LYMPHEDEMA FIBROSIS

LYMPHEDEMA FIBROSIS

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Lymphedema and Fibrosis

Discussion

Long standing lymphedema causes a condition known as fibrosis. As the fluid continually collects in a limb, it becomes hard and dense. With each stage of lymphedema there is also a change in the tissue texture of a limb. Each stage of lymphedema presents additional difficulties and worsening of fibrosis, if treatment is not received.

Initially, there is no fibrosis associated with lymphedema. It is also important to remember that the size of a limb (arm lymphedema, leg lymphedema) is NOT an indication of how much fibrosis there is. I have seen very slightly swollen legs that were as hard as a rock because of late stage fibrosis.

With stage one the tissue is still much like normal tissue, its just satiated with fluid. As the swelling continues and as he fluid changes to that protein-rich fluid referred to a lymphorrea, you enter into stage two. In this stage, the tissue become very similar to a grape (best image I can think of). Already it is becoming much more difficult for antibiotics to reach bacteria and it becomes less responsive to the decongestive therapy.

At stage three, the tissue become similar to one of those old synthetic kitchen sponges, the ones that become rock hard when they are dry.

This is the very real serious side affect of stage three lymphedema. This type of tissue increases potential of persistent and very hard to treat cellulitis or lymphangitis.

The denseness of the limb prohibits antibiotics from reaching the infecting bacterium and it is often able to survive in pockets of fibrotic tissue. These pockets act as a septic foci and after antibiotic treatment is completed, the infections will reappear.

Generally at this stage it is going to take IV antibiotics to deal with any infection because oral antibiotics just are not able to penetrate this mass of hard tissue.

Also, as the fibrosis intensifies you become more susceptible to deep venous thrombosis (DVT) (and/or thrombophlebitis) and other circulatory problems. You may also start to experience neuropathy as the pressure of this tissue compresses nerves (see: peripheral neuropathy) within the limb.

Other Causes of Tissue Fibrosis

Tissue fibrosis can also be caused repeated infections, chemotherapy, radiation damage or burns to the skin, the long term use of a compression pump and other trauma.

Prevention of Fibrosis

Ideally, the goal would be to prevent the build up of fibrosis to begin with. This can only be achieved by early diagnoses of lymphedema, immediate treatment and by faithful compliance in self-care by the patient. Generally, this is not the case and lymphedema patients often go years before realizing an accurate diagnoses and even longer in receiving proper treatment.

Treatment of Fibrosis

The recognized gold standard of treatment is lymphatic massage physiotherapy. This is referred to generally as manual decongestive therapy, complex decongestive therapy or complete decongrestive therapy. The therapy is followed up by consistent daily skin care, compression bandaging, good dietary habits leading to weight control, it is also imperative that the lymphedema patient no allow themselves to become obese or especially morbidly obese and systematic exercises.

If fibrosis has set in, it can be reversed by a program of decongestive physiotherapy, and through the use of special garments (referred to as chips) used in conjunction with compression bandaging. A partial list of suppliers is included below.

These "chips" are underneath the compression banadage on top of the area of especially hardened (fibrotic) tissue. By doing so, this provides additional compression and a type of massage that helps breakdown the hardness.

You can get the chips in three ways. First, you can make them. This isn't the preferred method and can be cumbersome and somewhat tedious. There are two basic types of manufactured chips.

First, there are the sheets of textured chips, usually made of a type of foam rubber. These are easy to use as they can be trimmed and shapped for specific areas of need.

Secondly, are ready-made designed fabric chips.

The National Lymphedema Network has an excellent description of these chips, their use and purpose:

Creative foam applications are a mainstay in Phase 1 CDT. Foam applications such as chip pads or custom-cut, flat foam pieces will maximize the effect of the compression bandages by distributing consistent pressure over a greater surface area within the bandage structure. Compression needs to be continued in Phase 2 to maintain volume reduction(5) results. Adequate, consistent and sustainable compression for the trunk has, in the past, been difficult to achieve. Fortunately, there now exists a number of specialty garments and devices that adequately apply compression for chest/trunk edema and also contribute to independent patient self-management. Lymphedema-specific bras, custom foam-chip vests, and pre-made chip pads are available to assist with maintaining the positive results of CDT. The key to success is regular, consistent compression on the trunk/chest wall with regular self-manual lymphatic drainage and foam support when needed.(1)

There is a new treatment available that shows promise of helping to break down fibrotic tissue as well. This is the low level laser, specifically the LTU-904 laser manufactured by the RianCorp. They are included in the suppliers list below.

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Lymphedema is an accumulation of lymphatic fluid that causes swelling in the arms and legs. Edema occurs when venous and/or lymphatic vessels are impaired. When the impairment is so great that the lymph fluid exceeds the lymphatic transport capacity, an abnormal amount of protein fluid collects in the tissues of the extremity. Untreated, this stagnant, protein-rich fluid not only causes tissue channels to increase in size and number, but also reduces oxygen through the transport system, interferes with wound healing and provides a culture medium for bacteria that can result in various infections.

