necessary and thus controls the edema independently. The aim in the maintenance phase is to maintain the result of the edema reduction from the intensive phase as best as possible. Depending on the extent of the edema, we arrange further appointments or intensive phases individually.
Long-term therapeutic success is based on the 5 pillars of lymphological physiotherapy
- Compression/bandaging
- Manual lymphatic drainage
- Skin care
- Self-management
- Movement
Compression involves bandaging the affected limb or body part with compression material. Whenever possible, patients also learn how to bandage themselves.
Once decongestion has been achieved, compression is continued with a customized compression garment. This makes everyday life easier compared to bandaging.
Manual lymphatic drainage as a component of lymphological physiotherapy supports the removal of lymphatic fluid. Lymphatic drainage alone, without further bandaging or compression measures, is not sufficient, as drainage without compression only has a very short effect. We use special grip techniques to treat hardened tissue, fibrosis or scars.
Skin care is key: to prevent infections, it is important that the skin remains elastic, sufficiently hydrated and free of injuries.
Self-management includes informing patients about their clinical picture, the conservative treatment options and what they themselves can contribute to a positive outcome. In this way, patients themselves can become the “main manager” of their edema.
Exercise, also with bandages and compression, is another important component in maintaining the edema situation stable and, if necessary, reducing it further.
Other points in lymphological physiotherapy are very important for the success of good edema treatment: good weight management, support in dealing with the disease and possible referral to external services if there are questions about the social, financial and professional situation.
Cooperation
All specialists who treat patients with lymphoedema in the Occupational Therapy Department at the University Hospital Zurich have specific lymphology training. We treat the entire spectrum of edema diseases and also specialize in the treatment of the following complex lymphedema.
Specialization in complex lymphedema
Head lymphoedema
After major surgical procedures on the head and neck and/or with radiation. For swallowing and speech disorders, we work closely with phoniatrists and clinical speech therapists
Genital lymphedema
After gynecological or urological surgery with removal of lymph nodes. In the case of continence problems, we work closely with the stoma consultation and pelvic floor rehabilitation departments. Patients with lipoedema or scleroderma also benefit from the specialized expertise of lymphological physiotherapy.
Close internal and external network
We have an extensive internal and external network of other specialists and experts who we consult to ensure the best possible treatment:
Interdisciplinary lymph consultation
Together with the angiology and plastic surgery departments, the lymph therapists advise patients in complex lymphological situations and discuss the best treatment options.
Cooperation with trained orthopaedic and bandage specialists
In close cooperation with the therapists, the specialized support specialists advise patients on the best compression garments for them, including the various custom-made products (round and flat knit), materials (for allergies), donning aids and special products for head or genital lymphoedema or adjustments for stoma care.
To the self-bandage videos
Wound consultation
For wound care or training in dealing with wounds, we can call in specialized wound consultants in-house. .
Psycho-oncology service
Patients can make use of the psycho-oncology service at the USZ for support in coping with their illness.