Abstracts LymphForsch 2/2021
– full text in German –
Microsurgical reconstruction for central lymphatic lesions and anomalies
L. Grünherz, N. Lindenblatt
LymphForsch 25 (2) 2021, 52-56
Central lymphatic lesions can be congenital or iatrogenic. The latter can result from any surgical intervention in the area of the thoracic duct, such as a neck dissection. Thoracic duct lesions cause recurrent chylogenic effusions and increased mortality due to the ongoing loss of protein and fluid. If conservative therapy is unsuccessful, a thoracic ductto-vein anastomosis can be performed in cases with an isolated lesion. In contrast to interventional embolization, this microsurgical technique enables reconstruction of physiological lymphatic drainage. As a result, remission has been achieved in some patients over the past few years.
Central conducting lymphatic anomaly, thoracic duct lesion, lympho-venous anastomosis, thoracic duct, central lymphatic lesion.
Manual lymphatic drainage after surgical treatment of breast cancer: Critical analysis of a systematic review and meta-analysis of randomized controlled studies
LymphForsch 25 (2) 2021, 57-63
A meta-analysis (MA) investigating the effectiveness of manual lymphatic drainage (MLD) for prevention and treatment of breast cancer-related lymphedema was published in 2020. The conclusion was that MLD cannot significantly reduce or prevent lymphedema. A critical appraisal of this MA shows several weaknesses regarding the literature search process and the content. Clinically relevant parameters beyond significance were not mentioned or discussed. In addition, potential confounders or biases were not addressed or discussed in detail. Furthermore, the MA failed to include Sackett’s evidence-based model and needs-oriented therapy for patients.
Secondary breast cancer-related lymphedema, manual lymphatic drainage, effectiveness.
Mechanoregulation of lymphatic endothelial cells
LymphForsch 25 (2) 2021, 64-69
Lymphatic endothelial cells form the innermost layer of lymphatic vessels and continuously interact with their luminal and abluminal microenvironments. These interactions transfer mechanical forces, such as fluid shear stress, stretch and matrix stiffness, onto the lymphatic endothelium and translate extracellular information into intracellular biological responses.
In recent years it has already been demonstrated that mechanical forces play an important role in the early development and maturation of the lymphatic vasculature and contribute fundamentally to the development and maintenance of lymphatic valves. In contrast to blood vessels, the mechanisms of lymphatic mechanoregulation are poorly understood. This review provides a brief overview of what is already known about the mechanical forces that regulate the behavior of lymphatic endothelial cells and aims to demonstrate that a comprehensive analysis of mechano-regulated mechanisms can improve the understanding of lymphatic vascular development, homeostasis and, in particular, lymphatic diseases.
Lymphatic endothelial cells, mechanotransduction, extracellular matrix, tissue stiffness.
Macroscopic markers in the diagnosis of lipedema
S. Michel, M. Sauter, P. Leuthner, A. Siafliakis, C. Belay, D. von Lukowicz, K. Lossagk
LymphForsch 25 (2) 2021, 70-72
The diagnosis of lipedema is based on the patient's medical history and clinical findings. We were able to name two macroscopic markers that provide a strong indication of the presence of lipedema. The two areas are located on the coccyx and on the medial, proximal lower leg. Thickening of the fat layer and the presence of symptoms typical of lipedema indicate a high risk of lipedema. In the case of pure obesity, the fat layer in these areas is not thickened, which makes it easier to distinguish it from lipedema.
Lipedema, diagnosis, marker, obesity.
The role of lymphedema compression garments in complex physical decongestive therapy in Germany and internationally
LymphForsch 25 (2) 2021, 74-77
Compression therapy is as old as medicine itself. Its impact as a highly effective measure to reduce pain and swelling is now being scientifically researched. Whether for trauma or post-surgical treatment, to treat primary and secondary lymphedema, advanced venous disease, advanced arterial lymphedema, diabetes, as well as lipedema syndromes, compression therapy is being applied successfully. Current statistics show that approx. 4 % of the world‘s population has lymphedema from different causes.
