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Joachim Zuther, Lymphedema Specialist. Read more
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Complications of Lymphedema

 

Lymphedema is caused by a blockage or dysfunction of the lymphatic system, causing a disruption of the normal flow of lymph fluid, which may result in swelling affecting various parts of the body. Lymphedema most commonly presents in soft tissues of arms and legs; however, it may also affect the trunk, abdomen, head and neck, exterior genitalia and inner organs.

Individuals affected by lymphedema may encounter a number of problems, which can be either attributed to other pathologies (comorbidities) that may be present in addition to existing lymphedema and further exacerbate its symptoms, or secondary complications which may develop as a result of stagnated lymphatic fluid. Secondary complications are common to lymphedema, especially if the swelling is left untreated, and often contribute to the progression of this common and serious disorder.

Comorbidities that may aggravate existing lymphedema
The presence of certain comorbidities may worsen or aggravate the symptoms associated with lymphedema, or may present an added obstacle in the treatment for lymphedema. Additional fluid retention associated with cardiac or venous insufficiencies frequently cause an increase in swelling, especially in lymphedema affecting the lower extremities. Certain orthopedic comorbidities limiting the mobility of joints, or affecting musculoskeletal activity may negatively impact the decongestive exercise regimen, which is an imperative part in the treatment and management of lymphedema. To successfully treat lymphedema, it is necessary to address the symptoms associated with comorbidities and to incorporate appropriate modifications to the treatment protocol.

Complications resulting from bacterial or fungal infections
The lymphatic system plays an important role in the body’s immune defense; any disruption in lymph flow may result in reduced immune surveillance. Lymphedema is defined as a high-protein swelling; the accumulation of water and protein molecules creates an ideal breeding environment for pathogens in the affected tissues. This often results in a high susceptibility to infections in lymphedemateous tissues.

Cellulitis, an acute infection of the skin and subcutis, is a common complication associated with lymphedema. Cellulitis is characterized by fever, diffuse redness, tenderness, pain and edema, and is treated with antibiotics. Lymphedema patients suffering from recurring episodes of cellulitis may be placed on prophylactic antibacterial therapy and be required to use antibiotics as a preventative.

Fungal infections are also common in lymphedema and most often affect the skin and nails in lower extremities. In order to avoid spreading, treatment of any fungal infection precedes lymphedema therapy.

Complications on the skin
When lymphedema remains untreated, protein continues to accumulate and contributes to a progressive hardening of the soft tissues, known as lymphostatic fibrosis. This hardening is caused by a proliferation of connective tissue cells and can be compared to scar tissue. This hardening of the soft tissue can be successfully reversed with appropriate lymphedema treatment.
Other skin complications include lymphatic cysts, blister-like formations on the surface of the skin, which develop due to lymphatic blockage. Lymphatic cysts contain lymph fluid and can easily break open, thus presenting an entryway for pathogens. It is recommended to cover lymphatic cysts with sterile gauze to avoid damage and possible secondary infections.

Lymphedema and the risk of malignancies
Angiosarcoma is a rare form of a malignant tumor that may develop as a result of long-standing lymphedema. It may involve the upper or lower extremities and has a tendency to metastasize quickly. Angiosarcoma initially appears as a bruise-like discoloration on the surface of the skin, progressing into ulcerations and tissue necrosis involving the skin and surrounding soft tissues.

Psycho-social implications
Lymphedema is disfiguring and often painful and disabling. It can negatively impact the emotional, vocational, recreational and financial aspects of the patient’s life.  Most individuals affected by lymphedema are able to continue a normal life; however, some patients experience depression, anxiety, and impairments related to their intimate, work, and social relationships.
While lymphedema may be caused by developmental abnormalities of the lymphatic system (primary lymphedema), the highest incidence of lymphedema in the United States is observed following cancer surgery including the removal and/or radiation of lymph nodes (secondary lymphedema). The fact of being diagnosed with cancer and the often sterile and impersonal nature of cancer care can be devastating and exact an additional toll on the patient’s emotional well-being.

Group and individual counseling by the lymphedema therapist or physician can be helpful to patients coping with lymphedema. Counseling should include specific information about preventive measures, the role of diet and exercise, advice for selecting comfortable and concealing clothing, and emotional support.

Risk reduction
Lymphedema caused by surgery and/or radiation may occur directly after or months, even years following the procedure. Certain activities and situations may trigger the onset of lymphedema, exacerbate the symptoms of existing lymphedema, or cause infections in the affected tissues. Caregivers, to include physicians, lymphedema therapists and nurses play a crucial role in the prevention of complications associated with lymphedema by educating the patient about signs and symptoms of acute inflammatory episodes and risk reduction guidelines.

Additional Resources:
Mayo Clinic – Complications of Lymphedema
U.S. National Library of Medicine: Incidence and Complications of Lymphedema
The Psycho-Social Impact of Lymphedema: S. Ridner, Ph.D.
Breastcancer.org: How to avoid Lymphedema
E-Medicine: Treatment of Lymphedema
National Cancer Institute: Treatment of Lymphedema
National Lymphedema Network: What is Lymphedema
National Lymphedema Network: Treatment of Lymphedema

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7 comments to Complications of Lymphedema

  • OMD

    Very interesting. What is your view on acupuncture and its use in regulating the lymphatic system.

    There is much evidence showing the association of acupuncture being effective due to neurological and immunological impacts.

    When dealing with immunology one can not ignore the importance the lymphatic system plays. I feel that acupuncture (if used early) can help in drainage and stability of the lymphatic system?

    Your thoughts on this matter are much appreciated.

    Thank You

  • Martha J. Davis

    I am a 38 year double breast cancer survivor – 91 years old. I have had lymphedema in both arms for many years, and your articles have helped me. I drain both arms every morning, stroking gently down the lymph system as my therapist taught me. I get cellulitis with any sickness or weakness of the my body, when it gets real bad my doctor has put me on Azythromax. I drink lots of gatorade -G2,& water and electrolyte immune pops that I keep in the freezer.. When I have to have blood taken for any medical tests, I have had problems with any blood bank because the only place they can take blood is from my right foot, I have FINALLY found a phlebotomist who has come to our hospital and she did it just as you had explained in one of your articles- lower foot, warm compress, tournequet, butterfly needle – it is no problem..when I have to have an operation they put the IV in the right side of my neck, and B/P on right ankle.
    Martha J. Davis – Plymouth, Ma. davis.martha@gmail.com

  • Wonderful article! May I print and mail this article to physicians in my area to educate them about lymphedema? Thank you.

  • Laura Anderson

    Do you see patients? If so, how can I contact your office? Do you plan on speaking in the NYC area?

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