Jul 15, 2018
Lymphedemais a surgical pathology characterized by the fact that as a result of certain disorders, the normal lymph flow through its vessels is disturbed, and instead of rushing into the following sections on its way, it accumulates in certain places. This accumulation of lymph with lymphedema causes deformations of individual parts of the body( often the limbs).
Lymphedema can be either primary or secondary. Primary lymphedema is exclusively hereditary. Its cause is a congenital malformation of the lymphatic vessels. Secondary lymphedema is most often the result of certain diseases, as well as the effects of certain factors( eg, surgical operations).Most often manifestations of secondary lymphedema are found in clinical practice.
Lymphedema is a fairly difficult curable disease. Complete elimination of this is possible not only with the proper administration of the appropriate drugs, but also with patient compliance with a certain regimen and rhythm of life.
Lipodemia of the lower extremities
The lymphoedema of the lower extremities is the most common variant of lymphedema. Among all cases of the appearance of lymphedema, about 91% is due to lymphedema of the lower extremities.
The causes of this disease are different: they can be either primary or secondary. The primary causes of lymphedema are exclusively genetic. In addition, signs of "primary" causes of this disease will appear only in a certain symptom complex. This symptom complex will include lymphedema in the area of the feet, legs and thighs, which will be accompanied by underdevelopment of the external genitalia, infantilism and slow psychophysical development. Lymphatic edema with this type of lymphedema of the lower extremities can vary from minor swelling on the lower legs to an increase in the entire lower limb.
Secondary causes of lymphoedema of the lower extremities are different. This may be the effects of certain physical conditions( eg, pregnancy), as well as certain diseases. Most often, lymphoedema can generate infectious and traumatic local lesions. In addition to the above diseases, there is another disease, which is the most favorable factor for the development of lymphedema - it is erysipelas.
It is important to correctly distinguish the first clinical signs of both subspecies of lymphedema among themselves: both primarily conditioned and secondary. Their main distinguishing feature will be the nature of the appearance of the first changes in the areas with disturbed lymph flow. Thus, the manifestations of primary lymphedema of the lower limbs in the patient will begin with edema, located on the distal( distant from the center) structures: feet, legs. The secondary conditioned variant of the disease will begin its activity from proximal( near to the center) structures. Most often, on the lower limbs - it's thighs.
In addition to the initial lesions of the proximal part of the lower limb, the secondary manifestation of lymphedema is characterized by a specific localization of lymphatic edema: they will be located slightly lower or at a level with damaged lymphatic areas. Also important is the symmetry of lymphatic lesions: in the primary disease, the lesion will most often be symmetrical on both lower limbs, and with secondary genesis, only one limb will be affected most often.
The first signs of lymphoedema of the lower limbs will begin with complaints of pain in the affected area of the lower limb. At first these pains will arise only with physical exertion, and then completely spontaneously without any prerequisites. Exactly the same tactics of manifestation will be in edematous manifestations: in the first stages they can even disappear at rest and give the limb a horizontal or elevated position. Another interesting feature of lymphatic edema is that they will be most pronounced in the summer season when exposed to high temperatures. These swelling will gradually capture the entire limb, moving in accordance with its order: from bottom to top with the primary development;Or from the top down to the secondary. Such extensive swelling deforms the affected limb. The skin on it becomes shiny, stretched and pale, with no visible pattern of vessels.
By the way, unlike the secondary, the primary lymphedema of the lower limbs does not always develop so rapidly and can enter the so-called "stasis"( stable state) in one of the stages and for a long time not develop further.
The causes of the appearance of lymphedema are very different, because this disease is multifactorial( such that it can be caused by various and often unrelated causes).As already mentioned above, lymphedema is primary and secondary. It is based on these subspecies that it is easiest to explain and remember the main and important reasons for the appearance of lymphedema.
But apart from the main reasons for understanding the essence of the disease, it is also necessary to understand the principles of normal lymph flow out of the lymph vessels.
Normally, the lymphatic network has its own specific structure, which is somewhere similar to the circulatory structure. The main structural units of the lymphatic network are lymphatic capillaries and lymph nodes. Lymphocapillaries perform a collective function: they collect lymph from various structures of the body. According to this function they have two subspecies: superficial lymphatic vessels and lymphatic vessels of deep order. The first lymph vessels take lymph from the skin and underlying subcutaneous tissue. The second type of vessel deals with the fact that it collects lymph from tissue structures. Each kind of lymphatic vessels accompanies certain veins along its course. Usually the surface vessels of the lymphatic system accompany the subcutaneous veins, and vessels of deep order entwine large deep vessels. Lymph nodes are the peculiar peripheral centers of the lymphatic system, because in them the main cells that make up the immune system undergo final development. Lymph nodes are located in certain places throughout the human body, and it is in them that the lymphatic capillaries flow. Together, the lymph nodes and vessels form large formations - the lymphatic ducts.
The main reason for the appearance of lymphedema is a violation of the outflow and movement of lymph along its vessels. This disorder can appear in two ways: an inborn violation and underdevelopment of lymphatic vessels or an effect on initially normal vessels of various factors.
