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Complications of Lymphedema

When I first started Lymphedema People just 3 ½ years ago, there was basically a short list of complications associated with lymphedema. As time has continued and studies have bee completed and as there has been better follow up on lymphedema patients, the list of complications has expanded.

Furthermore, there has been more thorough documentation of the complications face by those of us with long term lymphedema. Usually, these complications are a result of our LE not being treated properly or infact treated at all.

List of Lymphedema Complications

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immunodeficient and the proein rich fluid provides an excellent nurturing invironment for bacteria. See our page Infections Associated with Lymphedema for further information on infections.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids. See Lymphedema and Pain Management.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections. See also Thrombophlebitis

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as dry skin, splitting, plaques and nodules, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

12. Pain ranging from mild in early lymphedema to severe in late stage lymphedema.

13. Lymphatic cancers which can include angiosarcoma, lymphoma; Kaposi's Sarcoma; lymphangiosarcoma (Stewart_treves Syndrome); Cutaneous T-Cell lymphoma; Cutaneous B-Cell lymphoma; Pseudolymphomatous Cutaneous Angiosarcoma.

See also: Primary Lymphedema and Cancer for a discussion and Lymphatic Cancers Secondary to Lymphedema.

Note: These cancers are rare and are usually associated with long term, untreated or improperly treated lymphedema. Typically occuring in stage three or four; quite rare in stage two.

14. Skin complications possible in stages 3 and 4 include papillomatosis; placques including “cobblestone” appearing placque; dermatofibroma; Skin Tags; Warts and Verrucas; Mycetoma skin fungus; dermatitis and many lymphedema patients report increased problems with psoriasis; eczema and shingles. I would suspect this may be due to again, the immunocompromised condition of the arm or leg afflicted with lymphedema.

15. Documented but rare complications in late stage also can include Lymphomatoid Papulosis; Cutis Marmorata; Acroangiodermatitis; Dermatolymphangioadenitis (DLA); Papillomatosis cutis carcinoides

16. Debilitating joint problems. This is caused by a combination of the excess fluid weight and the constant inflammatory process that accompanies lymphedema. As we have gotten older, many lymphedemapatients are having total knee replacement, total hip replacement, or total shoulder replacement while others are experiencing carpal tunnel syndrome and are having carpal tunnel surgery or experiencing shoulder problems associated with lymphedema and must haverotator cuff surgery

LONG TERM EFFECTS

There are numerous side effects and long term affects you may experience with lymphedema. Some of these include fatigue, weight gain, pain (sometimes to the extreme), depression, continued swelling of the limbs or abdomen. Some have experienced cardio cavity and pleural edema. Lymphedema can also cause fibrosis. This is where the limb becomes very hard and can become nonresponsive to available treatment options. With extensive fibrosis also comes heightened risks of blood clots in the affected areas.

Lymphedema also cause localized immunodeficiency problems. It also may be suspect in long term immunity problems, especially in very long term primary lymphedema patients. This may be a controversial statement, but I have known of primary lymphedema patients who's immune system seems to have collapsed from unknown reasons. In my personal situation, mine did just that with the result I acquired two different lymphomas. Hopefully, research will be done in this area.

Lymphangiosarcoma is another possible complication of lymphedema. While many LE'ers worry about contracting this, it is extremely rare. Risk factors are extreme fibrosis, radiation on fibrotic areas and continued infections.

Complications of Lymphedema

by Bruno Chikly, M.D

Complications of Lymphedema, by Bruno Chikly, M.D

Complications of Lymphedema

1) Infection/cellulitis 2) Cancer 3) Lymphorrhea, lympho-cutaneous fistula 4) Genital lymphedema 5) Complications due to bandaging

Always bear in mind that infection and cancer are the two major complications of lymphedema.

1) Infection/Cellulitis

A- terminology The secondary infection of lymphedema can be described using different terms: secondary acute inflammation (SAI), cellulitis (any inflammation of the loose subcutaneous tissue), lymphangitis (inflammation or infection of a lymphatic vessel), erysipelas (infection due to streptococcus), septicemia (infection in the blood system, with signs of fever, chills, etc.) and dermatolymphangioadenitis (DLA, inflammation of skin, lymphatic vessels and nodes - Olszewski W.L., JamalS, 1994).

These are infections usually caused by Staphylococcusaureus, penicillin-sensitive Streptococcus, or fungus. Lymphangitis is specifically an inflammation of a lymphatic vessel, usually seen clinically as red stripes running along an extremity.

B- Description The inflammatory process starts in the skin, most often in the web spaces between the toes, the hand, or the anal region, and proceeds along lymphatic vessels to regional lymph nodes. The origin of the infection is very often facilitated by a crack in the skin secondary to a fungal infection. (The skin of the foot is broken three times more often than that of the upper extremity in lymphedema.) Rupture of the skin can also take place with trauma, insect bites, needles of any kind, postoperative fluid extraction, post-radiation dermatitis, etc. Infection will generally increase the swelling and make the edema more difficult to treat and more likely to be irreversible.

That is why preventative care is really important to avoid fungus, (e.g. athlete 's foot), ingrown toenails, streptococcal or staphylococcal infections, etc.

C- rate of infection: Chronic inflammation is a condition experienced by many lymphedema patients. An estimated 25 to 40% of patients have clinical infection. In a study of 353 cases of Saskia Thiadens, (Thiadens S., 91), 31% of males and 33% of females with chronic lymphedema had had one or more episodes of infection, including 26% of primary lymphedema patients versus 36% suffering from secondary lymphedema.

