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

Antibiotic regimens
Antibiotic regimens for cellulitis/erysipelas in
lymphoedema vary according to the clinical
situation (Table 4). Antibiotics should be
continued for at least 14 days after an acute
episode has responded clinically to treatment.
It may take one to two months of antibiotic
treatment to achieve complete resolution.
Antibiotics 'in case'
The risk of further attacks of
cellulitis/erysipelas in lymphoedema is high. It
is recommended that patients who have had
an attack of cellulitis/erysipelas carry a two
week supply of oral antibiotics, particularly
when away from home for any length of time,
eg on holiday. Patients should be advised to
Lymphatic massage
Lymphatic massage – manual lymphatic
drainage (MLD) and simple lymphatic
drainage (SLD) – aims to reduce swelling by
encouraging lymph flow.
The efficacy of MLD and SLD remains to be
proven, but there is no doubt that they are
of immense value in providing
psychological and symptomatic benefits.
MANUAL LYMPHATIC DRAINAGE
C MLD
and compression can reduce and
control lymphoedema of the head, neck
and body.
Manual lymphatic drainage (MLD) is a
gentle massage technique that is
recognised as a key component of
decongestive therapy. MLD aims to
encourage fluid away from congested
areas by increasing activity of normal
lymphatics and bypassing ineffective or
obliterated lymph vessels. Although there
is a wealth of clinical opinion advocating
the benefits of MLD, there are little
start antibiotics immediately when familiar
symptoms of cellulitis/erysipelas arise and to
seek a medical opinion as soon as possible.
Recurrent cellulitis/erysipelas
Antibiotic prophylaxis should be offered to
patients who have two or more attacks of
cellulitis/erysipelas per year (Table 4). After
two years of successful prophylaxis the
antibiotics can be discontinued. However, if
cellulitis/erysipelas recurs, lifelong antibiotic
prophylaxis is required.
The risk of recurrent cellulitis/erysipelas
can be reduced by controlling swelling, and by
treating interdigital scaling, fungal infections,
folliculitis, dermatitis, open wounds (including
leg ulcers) and weeping lymphangiectasia.
research data to conclusively support its
use 2,58-60 . The most appropriate
techniques, optimal frequency and
indications for MLD, as well as the benefits
of treatment, all remain to be clarified.
MLD remains a specialist skill that needs
regular practice in order to maintain
competence. Deep, heavy-handed
massage should be avoided because it may
damage tissues and exacerbate oedema by
increasing capillary filtration.
Indications
MLD may be indicated as part of intensive
therapy, transition management, long-term
management or palliative care (Box 19).
MLD on its own is not sufficient treatment
for lymphoedema; it should be combined
with compression therapy to support and
maintain its effects. However, where
compression is difficult or is not well
tolerated, eg in lymphoedema of the head,
neck, trunk, breast and genitalia, MLD may
be the only realistic option.
LYMPHATIC
MASSAGE
BOX 19 Indications for MLD
and SLD
■ Swelling at the root of a
limb
■ Trunk and midline oedema
(eg chest, breast, back,
abdomen, genitalia, head
and neck)
■ Provision of comfort and
pain relief when other
physical therapies are no
longer appropriate
■ Adjunctive treatment to
pain management
BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA 29