best practice for the management of lymphoedema ... - EWMA

FIGURE 7 Intensive therapy options for patients with lower limb lymphoedema
•
•
Lower limb peripheral arterial
occlusive disease
(ABPI 0.5–0.8)?*
Yes
No
Can the patient commit to
standard intensive therapy?
Standard intensive therapy†
MLD/SLD
MLLB (inelastic bandages)
>45mmHg
Yes
No
UPPER LIMB LYMPHOEDEMA –
INITIAL MANAGEMENT
As for the lower limb, initial management
for upper limb lymphoedema will involve
psychosocial support, education, skin care,
exercise/movement, elevation and
management of any concomitant medical
conditions, pain or discomfort (Figure 6,
page 16). The patient's initial management
may also include:
■ compression garments
■ modified MLLB
■ intensive therapy.
•
•
•
•
•
•
Modified intensive therapy
with high pressure†
MLD/SLD
MLLB (inelastic bandages)
>45mmHg
Lower limb lymphoedema
Patient suitable for
intensive therapy
Does the patient have:
Neurological deficit?
Lipoedema/lipolymphoedema?
Palliative needs ?
Poor mobility/frailty?
•
•
•
Compression garments
Compression garments can be used as
initial management in patients who have
mild upper limb lymphoedema (ISL stage I)
with minimal subcutaneous tissue changes
and shape distortion. Where there is
considerable soft pitting oedema, MLLB
(inelastic bandaging) will be required to
reduce and stabilise the swelling prior to the
application of compression garments.
In general, the level of compression used
to treat lymphoedema of the upper limb is
lower than that required for lower limb
lymphoedema. Lower pressure compression
garments also have a role to play in
managing symptoms in a palliative context.
Chronic venous
insufficiency?
Venous ulceration?
TREATMENT
DECISIONS
BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA 19
Yes
Modified intensive therapy
with reduced pressure†
SLD
±IPC
MLLB (inelastic bandages)
15–25mmHg
*Patients with ABPI