A man aged 56 years underwent a liver transplant five years ago. He recently presented with bilateral leg swelling that has progressively worsened. He has no deep venous thrombosis or venous insufficiency. A diagnosis of lymphedema has been made. What are the most effective therapies available to treat this condition? — Jeannie Brennan, ANP-C, ACNP-C, Phoenix
Complete decongestive therapy (CDT) (also called combined, complex, or comprehensive decongestive therapy) is the gold standard of treatment for lymphedema. The goals of therapy are to decrease swelling, increase lymph drainage from the congested area, reduce skin fibrosis and improve the condition of the skin, enhance the patient’s functional status and quality of life, relieve pain and discomfort and decrease the risk of cellulitis.
Components of CDT include manual lymph drainage, compression bandaging, lymphatic exercise, skin care and patient education. Lymphedema is a chronic condition, so the patient must be educated in the important areas of risk reduction; self-lymph drainage; skin care; signs and symptoms of infections; proper fit and care of garments; and the importance of a healthy diet, exercise and weight management. There are lymphedema treatment centers (including one in Scottsdale, Ariz.) that provide expertise in lymphedema management. — Eileen F. Campbell, MSN, CRNP (161-4)
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