Signs of secondary infection - The signs of infection can often be negligible and the therapist must be extremely vigilant for them. The physician may prescribe antibiotic therapy if he or she suspects it. Signs of SAI can also be unmistakable with high fever and chills; the patient may require a ten-day hospitalization with intravenous antibiotic therapy.

Clinical signs of infections: - Minor rash or red streaks may be visible. Any of the following may be present or not:: Itching, tenderness, dull aching in a limb, blotchy areas, small blisters, general malaise, etc. In septicemia fever, chills and nausea are common. The signs may include aggravation of the lymphedema condition: Increase in edema volume so that the medical compression feels too tight for reasons that are unclear. Lymph nodes may become enlarged, or pain may occur in lymph nodes. There may be an elevation of temperature of the extremity. Pain may appear or increase, with tender spots, heaviness, tightness, tiredness, etc. Fistulae (lymphorrhea) may also occur; the reason for this is not known.

Chronic secondary infections are more difficult to assess, with slight elevation in skin temperature, increased sensitivity, slight itching or redness. Sometimes the redness (erythema) is not present if the infection is situated deep in the tissue. This condition may be pain-free in a patient whose affected limb is numb. Some episodes of infection are milder and resolve in a few days without antibiotic treatment. Fungusor staphylococcus may be the agents causing these kinds of infections. D- Prevention of Secondary Infection: - Decongestion of the edema - Extremely careful skin care - Prophylactic antibiotic therapy may be suggested by the physician in cases of recurrent SAI. Allergic inquiry / test is recommended first.

E- Treatment: The therapist should be able to work with a medical team. It is imperative to check with a physician if there is any suspicion of secondary infection, and scrupulously treat any infection. Hands-on lymphatic drainage and medical compression (bandages, garments) should be interrupted until the condition is under control (at least 48 to 72 hours, up to 8 days). The signs of infections (edema, erythema, warmth, aching, etc.) should have clearly disappeared. Antibiotic therapy: Bacterial infection calls for immediate antibiotic therapy. The sensitivity of the bacteria to antibiotics (regular penicillin G) is generally good.

Suggested treatment (Olszewski W.L.): first episode: 3 months of antibiotic therapy. If there are more than two episodes, one year's antibiotic therapy may be indicated. Check for the few adverse effects of prolonged antibiotic therapy: change in intestinal flora, gastro-intestinal disorders, damage to liver, kidneys and bones, allergic reactions, etc. Where the patient is allergic to penicillin, erythromycin usually works well. After one episode of infection, it may be wise for lymphedema patients to carry a supply of antibiotics or a prescription with them, especially when traveling away from home.

Published with permission from the author of Silent Waves Theory And Practice Of Lymph Drainage Therapy (Ldt) With Applications For Lymphedema, Chronic Pain And Inflammation Author: Bruno Chikly, M.D.2000 Publisher: I.H.H. Publishing, Arizona. Isbn Hard Cover = 0-9700530-5-3 Part 3, Chapter 9, page 209-210

About The Author

Bruno Chikly, M.D., is a graduate of the medical school at Saint Antoine Hospital in France, where his internship in general medicine included training in endocrinology, surgery, neurology and psychiatry.

Dr.Chikly also earned the French equivalent of a Master 's degree in psychology. His doctoral thesis addressing the lymphatic system, its historical evolution and the manual lymphatic drainage technique was awarded a Medal of the Medical Faculty of Paris, VI, a prestigious acknowledgment for in-depth work and scientific presentation.

He extensively studied osteopathic techniques and other hands-on modalities both in Europe and in the USA, including Manual Lymphatic Therapies, Cranio-sacral Therapy, Visceral Manipulation, Mechanical Link, Muscle Energy, Strain/Counter Strain, Myofascia Release, Neuromuscular Therapy, Somato Emotional Release.

Lymph Drainage Therapy workshops are taught in collaboration with Upledger Institute (USA) in Brazil, Canada, and the United States, Germany, Israel, Tunisia, China, Singapore. He is member of the International Society of Lymphology (I.S.L.), Associate Member of The American Academy of Osteopathy (A.A.O.).

He is also on the Advisory Board of the Massage and Bodywork Journal (Churchill Livingstone) and listed in the Millennium edition of the Marquis Who 's Who in the World. He is an international seminar leader, writer and lecturer. He has spoken to numerous North American medical and health related groups, and many lymphedema support groups. He lives in Arizona with is wife and partner Alaya *link no longer available*

External Links

Lymphedema complicated by pain and psychological distress: a case with complex treatment needs.

A Guide to Lymphedema: Complications of Lymphedema

Risk factors for short- and long-term complications after groin surgery in vulvar cancer. Oct 2011

Angiosarcoma in an obese woman with worsening lymphedema after weight-loss and skin-reduction surgeries. Aug 2011

Prevention of complications after surgery in patients with upper limbs'lymphedema 2011

De Quervain's tenosynovitis in patients with lymphedema: a report of 2 cases with management approach.

Malignant tumors as complications of lymphedema

Complications of Lymphedema

Lymphedema complicated by pain and psychological distress: a case with complex treatment needs.

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complications_of_lymphedema.txt · Last modified: 2012/11/25 08:31 by Pat O'Connor