Despite the increased number of strategies studied for individuals with Lymphedema, Combined Decongestive Therapy (CDT) for lymphedema still remains the gold standard for lymphedema management. While Manual Lymphatic Drainage and Compression have been the most commonly thought of in this five-step approach, there has not yet been a pharmacological, surgical treatment that surpasses it.
CDT remains the gold standard of care and is an ongoing process supported by a Certified Combined Decongestive Therapist or Physiotherapist. And this approach is highly effective at reducing the symptoms of lymphedema when the CDT physio and the patient work together to incorporate the components of CDT into one’s lifestyle.
There have been surgical initiatives from researchers of the lymphatic system around the world to create a lymphatic venous anastomosis (LVA) or a lymphaticovenular anastomosis to reconnect pathways to direct fluid into the venous system due to the missing or damaged lymph nodes and lymph vessels from the required cancer surgical treatment. In some cases, other reasons for surgery or multiple surgeries have now affected the fluid flow through the lymph system. Another surgery out in the medical realm is lymph node transfer (LNT), which is aimed at removing and transplanting lymph nodes from another site on the patient.
The other surgical offer is what is called a specialized lymphatics-sparing procedure, which uses a special technique of liposuction. This surgery is considered a last resort option for very bulky limbs that may sustain multiple life-threatening infections or impair function, and it is used when the gold standard option of treatment (CDT) has been exhausted and the patient is experiencing functional limitations and quality of life infringements. This procedure is aimed at debulking the limb and limb volume to assist the patient to then return to CDT gold standard therapy with more success to maintain the debulking of their very large limb from the debulking procedure.
Any way you cut it, Combined Decongestive Therapy’s five components cannot be avoided. This must be considered pre-surgery and is also a must post-surgery. Any one component of CDT like Manual Lymphatic Drainage and/or Compression is not a stand-alone. There is more to be examined with high-quality studies of outcomes for those patients that have undergone these different surgical undertakings.
At East Gwillimbury Physiotherapy located in Newmarket, Ontario, we are passionate about helping you on your cancer rehabilitation journey, including Combined Decongestive Therapy and other rehabilitation strategies to meet your needs and goals post-cancer treatment.
