Management of Lymphoedema
Patients presenting lymphoedema should benefit from coordinated management and receive information adapted to their needs.
The main objectives of the treatment are:
- Reduction, then stabilization of the volume,
- Improvement of the limb function,
- Prevention of complication risks,
- Patient education and psycho-social support.
This chronic disease therefore requires continuous management, which can be split into two essential and complementary phases:
The Reduction Phase
Its goal is to achieve maximum reduction of the oedema to come as close as possible to the volume of the opposite healthy limb.
The reduction phase is also known as The Intensive Decongestive Treatment.
The main treatments used are:
- Manual lymphatic drainage, carried out by a specifically trained physiotherapist.
- Reducing and draining bandages requiring the use of several bandages which can be adapted to the volume and repositioned at will.
- Coached physical activity, under bandages.
- Skin care.
This phase may vary from one to several weeks, depending on the severity of the lymphoedema, and can be renewed later.
The Protocols
The reduction phase can only be performed using bandages.
The advantage of bandages is that they can be repositioned again and again to ensure the best possible fit to successive variations in oedema volume.
There are different sorts of bandages and it is their combined use that rapidly and efficiently reduces oedema:
Basic assembly: 3 short-stretch bandages
1. Skin Protection
SHORT STRETCH COTTON BANDAGE
Rigid cotton bandage In direct contact with the skin, this tubular cotton bandage provides tight retention of the limb. Soft and lined, it has a comfortable upper layer for efficient protection of the skin weakened by the lymphœdema.
2. Drainage of Oedema
MOBIDERM
Anti-œdema device Used under a reducing bandage, the Mobiderm device mobilises œdematous or indurated subcutaneous tissue. It is superimposed on top of the first cutaneous protection bandage.
3. Retention
BIFLEXIDEAL®
Short stretch bandage A short stretch bandage (<100% stretch), Biflexideal®, as the third layer guarantees retention of the œdema, as well as efficacious drainage in case of physical activity (high work pressure).
4. Compression
BIFLEX
Elastic bandage Lastly, for active compression of the œdema and thereby reduce it efficaciously, even in case of reduced mobility, a fourth compression bandage, Biflex, is used for daytime wear only.
The Mobiderm Device
Mobiderm is a medical device made up of foam cubes encased between two non-woven bandages. The Mobiderm technology can be used under a reducing bandage (in its bandage version or mobilising plate), or incorporated into mobilising garments.
Thanks to the pressure difference it creates between the support area of the cubes and their surrounding area, it improves the flow of lymphatic fluid and optimizes the drainage efficacy. Through a shearing effect on the œdematous subcutaneous tissues, Mobiderm also softens the fibrotic or sclerotic cutaneous areas.
The Maintenance Phase
As soon as a satisfactory volume reduction is achieved, the maintenance phase of the lymphoedema starts.
Its role is to stabilize the volume of the reduced limb in the inital phase, or even to continue the volume reduction, but also to avoid relapses and enable the patient to recover normal mobility.
This phase is conducted with elastic compression ortheses, that should be regularly reviewed for size and comfort.
Worn daily from waking up to bedtime, they ensure both:
- effective compression aimed at easing the circulation of the lymph to the heart, thus preventing the formation of oedema.
- effective retention guaranteeing that the oedema cannot recover more than a certain percentage of volume, irrespective of its intrinsic expansion force.
A variety of garment models are available (stockings, tights, sleeves…) in several compression classes.
Mobiderm is a high-tech anti-Oedema compression device
EFFECTIVE
Rapid reduction of the volume of the oedema, softening of fibrotic, sclerotic or oedematous skin…
PRACTICAL
Light, comfortable and flexible, it enables the patient to keep the freedom of movement and hence, the limb’s drainage capacity.
COMFORTABLE
- Soft skin contact,
- Conformability of product for improved anatomical fit.