causes a condition known as fibrosis. As the fluid
continually collects in a limb, it becomes hard and dense. With each
lymphedema there is also a change in the tissue texture of a limb. Each
of lymphedema presents additional difficulties and worsening of
treatment is not received.
there is no fibrosis associated with lymphedema. It is also important
remember that the size of a limb (arm lymphedema, leg lymphedema) is
indication of how much fibrosis there is. I have seen very
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
you enter into stage two. In this
stage, the tissue become very similar to a grape (best image I can
Already it is becoming much more difficult for
antibiotics to reach
it becomes less responsive to the decongestive therapy.
At stage three, the tissue become similar to one of those old synthetic
sponges, the ones that become rock hard when they are dry.
This is the very real serious side affect of stage three lymphedema.
of tissue increases potential of persistent and very hard to treat
The denseness of the limb prohibits antibiotics from reaching the
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
because oral antibiotics just are not able to penetrate this mass of
Also, as the fibrosis intensifies you become more susceptible to
thrombosis (DVT) (and/or thrombophlebitis)
and other circulatory problems. You may also start to
experience neuropathy as the pressure of this tissue compresses nerves
Causes of Tissue Fibrosis
fibrosis can also be caused repeated infections, chemotherapy,
or burns to the skin, the long term use of a compression pump and other
the goal would be to
prevent the build up of fibrosis to begin with. This can only
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
diagnoses and even longer in receiving proper treatment.
recognized gold standard of treatment is lymphatic massage
This is referred to generally as manual
decongestive therapy, complex decongestive therapy or
therapy. The therapy is followed up by consistent daily skin
bandaging, good dietary
habits leading to weight control, it is also imperative that
patient no allow themselves to become obese
or especially morbidly obese and systematic exercises.
fibrosis has set in, it can be reversed by a program of decongestive
physiotherapy, and through the use of special garments (referred to as
used in conjunction with compression bandaging. A partial list of
"chips" are underneath the compression banadage on top of the area of
especially hardened (fibrotic) tissue. By doing so, this
additional compression and a type of massage that helps breakdown the
can get the chips in three ways. First, you can make
isn't the preferred method and can be cumbersome and somewhat
There are two basic types of manufactured chips.
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
specific areas of need.
are ready-made designed fabric chips.
Network has an excellent description of these
chips, their use and
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
bandages by distributing consistent pressure over a greater surface
the bandage structure. Compression needs to be continued in Phase 2 to
volume reduction(5) results. Adequate, consistent and sustainable
for the trunk has, in the past, been difficult to achieve. Fortunately,
now exists a number of specialty garments and devices that adequately
compression for chest/trunk edema and also contribute to independent
self-management. Lymphedema-specific bras, custom foam-chip vests, and
chip pads are available to assist with maintaining the positive results
The key to success is regular, consistent compression on the
with regular self-manual lymphatic drainage and foam support when
is a new treatment
available that shows promise of helping to break down fibrotic tissue
well. This is the low level laser, specifically the LTU-904
manufactured by the RianCorp. They are included in the
Lymphedema is an accumulation of lymphatic fluid that causes swelling
arms and legs. Edema occurs when venous and/or lymphatic vessels are
When the impairment is so great that the lymph fluid exceeds the
transport capacity, an abnormal amount of protein fluid
collects in the tissues
of the extremity. Untreated, this stagnant, protein-rich fluid not only
tissue channels to increase in size and number, but also reduces oxygen
the transport system, interferes with wound healing and provides a
medium for bacteria that can result in various infections.
Extreme fibrosis can also lead to circulatory problems and can be
for blood clots in the affected limb.
The goal of decongestive therapy is preventing the lymphedema from
stage. It also can reverse fibrosis even in early stage 3 lymphedema
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
limb continues to harden, it will effect blood flow and supply. This
can lead to
2.) With late term fibrosis, bacteria find many places to hide and be
The more extensive the fibrosis is, the harder it is for antibiotics to
the bacteria. This leads to persistent cellulitus. Eventually this can
gangrene and/or necrosis.
