Nonsurgical management of the lymphedema patient

Management of all patients with lymphedema begins with nonsurgical management. Lymphedema physical therapy using complete decongestive therapy (CDT) is the mainstay of lymphedema management and consists of two phases: the reduction phase and the maintenance phase. The reduction phase involves either the use of low-stretch bandages or a specialized reduction garment, complemented by manual lymphatic drainage (MLD), to achieve an intensive volume decrease, with adjunctive exercises and skin care. This is followed by a maintenance phase to retain the reduction achieved, which consists primarily of compression garment use with adjunctive use of MLD or a sequential gradient pump. Optimized conservative therapy reduces the rate of disease progression and the risk of cellulitis by reducing the lymphatic fluid stasis and thereby lowering the inflammation. Patients are encouraged to maintain a normal body mass index, exercise, and engage in all activities that do not provoke swelling. Although CDT is an important component of the postoperative management of patients that have undergone surgery for lymphedema, there is increasing emphasis on its role as part of a prehabilitation process to optimize patients before surgery. In this chapter, we describe the techniques and approach for the nonsurgical management of lymphedema.