LYMPHEDEMA FIBROSIS
---------------------------------------------
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.
-----------------------------------------
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
-----------------------------------------
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.
=============
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
-----------------------------------------
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
===========================
External
Links
-----------------------------------------
National
Lymphedema Network (1)
http://www.lymphnet.org/home.htm
-----------------------------------------
Fibrosis
- Definition with Related Words
http://www.thefreedictionary.com/fibrosis
-----------------------------------------
Fibrosis -
Definition
http://www.hyperdictionary.com/dictionary/fibrosis
-----------------------------------------
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
-----------------------------------------
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.
------------
*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*
-----------------------------------------
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/
===========================
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
===========================
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
===========================
Lymphedema People - Support
Groups
-----------------------------------------------
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
......................
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
......................
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
......................
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
......................
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
===========================
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
Exercises
for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema
Diuretics
are not for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema
Lymphedema
People Online Support
Groups
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups
Lipedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema
Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
Lymphedema
and Pain Management
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management
Manual
Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)
http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt
Infections
Associated with Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema
How
to Treat a Lymphedema Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
Fungal
Infections Associated with
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema
Lymphedema
in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
Lymphoscintigraphy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy
Magnetic
Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Extraperitoneal
para-aortic lymph node dissection (EPLND)
http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd
Axillary
node biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy
Sentinel
Node Biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy
Small
Needle Biopsy - Fine Needle Aspiration
http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy
Magnetic
Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Lymphedema
Gene FOXC2
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2
Lymphedema
Gene VEGFC
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc
Lymphedema
Gene SOX18
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18
Lymphedema
and Pregnancy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy
Home page:
Lymphedema People
http://www.lymphedemapeople.com
Page Updated: Dec. 15, 2011