Lymphoedema
Date issued: November 2023
Review date: November 2025
Ref: A-88/S/V/CC/Lymphoedema V4
PDF: Lymphoedema.pdf[pdf] 206KB
What is lymphoedema?
Lymphoedema is a chronic swelling in the leg due to a build up of fluid (lymph). Normally, this fluid drains out of the leg via a network of tiny tubes (lymphatics) back into the bloodstream. This fluid is made up of mostly water and protein.
With lymphoedema, the fluid is not draining out properly from the limb. To start with, the swelling is often noticeable at the end of the day and goes down at night. However, unless the swelling is treated properly, the fluid becomes “fixed” in the leg permanently and with the increase in the fat and fibrous tissues, the skin becomes thickened. This causes discomfort and reduction in movement.
What causes lymphoedema?
Primary Lymphoedema: The most common cause for lymphoedema in the UK is that you were born without enough lymphatics (congenital). If there are very few lymphatics, the swelling may start as a teenager or even earlier. This type of lymphoedema is called Milroy's Disease. One leg is often worse than the other and sometimes only one leg can be affected. In less severe cases, the lymphatics may be able to cope initially and only start to fail when you are older.
Secondary Lymphoedema: Lymphoedema can also be caused if the lymphatics of the arm and leg are damaged by surgery or radiotherapy for the treatment of cancer. Sometimes this is unavoidable if the cancer is to be cured. There are also some rare tropical parasites (Filariasis) that invade and block the lymphatics and this is the commonest cause of lymphoedema worldwide. These parasites do not live in Great Britain.
What effects does lymphoedema have?
Apart from the uncomfortable and unsightly swelling, lymphoedema can cause problems, especially if it is not kept under control. There is an increased risk of infection under the skin (cellulitis) and repeated attacks of cellulitis lead to more lymphatic damage. If untreated, the skin may thicken and small skin blisters may develop. Small cracks in the skin can develop and this can be a further source of infection. Ulceration of the skin is rare but can occur. The resulting swelling, discomfort and heaviness in your legs can cause a lack of movement in your joints, thus affecting your mobility.
How is lymphoedema diagnosed?
The diagnosis of lymphoedema can usually be made by history and examination but, when the diagnosis is uncertain, further investigations are necessary. Other causes of leg swelling
such as venous disease should be excluded and this can be done by ultrasound scanning. Compression of the veins or lymphatic channels by a mass in the pelvis can also be excluded by ultrasound scanning.
What is the treatment?
Lymphoedema cannot be cured but it can usually be reduced and controlled so that complications do not occur later. The mainstays of treatment are compression bandages or stockings, elevation of the limb and external pneumatic compression. Surgery is rarely used for lymphoedema.
Elevation of the limb & exercise: Whenever the leg is elevated, fluid will tend to drain out of it. Put your legs up whenever you can and as high as you are able, the arm of a sofa is good. Elevate the end of your bed (6 inches or so) in order that your feet are a little higher than your head. Exercise such as walking combined with other therapies below will also be of benefit.
Compression bandages or stockings: Compression is required to squeeze the fluid out of your legs when you are standing up. Bandages may be required at first, to remove the worst of the swelling, before stockings can be used. These stockings need to be specially fitted and are much stronger than ordinary "support tights". If the swelling only affects the lower leg, then you can wear a below-knee stocking that is self-supporting, like a pop-sock. The usual strength of stocking used is Class II, but, sometimes, a stronger Class III is required. If you have difficulty putting on your stockings, you can buy a special stocking applicator. Stockings applied to a swollen leg will not work properly and therefore it is important to reduce the swelling first by bandaging.
External Pneumatic Compression (EPC): Despite compression stockings, many people find that some swelling accumulates by the end of the day. The EPC device is a pneumatic boot that inflates and deflates to squeeze fluid out of the leg. These should only be used under the direction of a lymphoedema specialist.
Prevention of Infection: Care should be taken to avoid trauma to the feet as this may allow infection to enter the tissues. Fungal infections can be avoided by keeping the skin between the toes clean and dry. Occasionally, when recurrent infections of the skin occur, it may be necessary to take long-term low-dose antibiotics.
Contact details
Vascular Surgical Unit
Surgical Directorate
Plymouth Hospitals NHS Trust
Derriford Hospital
PL6 8DH
Tel 01752 202082
Consultant Vascular Surgeon and Lead Clinician
Mr Devender Mittapalli
Secretary: 01752 431822
Consultant Vascular and Transplant Surgeon
Mr Jamie Barwell
Secretary: 01752 431822
Consultant Vascular Surgeon
Surgeon Commander Cris Parry RN
Secretary: 01752 431822
Consultant Vascular Surgeon
Miss Catherine Western
Secretary: 01752 431805
Consultant Vascular Surgeon
Lt Col Robert Faulconer
Secretary: 01752 431805
Consultant Vascular Surgeon
Mr Hashem Barakat
Secretary: 01752 431822
Vascular Scientists
- Mrs J George
- Mr A Ellison
- Mr R Craven
01752 439228
Vascular Nurse Specialist
Mr Alan Elstone
01752 431805
Matron
Judy Frame
01752 431847