3.) Fibrosis will affect nerves. The result will be a substantial
pain and discomfort.
4.) Fibrosis along with continuous cellulitis and radiation has been
If you have lymphedema, it must be your priority to seek treatment and
to prevent 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 and endomyocardial
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.
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
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
immunohistochemistry for detection of TGF-beta, procollagen
procollagen III mRNAs and corresponding peptides expressions.
RESULTS: It was
discovered that expressions of TGF-beta 1 peptide were located at the
and granular layer of the epidermal cells with a great amount of dermal
I, III formation in accordance with high expressions of TGF-beta,
procollagen III mRNAs in the dermal and subcutaneous tissue
microwave heating treatment, the epidermal expression of TGF-beta 1 and
TGF-beta, procollagen I, procollagen III mRNAs expressions in dermal
were greatly reduced. The smaller calibre of collagen fibers after
heating was also observed.
CONCLUSIONS: It is
indicated that fibrosis in
lymphedema is resulted from overexpressions of relevant genes like
subsequent extracellular matrixes (ECM) syntheses and deposition.
heating can reduce fibroblast expressions of TGF-beta, procollagen I,
procollagen III mRNAs as well as TGF-beta peptide synthesis, inhibiting
syntheses and deposition and finally reverse the skin fibrosis process.
PMID: 11301658 [PubMed - indexed for MEDLINE]
Lymphedema Network (1)
- Definition with Related Words
Tissue Fibrosis as a Factor Influencing Blood Flow and Oxygenation in
Woman with Postmastectomy Lymphedema
Products - Norton School of Lymphatic Therapy / Store
rolled chip sheets*
- Lymphedema Products
chips" that will cover specific areas*
their products also at:
of Lymphatic Studies Store
do not find a specific product
fitting your needs, you may wish to contact this company also.
is only a partial list. There are many other fine distributors and
that sell lymphedema products, Inclusion in the list does not
either a recommendation or referral*
LASER - LTU-904
*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
us as we work for lymphedema patients everywehere:
Dedicated to be an advocacy
group for lymphedema patients.
Working towards education, legal reform, changing insurance practices,
research, reaching for a cure.
People / Advocates for
For information about
For Information about
For Lymphedema Personal
For information about How
to Treat a Lymphedema Wound
For information about
For information about
Exercises for Lymphedema
For information on Infections
Associated with Lymphedema
information on Lymphedema in
Lymphedema People - Support
The time has come for families, parents, caregivers to have a support
their own. Support group for parents, families and caregivers of
lymphedema. Sharing information on coping, diagnosis, treatment and
Sponsored by Lymphedema People.
No matter how you spell it, this is another very little understood and
frustrating conditions out there. This will be a support group for
suffering with lipedema/lipodema. A place for information, sharing
exploring treatment options and coping.
Come join, be a part of the family!
you are a man with lymphedema; a
man with a loved one with lymphedema who you are trying to help and
come join us and discover what it is to be the master instead of the
Support group for parents, patients, children who suffer from all forms
lymphangiectasia. This condition is caused by dilation of the
lymphatics. It can
affect the intestinal tract, lungs and other critical body areas.
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is
there for other lymphatic disorders. Because we have one of the most
comprehensive information sites on all lymphatic disorders, I thought
it is time that one be offered.
Information and support for rare and unusual disorders affecting the
system. Includes lymphangiomas, lymphatic malformations,
hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of
available through sister site Lymphedema People.
People New Wiki Pages
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
working on hundred more. Come
take a stroll!
are not for Lymphedema
People Online Support
and Pain Management
Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)
Associated with Lymphedema
to Treat a Lymphedema Wound
Infections Associated with
para-aortic lymph node dissection (EPLND)
Needle Biopsy - Fine Needle Aspiration
Page Updated: Dec. 15, 2011