Manual lymphatic drainage (MLD), which accelerates the resorption of edema, is only effective in combination with compression therapy (decongestion phase with multilayer compression bandages), systemic skin care, physical activity in compression and selfmanagement by the patient to support the treatment.
While the acceptance of compression bandage therapy is high in many non-European countries, this is not the case in some parts of Europe. In Germany, for example, MLD is all too often prescribed as a standalone therapy measure. However, the only way to maintain the treatment success of a decongestion phase is with compression stockings or garments.
The best possible therapy-based approach is outlined in the internationally recognised scientific guidelines published by the Association of the Scientific Medical Societies in Germany (AWMF) entitled Diagnostic and Therapy of Lymphoedema  endorsed by 32 different medical associations.
The training of all medical professionals working toward the diagnosis and treatment of lymphostatic edema is a central focus of professional efforts worldwide. To this end, more than 80 lymphedema networks have now been established in Germany which provide high-quality care at both specialist clinics and in outpatient treatment.
lymphedema compression bandaging, complex physical decongestive therapy, compression therapy, lymphedema, lipedema, acute edema, edema in venous and arterial insufficiency.
A comparison of postoperative edema and lymphedema
LymphForsch 25 (2) 2021, 78-80
A proper patient history, as well as inspection and palpation during the physical examination are the key factors for determining therapy for patients with lymphedema. In this article, we present the case of a patient to demonstrate the important role of proper diagnosis.
Patient history, inspection, palpation, secondary lymphedema
Presenting and assessing self-management workshops offered by the lymphedema support group Lymphselbsthilfe e. V.
S. Helmbrecht, I. Kraus
LymphForsch 25 (2) 2021, 83-87
Since 2009, psychologist Susanne Helmbrecht and MLD/CPD instructor Ralf Gauer have teamed up to offer one-day workshops for patients with lymphedema and lipedema to enhance their understanding and management of the condition. The self-management program entitled “Living a healthy and active life with lipedema and lymphedema (GALLiLy)” is in demand by support groups and increasingly also by individuals throughout Germany, causing the program to be expanded. The registered association “Lymphedema Self-Help” offers conventionalone-day workshops and four-day intensive workshops, as well as modular day-long workshops addressing specific topics in-depth.
The one-day basic and multi-day intensive workshops mainly focus on the medical and technical background of the disease and the principles of complete physical decongestive therapy, an introduction to adjuvant therapies and ways to cope with work, everyday life or physical activity. The workshops also provide an opportunity for participants to share their personal experiences with others. All in all, the program aims to empower participants to manage their disease themselves and take a more positive attitude toward it. In 2018 and 2019, we conducted surveys to learn about the workshop participants’ starting situation and expectations and find out about the subjective benefits of the workshop content.
The survey results impressively demonstrate the great need for such workshops, with numerous participants reporting feeling underinformed; in many cases knowledge of the condition is acquired through their own research. The final evaluation of the workshops showed that nearly all participants were very to highly satisfied. The participants reported that attending the workshop had enhanced their competency and that they were better able to manage their edema.
Lymphselbsthilfe e. V., lymphedema support group, self-management program, GALLiLy, lymphedema, lipedema
How does scar tissue influence manual lymphatic drainage and complex physical decongestive therapy?
LymphForsch 25 (2) 2021, 88-91
Manual lymphatic drainage as a component of complex physical decongestive therapy is used in physical therapy practices to manage lymphedema. Treating patients with scars often requires modification of therapy. Unfortunately, however, increased keloid scars impair lymphatic drainage as a secondary condition during wound healing. We therefore decided to investigate the expediency of conducting perioperative decongestive therapy to enhance regeneration of the lymphatic vessels through manual lymphatic drainage. Offering modified compression therapy in the first six weeks with Class 1 compression stockings may have an additional positive influence on the tissue condition.
Manual lymphatic drainage, complex physical decongestive therapy, scars, wound healing, lymphatic vessels, shin splints