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Summary of Guidelines for Lymphoedema

PostPosted: Sat Jun 10, 2006 8:24 pm
by patoco

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• Always measure both arms or both legs and note down whether the patient is right- or left-handed.
• Place the beginning of the tape measure at the cuticle of the index finger or the second toe and roll
the tape upward along the arm or leg.
• Arms: measure the distance between the cuticle of the index finger and the following four points: the
wrist, the thickest part of the forearm, the beginning of the upper arm, and the thickest part of the
upper arm. Legs: measure the distance between the heel and the following four points: the ankle, the
thickest part of the lower leg, the beginning of the thigh, and the thickest part of the thigh. Note down
these distances.
• Measure the circumference at the level of the above measuring points and note this down.
• Carry out every following measurement in the same way. Determine the relative volumes in percent
by means of a special measuring rod or with the formula:
(circumference on the affected side)2
(circumference on the healthy side)2


• A plan of treatment for lymph oedema comprises non-pharmacological methods of treatment that are
geared to one another.
The combined nonoperative therapy is concluded with the prescription of a therapeutic elastic stocking.
• Therapeutic elastic stockings must be prescribed by specialists in the field. Flat knit stockings with a high
degree of stiffness (coefficient of elasticity) and little longitudinal stretch are preferred. For lymph oedema
in the legs a class III (sometimes class IV) stocking is preferred, while for lymph oedema in the arms the
stocking must exert a pressure of at least 15 mmHg. Such stockings should be replaced frequently.


• Every treatment of lymph oedema must be followed up via an objective measurement of the effects.
• Systematic trend measurement is desirable for all patients with a risk of lymphoedema following oncology surgery.


The following aspects should be referred to during the specific anamnesis:
• manner and time of development and course;
• effect of gravity on the oedema;
• relation with exercise, outdoor temperature and pregnancy;
• type and nature of the symptoms;
• family history pertaining to the affections and symptoms that have been determined;
• prior history and comorbidity;
• limitations of function;
• previous therapy.

The following aspects should be evaluated during the specific physical examination:

• presence of scars from previous surgery or radiotherapy;
• signs of venous insufficiency;
• nature of the swelling: pitting versus non-pitting, unilateral versus bilateral, proximal versus distal;
• any accompanying symptoms, such as redness, warmth, pain on palpation, hyperpigmentation,
thickening of the skin with congestive papillomatosis;
• the degree of fibrosis of the skin;
• Stemmer’s test; when the result is positive, it is no longer possible to make a skin crease on top of
the foot at the level of the proximal phalanx of the second and third toes because the skin has become
thicker there;
• abnormalities in the nails, such as onychodystrophy or slower growth;
• palpable resistance in the lymph drainage area;
• indications of recurrent tumour growth;
• presence of coetaneous pathology.

Supplementary diagnostics to determine the cause of the swelling are indicated in the following situations:

• inexplicable oedema at a young age (< 35 years);
• oedema and swelling of unknown cause and doubts concerning lymph oedema;
• oedema during the follow-up of patients belonging to a high-risk group;
• progressive development of oedema with venous and/or neurological symptoms following oncological
treatment of the regional lymph node station; it is important in this context, to distinguish lymph
oedema as a result of (recurrent) malignancy from benign oedema;
• unilateral persistent oedema following an erysipelas and adequate follow-up treatment with a therapeutic
elastic stocking;
• a suspicion of mixed forms, such as oedema as a result of venous insufficiency, and lipohypertrophy
• therapy-resistant lymph oedema as assessed by a multidisciplinary lymph oedema working group;
• discrepancy between a trauma and the (persistent) swelling, for example following an insect bite, a
sprained ankle or knee surgery;
• discrepancy between the subjective symptoms of a patient and the degree of objectively measured swelling of the extremity.

Complete Article at: ... versie.pdf