Extreme fibrosis can also lead to circulatory problems and can be responsible for blood clots in the affected limb.

The goal of decongestive therapy is preventing the lymphedema from reaching this stage. It also can reverse fibrosis even in early stage 3 lymphedema

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Late Term Complications - Fibrosis

Why it is so important to prevent, treat and control fibrosis?

1.) Fibrosis can eventually cause vascular problems. As the tissue in your LE limb continues to harden, it will effect blood flow and supply. This can lead to necrosis.

2.) With late term fibrosis, bacteria find many places to hide and be protected. The more extensive the fibrosis is, the harder it is for antibiotics to reach the bacteria. This leads to persistent cellulitus. Eventually this can cause gangrene and/or necrosis.

3.) Fibrosis will affect nerves. The result will be a substantial increase in pain and discomfort.

4.) Fibrosis along with continuous cellulitis and radiation has been implicated in lymphangiosarcoma.

If you have lymphedema, it must be your priority to seek treatment and control to prevent fibrosis.

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Fibrosis

The formation of fibrous tissue, which may be either normal or pathologic. Fibrosis occurs normally as part of the repair of damaged parenchymatous elements, or fibrous tissue may replace normal tissue in various disease states, such as cystic fibrosis, pulmonary fibrosis and endomyocardial fibrosis.

Fibrosis follows either acute or chronic inflammatory states. Chronic inflammation is characterized by persistent tissue destruction involving both parenchyma and stroma. The damage is so extensive that it cannot be repaired by parenchymal cells alone; as a consequence, fibrous connective tissue replaces some of the tissue lost. This fibrosis leads to formation of scar tissue.

http://www.amershamhealth.com/medcyclopaedia/Volume%20III%201/FIBROSIS.asp

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Microwave heating modulation of skin fibrosis in chronic extremity lymphedema

[Article in Chinese]

Cao W, Zhang D, Gan J.

Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai 200011, China.

OBJECTIVE: To observe the effects of microwave heating on skin fibrosis in chronic extremity lymphedema.

METHODS: Skin specimens from 8 cases of chronic limb lymphedema were tested by in situ hybridization (ISH) combined with avidin-biotin peroxidase (ABC) immunohistochemistry for detection of TGF-beta, procollagen I, procollagen III mRNAs and corresponding peptides expressions.

RESULTS: It was discovered that expressions of TGF-beta 1 peptide were located at the spinous and granular layer of the epidermal cells with a great amount of dermal collagen I, III formation in accordance with high expressions of TGF-beta, procollagen I, procollagen III mRNAs in the dermal and subcutaneous tissue fibroblasts. After microwave heating treatment, the epidermal expression of TGF-beta 1 and relative TGF-beta, procollagen I, procollagen III mRNAs expressions in dermal fibroblasts were greatly reduced. The smaller calibre of collagen fibers after microwave heating was also observed.

CONCLUSIONS: It is indicated that fibrosis in lymphedema is resulted from overexpressions of relevant genes like TGF-beta and subsequent extracellular matrixes (ECM) syntheses and deposition. Microwave heating can reduce fibroblast expressions of TGF-beta, procollagen I, procollagen III mRNAs as well as TGF-beta peptide synthesis, inhibiting ECM syntheses and deposition and finally reverse the skin fibrosis process.

PMID: 11301658 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11301658&dopt=Abstract

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External Links

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National Lymphedema Network (1)

http://www.lymphnet.org/home.htm

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Fibrosis - Definition with Related Words

http://www.thefreedictionary.com/fibrosis

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Fibrosis - Definition

http://www.hyperdictionary.com/dictionary/fibrosis

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Title: Tissue Fibrosis as a Factor Influencing Blood Flow and Oxygenation in Woman with Postmastectomy Lymphedema

Abstract

http://www.nova.edu/cwis/vpaa/facscholar/winners0304/tissue_fibrosis.html

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Fibrosis "Chips" Suppliers

Lymphedema Products - Norton School of Lymphatic Therapy / Store

*Manufactured rolled chip sheets*

http://www.lymphedemaproducts.com/products/foampadding.html

JoviPak - Lymphedema Products

*Manufactured "garment-style chips" that will cover specific areas*

Home Page: http://www.jovipak.com/index.shtml

See their products also at:

Bandages Plus

http://www.bandagesplus.com/catman.php?xMan=16

Academy of Lymphatic Studies Store

http://www.acols.com/Store.aspx

Tolesto/Medtec

http://www.telesto-medtech.com/

If you do not find a specific product fitting your needs, you may wish to contact this company also.

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*This is only a partial list. There are many other fine distributors and companies that sell lymphedema products, Inclusion in the list does not constitute either a recommendation or referral*

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LASER - LTU-904

RianCorp

*Please note this device has recently been cleared for use of post mastectomy lymphedema only* Additional studies are unway to verify or check it's possible use on other areas of lymphedema

http://www.riancorp.com/

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Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe:

AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

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For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

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Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

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All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet? Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more. Come and take a stroll!

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema

Arm Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema

Leg Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema

Acute Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema

The Lymphedema Diet

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet