ArticlePDF Available

Manual lymphatic drainage: Exploring the history and evidence base

Authors:

Abstract and Figures

Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but there is limited evidence to guide clinical practice. This paper outlines the historical background to MLD and provides insights into the evidence relating to the effect and efficacy of manual lymph drainage, highlighting considerations for lymphoedema practitioners.
Content may be subject to copyright.
CLINICAL FOCUS
S18 Chronic Oedema, April 2010
Over 100 years ago, Winiwarter, a German
surgeon, described the use of massage to
‘promote resorption’ of fluid from swollen
tissues in people with lymphoedema (Winiwarter, 1892:
397). In the present day, manual lymph drainage (MLD),
a type of massage, has become established as an integral
part of lymphoedema treatment. However, the limited
empirical evidence base and lack of consensus on the
use and efficacy of MLD (Devoogdt et al, 2009) means
there is a lack of clarity regarding the application of MLD
for people with lymphoedema. Some lymphoedema
practitioners may have limited knowledge of MLD.
Those who have learned the techniques may have limited
resources or support to continue using them. The current
drive towards cost effectiveness also means that bodywork
treatments such as MLD may be given low priority in the
planning and resourcing of services.
This paper will provide a brief history and outline the
main features and principles of MLD. It will discuss the
evidence around the mechanisms through which MLD
may exert its effect, and then overview the findings from
studies that have examined the clinical and therapeutic
efficacy of MLD. Finally, it will discuss some implications
for clinical practice in lymphoedema treatment and care.
History
In the 1930s, his ill health forced Emil Vodder to abandon
medical studies and move from Denmark to the French
Riviera. Inspired by a deep interest in anatomy and
bodywork, and a fascination with the lymphatic system, he
intuitively developed a form of massage. Vodder presented
his method of manual lymph drainage at a conference in
Paris (Vodder, 1936), returning to Copenhagen before
the outbreak of World War 2 (Wittlinger, 2004). It was
nearly 30 years later that his lectures drew interest from
doctors and others who greatly admired his work and
recognized that this type of manual massage could benefit
people with lymphoedema (Asdonk, 1966; Fischer,
1967). In 1965, Vodder made a presentation in which he
described his conviction that MLD, along with breathing
and relaxation exercises and improved diet, would play
a key role in lymphatic disorders (Vodder, 1965). His
conviction holds true today.
While Winiwarter had described massage methods
such as ‘petrissage’, ‘efflurage’ and ‘friction’ (Winiwarter,
1892), Vodder’s technique was characterized by gentle,
pumping, circular movements using pressures of around
30mmHg, combined with a ‘zero’ or resting phase.
The aim was to enhance drainage of lymph from the
interstitial tissues without producing increased capillary
filtration (Wittlinger and Wittlinger, 1992). Until his
death in 1984, Vodder worked with many colleagues
from different countries. This collaborative work led to
the development of the conservative physical therapy
approach to lymphoedema management, combining
MLD with compression bandaging, skin care and exercise
(Földi et al, 1985). Inevitably, these techniques have
now developed in various directions, owing to specific
expertise and research. While different schools of MLD
have been established (Table 1), the underlying features
and principles of the MLD technique remain similar
across the different methods (Table 2). Importantly, each
MLD school insists on robust training and updating
methods to ensure practitioners are fully skilled, and use
their hands wisely, in order to achieve a good outcome
for people with lymphoedema and other conditions.
Evidence base
How does MLD exert its effect?
Although one of the first studies of MLD took place
40 years ago (Börcsok et al, 1971), the mechanisms through
which MLD has its effect are not fully established. In part,
this is owing to problems in differentiating the effect of
MLD from those of other interventions such as compression
therapy. Additionally, there are challenges in establishing
valid and reliable means of measuring the changes that
take place in the lymphatic and other systems, as a result of
MLD. Techniques to measure lymph flow can be complex
(Olszewski and Bryla, 1994) and many focus on the uptake
of radio-labelled proteins at lymph nodes (Mortimer et al,
1990; Szuba et al, 2002, Kafejian-Haddad et al, 2006). As
Manual lymphatic drainage: exploring
the history and evidence base
Anne Williams
Anne Williams is PhD Student, Edinburgh Napier University Email: A.Williams@napier.ac.uk
ABSTRACT
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment
but there is limited evidence to guide clinical practice. This paper outlines
the historical background to MLD and provides insights into the evidence
relating to the effect and efficacy of manual lymph drainage, highlighting
considerations for lymphoedema practitioners
KEY WORDS
w Manual lymph drainage (MLD) w Lymphoedema w Evidence for
MLD w Therapeutic effect of MLD
CLINICAL FOCUSCLINICAL FOCUS
Chronic Oedema, April 2010 S19
CLINICAL FOCUS
such, lymphoscintigraphy has been used in several studies,
for example to measure the rate of flow into lymph nodes
(Szuba et al, 2002) or visualize and describe changes in lymph
drainage patterns (Ferrandez et al, 1996). While this provides
some insights, the studies do not provide information on the
long-term effects of MLD on the anatomical, physiological
or functional aspects of the lymphatic system and other
tissues. Measurement of nodal uptake is also impractical
following lymph node dissection.
Table 3 summarizes reported effects of MLD and
highlights some interesting features. For example, Leduc
et al used lymphoscintingraphy to suggest that proximal
use of the ‘call-up’ technique influenced lymph flow in
distal lymphatics (Leduc et al, 1988). Evidence suggests
that MLD enhances movement of fluid into initial
lymphatics, and influences the contraction rates of pre-
collector and collector lymph vessels, moving lymph
towards deeper drainage trunks. MLD also appears to
influence lymph flow between lymph territories and has
also been surmised to lead to proliferation of collateral
lymphatics (Casley Smith and Casley Smith, 1997). Some
important considerations arise from the findings of
various studies and warrant further research. For example,
it is known that inflammatory mediators, present in
interstitial tissue as a result of lymph stasis, will influence
smooth muscle and alter lymph pumping mechanisms
(von der Weid and Zawieja, 2004). This might suggest
that MLD could have a role in reversing these processes
at an early stage in the development of lymphoedema,
reducing local inflammation and oedema, and restoring
the function of lymphatic vessels even before a clinically
obvious or chronic oedema has developed.
It appears likely that MLD has local and systemic
effects, for example influencing the autonomic nervous
system (Hutzschreuter and Ehlers, 1986) and producing
significant changes in the secretion levels of serotonin,
histamine, adrenaline and noradrenaline (Kurz et al,
1978). However, the significance of these findings in
terms of using MLD for people with lymphoedema,
have not been established. Some studies have reported a
reduction in limb volume after MLD that did not appear
to correlate with a measurable change or improvement
in lymph flow (Francois et al, 1989; Kafejian-Haddad et
al, 2006), suggesting that changes in other aspects such as
blood flow may be significant. The potential for lymph to
return to the blood circulation at regional lymph nodes
(Levick and McHale, 2003), reflects the importance
of lymph node clearance, an important feature of the
MLD sequence. Additionally, the ways in which MLD
may reduce skeletal muscle spasm, and improve lymph
drainage, through its influence on connective tissue layers,
requires further consideration.
Clinical therapeutic effects of MLD in
lymphoedema
Some of the early work into the therapeutic effects of
MLD was published in German and therefore not easily
accessible to an English-speaking audience. Additionally,
much of the work around MLD has been descriptive, or
has evaluated the effects of combined treatments, without
distinguishing the specific effects of MLD. The majority
of studies have been undertaken with women who have
breast cancer-related lymphoedema. Studies also tend
Vodder (Wittlinger and This method uses different hand movements on
Wittlinger, 1992) the skin called ‘pump’, ‘scoop’, ‘rotary’,
‘stationery circle’ and ‘thumb circle’, depending
on what area of the body is being treated (
Figure
1, 2
). It includes oedema movements at areas of
fibrosis
Földi (Földi and This method is based on Vodder strokes as above
Strößenreuther, 2003) with emphasis on a ‘thrust’ and ‘relaxation’ phase.
It includes edema strokes such as the ‘encircling
stroke’
Casley-Smith (Casley- This method uses a slow and gentle ‘efflurage’,
Smith and Casley-Smith, with specific movements using the side of the
1997) hand, over the ‘watershed’ areas between
lymphotomes (skin lymph territories) (
Figure 3
)
Leduc (Leduc et al, This method uses specific techniques: ‘call up’ (or
1991) ’inciting’) and ‘reabsorption’ movements; this
reflects how lymph is absorbed into initial
lymphatics, then moves through larger pre-
collector and collector lymphatics
Table 1. Some features of different methods of MLD
Hand movements are used to stretch the skin in specific directions and
promote variations in interstitial pressures, usually without the use of oils
Movements are slow, repetitive and soporific, and usually incorporate a
brief ‘resting’ phase, where the skin is allowed to return to its normal
position
Pressures vary according to underlying tissues but aim to promote lymph
drainage without increasing capillary filtration and hyperaemia
Deeper or firmer movements may be incorporated when treating areas of
fibrosclerosis, with compression therapy usually applied afterwards
The MLD sequence starts proximally and centrally, often with treatment to
the neck (
Figure 4
)
Functional and healthy regional lymph nodes are treated, for example the
contralateral (opposite side) axilla and ipsilateral (same side) inguinal
nodes (
Figure 5
) in an upper limb lymphoedema, or both axillae in a lower
limb lymphoedema
Proximal areas such as contralateral and non-oedematous lymph territories
or lymphotomes are treated, including the midline or ‘watershed area’
between two skin lymph territories
The ipsilateral trunk and lymphoedematous limb are treated, starting
proximally, often with particular attention given to the root of the limb
Early in the treatment, emphasis may be on treating the anterior and
posterior trunk prior to treating the swollen limb.
Breathing techniques are commonly used with MLD, often combined with
controlled hand pressures by the therapist, to influence drainage in the
deep abdominal lymphatic vessels and nodes
Limb mobilization and relaxation techniques may be incorporated into the
MLD treatment session
Table 2. Features and principles of MLD
CLINICAL FOCUS
S20 Chronic Oedema, April 2010
to focus on changes in limb volume, using varied or
poorly defined ways to measure or calculate limb volume,
negating any opportunity for comparison or meta-
analysis. Other outcome measures such as tonometry to
assess changes in skin and tissues (Harris and Piller, 2003),
or measures of symptom changes or quality of life, also
require further validation as a means to evaluate MLD.
Table 4 highlights a sample of studies that have a particular
focus on MLD in breast cancer-related lymphoedema.
Most draw on small samples and some are not randomized
or controlled. Several studies suggest that in some patient
groups, MLD combined with compression bandaging may
be more effective than using compression bandaging alone
(Johansson et al, 1999; McNeeley et al, 2004). However,
specific details of how MLD was used or the effect
measured are often not made clear (Andersen et al, 2000).
Two studies from the UK investigated MLD and
patient-administered massage (Sitzia et al, 2002; Williams
et al, 2002). Williams et al (2002) undertook a randomized
controlled cross-over study and showed that MLD had
a significant effect in reducing excess limb volume
in women with breast cancer-related lymphoedema
(p=0.013) even without compression bandaging. Similar
results with a trend towards MLD being more effective
were reported by Sitzia et al (2002) although the authors
suggested a larger study sample was required.
Implications for practice
Asdonk, a German GP who was one of the first to use
MLD extensively in his practice, highlighted the broad
Stretching effect on lymph collectors and local smooth muscle, increased the frequency of contraction of lymphangions/
lymph vessels and increased lymphatic transport capacity (Hutzschenreuter and Brümmer, 1988; Hutzschenreuter and
Herpertz, 1993)
Lymph flow increased (as measured by lymphoscintigraphy) possibly owing to increased rate of contraction of
lymphatics (Francois et al, 1989)
Variations in interstitial pressures led to enhanced filling and emptying of initial lymphatics (Casley-Smith and Björlin,
1985)
‘Call-up’ technique propelled lymph in the collecting lymphatics and exerted a suction effect on distal lymphatics; the
‘reabsorption’ technique moved proteins from a subcutaneous tissue injection site (Leduc, 1988)
Proximal MLD treatments produced a reduction in distal tissue pressure (Deryden et al, 1994)
‘Accessory routes’ within the lymph drainage system appeared to be ‘stimulated’ (Ferrandez et al, 1996)
Reduction in limb volume occurred, but was not consistent with increased lymph transport as measured by
lymphoscintigraphy (Kafejian-Haddad et al, 2006)
Blood flow increased in superficial blood circulation and peripheral arteries (Hutzschenreuter et al, 1989)
Blood flow increased through the femoral vein (Deryden et al, 1994)
The influence of MLD on the autonomic nervous system produced a calming effect (Hutzschenreuter and Ehlers, 1988)
Skin circulation improved (Hutzschenreuter et al, 1992)
Urinary secretion of serotonin, histamine, adrenaline and noradrenaline increased (Kurz et al,1978)
Breathlessness decreased and sleep improved (Williams et al, 2002)
• Microlymphatic hypertension reduced (Franzeck et al, 1997), although this appeared to be a combined effect of MLD and
compression bandaging
Table 3. Evidence summary: reported effects of MLD
Figure 1: MLD across the back using rotary technique: Vodder
method
Figure 2: Thumb circles to the dorsum of the hand: Vodder
method
Chronic Oedema, April 2010 S21
CLINICAL FOCUS
Authors Design Findings and comments
Johansson et al (1999) Non-randomized consecutive Data on 35 women showed:
Effects of
sample of women with breast At end of Part 1 - mean reduction in excess
compression
cancer-related lymphoedema. volume of 26%
bandaging with or
Part 1- women with limb volume At end of Part 2:
without manual
excess of >10% received 2 weeks o Group 1 (CB/MLD) had further 11%
lymphatic drainage
of CB Part 2 - divided into 2 groups reduction in excess volume
in patients with
Group 1 had a further 1 week o Group 2 (CB) had further 4% reduction
post-operative arm
of CB/MLD (Vodder MLD method) in excess volume
lymphoedema
. Group 2 had 1 week of CB alone Both groups had improvement in symptoms
but MLD group had a significant reduction in
Setting: Sweden pain (p<0.03)
Andersen et al (2000) Prospective randomized study comparing Data on 42 patients showed:
Treatment of breast
standard treatment with custom-made No evidence of treatment effect from MLD
cancer-related
information versus standard treatment and Forty-eight percent reduction in absolute oedema
lymphedema with or
MLD (Vodder method ) with 8 MLD treatments volume at 3 months in MLD group
without manual lymphatic
over 2 weeks, in women with limb volume of <30% Sixty percent reduction in same in non-MLD group
drainage. A randomized
No difference in symptom scores between groups
study
. Complex method of calculating limb volume
Quality of life measured but data not reported
Setting: Denmark
Sitzia et al (2002) Prospective study of 28 women with unilateral Data from 28 women showed:
Manual lymphatic
arm lymphoedema . Women randomized to Group 1- 33.8% reduction in excess limb volume
drainage (MLD) compared
two groups: Group 2- 22% reduction in excess limb volume
with simple lymphatic
Group 1- 2 weeks CB/MLD (Leduc method) Initial excess volumes of 68.3% in Group 1 and
drainage (SLD) in the
given by therapist 58.5% in Group 2
treatment of post-
Group 2- 2 weeks CB/SLD (a simple form of MLD) Small pilot study suggested that MLD was more
mastectomy lymphoedema
. given by therapist effective than SLD but neither results were
A pilot randomised trial
significant and larger sample of 56 participants
required to achieve significance
Setting: UK
Williams et al (2002) Prospective cross-over study of 31 women with Data from 31 women showed:
A randomised controlled
limb volume excess of >10% (mean 35% excess) MLD achieved a significant reduction in excess
crossover study of manual
Women randomized to two groups: volume (p=0.013)
lymph drainage (MLD)
Group A: 3 weeks (15 treatments) MLD (Vodder MLD achieved a significant reduction in dermal
therapy in women with
method) combined with standard treatment of depth in the upper arm (p=0.03)
breast cancer-related
compression hosiery and information MLD achieved a statistically significant
lymphoedema
. Group B: 3 weeks of daily patient self-administered improvement in emotional function, dyspnoea,
massage combined with standard treatment with sleep disturbance and pain sensation
Setting: UK compression hosiery and information. Self-administered massage had no statistically
‘Wash-out’ period of 6 weeks then participants significant effects
crossed over to: MLD was used without CB in an attempt to isolate
Group A: 3 weeks SLD and compression hosiery the effect of MLD
Group B: 3 weeks MLD and compression hosiery Longer than 3 weeks is required to evaluate self-
Measurement of change in excess limb volume, massage
dermal depth using skin ulstrasound, caliper ‘creep’ Outcome measures such as caliper creep and
to assess trunk oedema and quality of life skin ultrasound need further validation
(EORTC QLQ C30)
McNeeley et al (2004) Sample of 50 women who had lymphoedema Data on 45 women showed:
The addition of manual
after breast cancer randomized to 4 weeks of daily Significant reduction in lymphoedema volume in
lymph drainage to
treatment with MLD (Vodder method) and both groups (CB and MLD/CB) with most benefit
compression therapy for
compression bandaging (CB) or CB alone. seen in the initial 2 weeks
breast cancer-related
Measurement of limb volume reduction expressed Statistically significant greater limb volume
lymphedema: a randomized
as percentage change in excess limb volume reduction with MLD/CB in those with early
controlled trial
lymphoedema (p < 0.05)
Better outcome with MLD/CB in those with mild
Setting: USA lymphoedema (<15% excess volume) than in any
other groups (p < 0.05)
Range of movement and other aspects of quality
of life or symptoms not assessed
Table 4. Evidence: examples of studies of the therapeutic effect of MLD in women with breast
cancer-related lymphoedema
Figure 3. MLD across the midline or ‘watershed’ between two
skin lymph territories: Casley-Smith method
Figure 4: MLD to the neck: Casley-Smith method
Figure 5: MLD clearance of superficial inguinal lymph nodes
CLINICAL FOCUS
S22 Chronic Oedema, April 2010
range of conditions for which MLD may be indicated,
including post-thrombotic syndrome, degenerative
nervous system and inflammatory conditions (Asdonk,
1975). Recent papers report on MLD in sports medicine
(Vairo et al, 2009), conditions such as fibromyalgia (Ekici
et al, 2009) and reflex sympathetic dystrophy (Duman
et al, 2009). A potential role for MLD as part of a
lymphoedema prevention programme is also highlighted
(Torres Lacomba et al, 2010).
However, for those using MLD within their daily
practice, a number of questions arise concerning how
MLD should be used with different groups. As yet, the
evidence to inform these decisions is limited and as a
result, it is important that practitioners reflect critically on
their practice in using MLD. Measurement of outcomes
using standardized, valid and reliable methods is crucial,
as is the sharing of results in terms of ‘successes’ and
‘failures’.
It is likely that some patient groups may respond
better to MLD than others. For example, there is some
indication that MLD may be more effective in those with
‘mild’ lymphoedema (McNeeley et al, 2004). Certainly
it is possible that the presence of fibrosclerotic tissues
influences the effect of MLD, rendering it less effective
and indicating that compression therapy in the form of
bandaging may more effective as a first line treatment in
some groups. Equally this may be an indication for early
intervention with MLD to reverse the changes that may
lead to long-term tissue fibrosis.
While MLD is frequently used in combination with
bandaging, some groups will require MLD as the first-line
treatment. For example, those with oedema of the trunk
and midline are a particular priority for MLD and there
are papers describing the use of MLD in genital oedema
(Katz et al, 2004), breast oedema (Mondry et al, 2002)
and head and neck oedema (Figure 6) (Reiss and Reiss,
2003). Clinical experience suggests that women who have
breast oedema after breast cancer treatment will respond
readily to MLD, with good long-term outcomes. This is
a particular group who may be motivated towards self-
management approaches and may be taught self-massage
of the breast area during a course of MLD. Importantly, the
use of MLD in this group may highlight how bodywork
provides a means through which health professionals can
enable people to adjust to and accept changes in their
body after cancer treatment.
The theoretical debate that MLD may somehow promote
metastatic cancer is not substantiated in the minimal
literature (Preisler et al, 1998), nor in clinical practice.
However, this highlights the need for lymphoedema
practitioners to work closely with medical colleagues
to ensure that MLD is appropriately given. It is usually
advisable to delay MLD treatments if someone is receiving
cytotoxic chemotherapy, particularly as the chemotherapy
itself may alleviate an obstructive oedema by reducing
tumour bulk. However, if the focus of care is palliative, it
may not be appropriate to delay lymphoedema treatment,
as swelling may become poorly controlled. In these
situations, MLD can also play an important role in the
management of other symptoms such as pain, dyspnoea
and constipation.
While MLD should not be used in the presence of
acute infection, once antibiotic therapy has begun and
systemic symptoms have passed, MLD can be considered.
MLD is also useful in those with chronic inflammatory
conditions. If recurrent infection has been a problem,
antibiotic therapy may be indicated during the MLD
period as temporary exacerbation of symptoms can
occur.
summary
MLD has a long history and a limited, but growing
evidence base to guide practice. This paper has identified
some of the principles and possible effects of MLD and
discussed some implications for lymphoedema practice.
The effects and efficacy of MLD will depend on
various factors relating to the person, the nature of their
lymphoedema, and the way the practitioner uses the MLD
techniques in combination with other interventions such
as compression therapy and self-management support.
There is still much to learn about how MLD should best
be used in order to ensure effective and equitable treatment
for all individuals with lymphoedema. However, fundamental
to this is the need for collaborative working and research.