In congenital disorders, their shape or number of lymphatic vessels is usually impaired. Exactly the same changes can occur with the lymph nodes: their form and development may be violated. Undeveloped vessels and lymph nodes can not transport even a normal lymph flow: with lymphedema, their lumen can be narrowed considerably, and some ducts may even be absent. As a result, all the lymph can not pass into the underlying vessels and part of it lingers.
Another factor that can be combined with abnormalities in the structure and function of lymphatic units, or act separately, is congenital hyperproduction of tissue fluid. This fluid is also the progenitor of lymph, and an increased amount of it, respectively, will lead to an increase in the amount of lymph in the bed. Lymphatic vessels are focused on the normal amount of lymph, and can not provide normal transport of its increased volumes. As a result, a separate amount of liquid is not transported further and is retained in certain areas, gradually accumulating and increasing edema.
With secondary lymphatic damage, the vessels of the lymphatic system initially have a normal structure and function. But under the influence of certain conditions on them, the performance of their functions may be violated. Most often, the permeability of lymphatic vessels is disturbed. The main causes that can cause such changes are traumatic injuries, chronic inflammation and radiation exposure. Particularly important causes are limb injuries and surgery( with radical surgery for breast cancer and there is a so-called lymphedema after a mastectomy or lymphedema of the hand).In case of trauma, one of two important mechanisms may occur: a rupture or damage to the vessels of the lymphatic network or, due to injury, the damaged lymphatic vessel is reflexively spasmed and turned off from the general lymphatic circulation system.
Also the second important factor that comes after traumatic causes, for the development of lymphedema, are erysipelas. Most often they appear already against a background of primary disturbances of lymphatic vessels. This is due to the fact that the damaged vessels have a bad current of lymph, and gradually in these places, pathogenic microorganisms accumulate. Accumulation in places of stagnation of nutritional compounds - proteins and fats, is an excellent medium for their development and activation. In addition, often in a pair with violations of the function of the lymph flow, there is a decrease in immunity, which also helps the bacteria to begin its pathogenic effect.
Each type of lymphedema has its key symptoms and manifestations. But there are also such signs that will necessarily appear in any variant of the disease.
The first mandatory sign of lymphedema is dense edema, which appears due to stagnation of lymph in the affected area. Due to the long-term effects of lymphatic edema on surrounding tissues, there are areas of development of connective tissue and in the pathological area of the tissue are subjected to fibrotic changes. As a result, the swelling becomes dense.
Most often, lymphatic edema develops rather slowly, gradually spreading to the entire limb. Patients complain of discomfort first. Then it is replaced by pains and unpleasant sensations, which decrease at positions that improve the lymph drainage in the affected limb or organ. After a while, the pain intensifies and is no longer suppressed by the above described methods. In addition, the pain at this stage is accompanied by quite strong cramps.
The next mandatory symptom is the deformity of the edematous limb. This is due to the fact that the lymph in a certain area still continues to accumulate. And this means that the clinically manifested edema continues to increase in the same way, gradually changing the shape of the limb. By the way, lymphatic edema can damage and deform not only limbs, but also separate organs. Most often this is the external genitalia( scrotal lymphedema).
The third sign is skin disorders. Because of the swelling, the skin on the affected area stretches, becomes shiny and pale. In addition to stretching, the skin becomes denser and therefore it is almost impossible to find a drawing of the subcutaneous venous network on it. In addition, in some places the skin acquires the appearance of an "orange peel" - dense with large and enlarged pores.
But in addition to common manifestations there will also be individual symptoms, characteristic for its subspecies of lymphedema. So its primary form has 2 types of flow: early and "late".The early form will manifest itself practically in the first days of life and is most often part of the above genetic disorder, combined with mental and nervous disorders. A "delayed" form will appear only after 35 years. In addition, congenital lymphedema can not develop for a long time and will only start if there is increased stress within the body: for example, during puberty or pregnancy. For the secondary caused lymphatic damage is very characteristic of the presence of a previous disease. Its presence can be determined using diagnostic procedures or based on an anamnesis of the disease.
It is important to note that lymphedema can develop slowly and slowly over a very long time. Also, with certain diseases, this disease can remain at a certain stage and not develop further. All terms of development depend solely on the reasons that cause it. So, for malignant primary causes, lymphedema has a rapid and rapid development, and with a primary genetic cause it can develop over several decades.
Lymphedema treatment of
Lymphedema is initially treated with conservative methods. All methods will be aimed at removing its root cause, primary or "maternal" disease. In addition, patients are assigned strict implementation of a certain regime: a constant hygienic control of the cleanliness of the affected areas, a restriction on the intake of fluid and giving the limb a horizontal position. In addition, a good effect is the constant tight elastic bandage of the limb.
If the abovementioned methods of treating lymphedema have not helped, then it is necessary to proceed to the implementation of the surgical manual. Usually an operation is performed to improve the lymphatic outflow through the surface lymphatic vessels. To do this, the skin flap cleared from the top layer is moved to the intermuscular space under the fascia. Thus, unmodified superficial lymphatic vessels replace damaged and restore lymphatic drainage.