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Other Contemporary Treatment Modalities

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Lymphedema

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Abstract

Our recently confirmed knowledge has indicated that the lymphatics are more important than previously thought in maintaining cellular well-being and tissue homeostasis – given that there is no longer any significant reuptake of what leaks out of the vascular system back into it and that the lymphatics are solely responsible for it. Lymphokines, cytokines, inflammatory mediators, and adipogenic factors are all dependent on the lymphatics for their tissue clearance.

The breadth of treatment options continues to widen, with not all being well evidenced. There remain differences of opinion regarding the benefit of even traditional treatment forms such as manual lymphatic drainage and compression, so it is no great wonder when patients and practitioners shift toward alternate treatment modalities.

The roles and effectiveness of pressure have been reviewed with some indications emerging that often good outcomes are not gained due to an inappropriate pressure or a poor pressure gradient or perhaps a lack of thought as to what part of the lymphatic or venous systems need compression. There is also a trend to wider use of negative pressures over the superficial lymphatics, these being created by various forms of lymph taping and by a range of units which deliver a negative suction on the skin.

With so many conservative therapies around, it is hard for even an informed patient or clinician to make the right decision for the patient in front of them. The solution of course is to carefully review the range of best practice documents and perhaps consider using only one new or contemporary or traditional treatment at a time and giving it time to work before deciding if that is optimal or beneficial for the patient.

We have a plethora of treatments and strategies for dealing with lymphedema. Some show scant evidence of their effectiveness and often little rationale for their use. We must advance our knowledge in the breadth of treatments with an open mind, but must provide evidence for their efficacy so that patients and practitioners know what to expect.

For many new treatments, the trials are often small, but some are well designed and are objective with rigorous evaluation, so we can have confidence in the outcomes. Many contemporary treatments start as a good case study and move to a small clinical trial, but for many of these, their construct and conduct can leave many unanswered questions and skepticism leading to the loss of an opportunity to broaden our treatment base.

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Author information

Authors and Affiliations

  1. Lymphoedema Clinical Research Unit, Department of Surgery, Flinders University, Adelaide, Australia

    Neil Piller

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  1. Neil Piller
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Correspondence to Neil Piller .

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Editors and Affiliations

  1. Center for the Lymphedema and Vascular Malformations, Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, DC, USA

    Byung-Boong Lee

  2. Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, California, USA

    Stanley G. Rockson

  3. La Jolla, California, USA

    John Bergan

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Piller, N. (2018). Other Contemporary Treatment Modalities. In: Lee, BB., Rockson, S., Bergan, J. (eds) Lymphedema. Springer, Cham. https://doi.org/10.1007/978-3-319-52423-8_35

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  • DOI: https://doi.org/10.1007/978-3-319-52423-8_35

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-52423-8

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