Good quality information about MLD is also required for
people with lymphoedema, other colleagues, and those
involved in managing and developing services. Practitioners
should be aware of the current evidence around MLD and
ensure they are appropriately educated in the techniques and
supported with applying them in practice. BJCN
Andersen L, Højris I, Erlandsen M et al (2000) Treatment of breast-cancer-relat-
ed lymphedema with or without manual lymphatic drainage. A randomised
study. Acta Oncologica 39(3): 399–405
Asdonk J (1966) Lymphdrainage, eine neue massagemethod. Physik Med U Reha
7 Jahrg: 39–42
Asdonk J (1975) Manuelle lymphdrainahe, ihre wirkungsart, Indikation und
Kontraindikation. Z Algern Med 51: 751–3
Figure 6: MLD to the head and neck region: Leduc method
(Coutesy of Leduc UK)
CLINICAL FOCUS
Chronic Oedema, April 2010 S23
CLINICAL FOCUS
CLINICAL FOCUS
S24 Chronic Oedema, April 2010
gesting therapy on positive interstitial pressure and on lymphangiomotor
activity. In: Progress in Lymphology; Elsevier Science Publishers: 557–60
Hutzschenreuter P, Brümmer H, Ebberfeld K (1989) Experimental and clini-
cal studies of the mechanisms of effect of manual lymph drainage therapy. J
Lymph 13(1): 62–4
Hutzschenreurter P, Brümmer H, Kurz I, Witlinger D (1992) Changes in
microcirculation during MLD technique according to Vodder. Topical
Contributions to MLD 44–52. ISBN 3-7760-1259-5
Hutzschenreuter P, Ehlers R (1986) The effect of manual lymph drainage on
the autonomic nervous system. Zeitschrift für Lymphologie 19: 58–60
Hutzschenreuter P, Herpertz U (1993) Primary and secondary lymphedema in
children treated with manual lymph drainage and compression therapy. Eur
J Lymphology and related problems 4(14): 51–7
Johansson K, Albertsson M, Ingvar C et al (1999) Effects of compression band-
aging with or without manual lymph drainage treatment in patients with
post-operative arm lymphedema. Lymphology 32(3): 103–10
Kafejian-Haddad AP, Perez JMC, Castilioni MLV et al (2006) Lymphoscintigraphic
evaluation of manual lymphatic drainage for lower extremity lymphedema.
Lymphology 39(1): 41–8
Katz EE, Lyon MB, Davis D et al (2004) Manual lymphatic drainage for the
treatment of acute genital lymphedema. Journal of Urology 172(1): 157–8
Kurz W, Wittlinger G, Litmanovitch YI et al (1978) Effect of manual lymph
drainage massage on urinary excretion of neurohormones and minerals in
chronic lymphedema. Angiology 29: 764–72
Leduc O, Bourgeois P, Leduc A (1988) Manual lymphatic drainage: scinti-
graphic demonstration of its efficacy on colloidal protein reabsorption. In:
Progress in Lymphology 551 - 4, Elsevier Science Publishers
Leduc A, Caplan I, Lievens P et al (1991) Le traitment physique de ‘oedème du
bras. Monographies de Bois-Larris Masson.
Levick JR, McHale N (2003) The physiology of lymph production and propul-
sion. In: Browse N, Burnand KG, Mortimer PS eds. Diseases of the Lymphatics.
Arnold, London
McNeeley ML, Magee DJ, Lees AW et al (2004) The addition of manual lymph
drainage to compression therapy for breast cancer related lymphedema:
a randomised controlled trial Breast Cancer Research and Treatment 86(2):
95–106
Mondry TE, Johnstone PA (2002) Manual lymphatic drainage for lymphedema
limited to the breast. J Surg Oncol 81: 101–4
Mortimer PS, Simmonds R, Rezvani M et al (1990) The measurement of
skin lymph flow by isotope clearances- reliability, reproducibility, injection
dynamics and the effect of massage. J Invest Derm 95: 677–82
Olszewski Wl, Bryla P (1994) Lymph and tissue pressures in patients with
lymphedema during massage and walking with elastic support. In: Witte MH
et al eds. Progress in Lymphology X1V. Elsevier Science Publishers: 512–6
Preisler VK Hagen R Hoope F (1998) Indications and risks of manual lymph
drainage in head-neck tumors. Laryngo-Rhino-Otologie 77(4): 207–12
Reiss M, Reiss G (2003) Manual lymph drainage as therapy of edema in the
head and neck area. Schweiz Runsch Med Prax 92(7): 271–4
Sitzia J, Sobrido L, Harlow W (2002) Manual lymphatic drainage compared
with simple lymphatic drainage in the treatment of post-mastectomy lym-
phoedema. A pilot randomised trial Physiotherapy 2: 99–107
Szuba A, Strauss W, Sirsikar SP et al (2002) Quantitative radionuclide lym-
phoscintigraphy predicts outcome of manual lymphatic therapy in breast
cancer-related lymphedema of the upper extremity. Nucl Med Commun
23(12): 1171–5
Torres Lacomba M, et al (2010) Effectiveness of early physiotherapy to prevent
lymphoedema after surgery for breast cancer: randomised, single blinded clini-
cal trial BMJ 340: b5396
Vairo G.L Miller SJ, McBrier NM, BuckleyWE (2009) Systematic review of
efficacy for manual lymphatic drainage techniques in sports medicine and
rehabilitation; an evidence-based practice approach. The Journal of Manual and
Manipulative Therapy 17(3): E80–89
Vodder E (1936) Le drainage lymphatique, une nouvelle methode therapeutique.
Santé pour tous. Paris.
Vodder E (1965) Lymphdrainage ad modum Vodder. Aesthetic Medizin 6: 190–1
von der Weid PY., Zawieja DC (2004) Lymphatic smooth muscle; the motor unit
of lymph drainage. Int J Biochem Cell Biol 36(7): 1147–53
Williams AF, Vadgama A, Franks P, Mortimer PS (2002) A randomized controlled
crossover study of manual lymphatic drainage therapy in women with breast
cancer-related lymphoedema. Eur J Cancer Care 11(2): 254–61
Winiwarter A (1892) Die elephantiasis. In: Deutsche Chirugie, Enke, Stuttgart
Wittlinger H, Wittlinger G (1992) Introduction to Dr Vodder’s manual lymph drainage
volume 1: basic course. 4th edon, Haug Publishers, Heidelberg, Germany.
Wittilinger H (2004) Emil Vodder; his life and work. Personal communication.
Walschee, Austria
General MLD information, training and therapist details:
http://www.mlduk.org.uk/
Casley-Smith method:
http://www.macmillan-lymphoedema-academy.org.uk/index.html
Leduc method: http://www.lymph.org.uk/
Vodder method:
http://www.vodder-school.co.uk/teachers/
USA-based school for Földi method:
http://www.klosetraining.com/
Further information
Börcsök E, Földi K, Wittlinger G, Földi M (1971) Zur therapeutischen
Beeinflussung des akuten experimentellen lymphostatischen Ödems mit
Vitaminen, vitaminartigen Naturstoffen sowie mittels Massage. Angiologica
8: 31–42
Casley-Smith JR, Casley Smith JR,. (1997) Modern Treatment for Lymphoedema
5th edn. The Lymphoedema Association of Australia Inc, Australia
Casley Smith JS, Björlin MO (1985) Some parameters affecting the removal of
oedema by massage - mechanical or manual In: Casley-Smith JR, Piller NB
eds. Progress in Lymphology X. University of Adelaide Press, 182–4
Derdeyn A, Aslam M, Pflug JJ (1994) Manual lymph drainage- mode of action
Progress in Lymphology. Conference Proceedings, Elsevier: 527–9 Devoogdt N,
Van Kampen M, Geraerts I et al (2009) Different physical treatment modali-
ties for lymphoedema developing after axillary node dissection for breast
cancer: a review. Eur J Obstet Gynecol doi.10.1016/j.ejogrb.2009.11.016
Duman I, Ozdemir A, Tan AK, Dincer K (2009) The efficacy of manual lym-
phatic drainage therapy in the management of limb edema secondary to
reflex sympathetic dystrophy. Rheumatology International 29(7): 759–63
Ekici G, Bakar Y, Akyrak T et al (2009) Comparison of manual lymph drain-
age therapy and tissue massage in women with fibromyalgia: a randomized
controlled trial J Manipulative Physio Ther 32: 127–33
Ferrandez JC, Laroche JP, Serin D et al (1996) Lymphoscintigraphic aspects of
manual lymphatic drainage. J Ma Vasc 21(5): 283–9
Fischer M (1967) 30 years of manual lymphatic drainage according to Vodder.
A special form of massage for decompression of the tissue. Landarzt 43:
219–20
Földi E, Földi M, Weissleder H (1985) Conservative treatment of lymphedema
of the limbs. Angiology 36: 171–80
Földi M, Strössenreuter RHK (2003) Foundations of manual lymph drainage 3rd
edn. Elsevier Mosby, Missouri
Francois A, Richaud C, Bouchet JY et al (1989) Does medical treatment of
lymphedema act by increasing lymph flow? VASA Band 18(4): 281–7
Franzeck UK, Speigel I, Fischer M et al (1997) Combined physical therapy
for lymphedema evaluated by fluorescence microlymphography and lymph
capillary pressure measurement. J Vasc Res 34(4): 306–11
Harris R, Piller N (2003) Three case studies indicating the effectiveness of
manual lymph drainage on patients with primary and secondary lymph-
edema using objective measuring tools. Journal of Bodywork and Movement
Therapies 7(4): 213–21
Hutzschenreuter P, Brümmer H (1988) Influence of complex physical decon-
KEY pOInts
w Manual lymphatic drainage (MLD) is often used in combination with
compression bandaging, exercises, skin care and self-management
support in the management of lymphoedema
w Manual lymph drainage has a long history but a limited empirical evidence
base
w Different schools of MLD have been established, but the underlying
principles of the MLD techniques remain similar across the various
methods
w Research studies have described many different ways in which MLD may
exert its’ effect on lymphatic, vascular and other systems
w Hands-on treatment to the body, such as MLD, can be important in helping
individuals to adjust to body changes after cancer treatment
Copyright of British Journal of Community Nursing is the property of Mark Allen Publishing Ltd and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.
... Another fundamental aspect that must be taken into account in the evaluated literature is the way in which manual lymphatic drainage is performed. There are different schools of lymphatic drainage (Vodder, Casley-Smith, Leduc, and Foldi) [53] and there may be differences in drainage results. However, all these different methods coincide in fundamental aspects, such as that manual lymphatic drainage should be performed by a trained physiotherapist and requires a long application time (from 40 min to 1 h) [53,54]; also, slow repetitive hand movements are performed, gently massaging along the anatomical lymphatic pathways over the affected areas that try to stimulate lymphatic flow [11,53]. ...
... There are different schools of lymphatic drainage (Vodder, Casley-Smith, Leduc, and Foldi) [53] and there may be differences in drainage results. However, all these different methods coincide in fundamental aspects, such as that manual lymphatic drainage should be performed by a trained physiotherapist and requires a long application time (from 40 min to 1 h) [53,54]; also, slow repetitive hand movements are performed, gently massaging along the anatomical lymphatic pathways over the affected areas that try to stimulate lymphatic flow [11,53]. The reviews checked [19,35,39,49] do not specify the type of drainage performed or do not differentiate between the results depending on the type of drainage. ...
... There are different schools of lymphatic drainage (Vodder, Casley-Smith, Leduc, and Foldi) [53] and there may be differences in drainage results. However, all these different methods coincide in fundamental aspects, such as that manual lymphatic drainage should be performed by a trained physiotherapist and requires a long application time (from 40 min to 1 h) [53,54]; also, slow repetitive hand movements are performed, gently massaging along the anatomical lymphatic pathways over the affected areas that try to stimulate lymphatic flow [11,53]. The reviews checked [19,35,39,49] do not specify the type of drainage performed or do not differentiate between the results depending on the type of drainage. ...
Article
Full-text available
(1) Background: Manual lymphatic drainage (MLD), included within the complex decongestive therapy, as a therapy for the treatment of lymphedema has raised controversy about its benefits for lymphedema after breast cancer. The aim of this research is to test the effects of MLD on lymphedema after breast cancer during the treatment maintenance phase. (2) Methods: A randomized, single-blinded, controlled crossover trial was conducted to analyze the effects of a manual lymphatic drainage intervention compared to a control group without MLD intervention for the treatment of lymphedema. Arm volume measured by circumference measurement, subcutaneous tissue thickness measured by ultrasound, and the sensation of pain, heaviness, and swelling were evaluated as outcome measures. (3) Results: For the control group, an increase in volume was found in some of the circumference and subcutaneous tissue thickness measurements, in addition to a worsening of arm pain, swelling and heaviness. (4) Conclusion: The absence of treatment based on MLD in lymphedema after breast cancer worsens volume measurements, as well as arm heaviness. Therefore, it would be advisable to carry out this type of therapy as part of the maintenance treatment for lymphedema in breast cancer.
... IPCT is an approved [15][16][17][18][19] therapy (especially in inpatient settings [20]) that, despite its potential as a home and continuous therapy, seems to be less established. There is an unsatisfactory situation in the study of the therapy of chronic lymphedema in general, and in manual lymphatic drainage and intermittent pneumatic compression in particular [21,22]. Within the guidelines, IPC therapy is only recommended as an additive therapy to CDT [4,23]. ...
... To our knowledge, the efficacy of IPCT, especially in comparison to the standard therapy of MLD, has never previously been analyzed. This is an unsatisfactory study situation in the therapy of chronic lymphedema in general, and in MLD and IPCT in particular [21,22]. ...
Article
Full-text available
Background: Complex decongestive therapy (CDT) is the standard and basic therapy for lymphedema. The central component of CDT is manual lymphatic drainage (MLD). In addition to CDT, other measures such as intermittent pneumatic compression therapy (IPCT) (active compression machine therapy) are available. In this prospective research study, the objective and subjective effects of MLD and IPCT on lymphedema of the lower extremity were investigated and both therapies were directly compared. Furthermore, the patients’ body mass index (BMI) and stage of lymphedema were tested for their effect on the respective therapy. Methods: Patients participating in the study received both therapies (MLD and IPCT) on the same lymphedema-affected limb at an interval of two days. The objective volumetric therapy effect was measured by the digital volume measurement of the affected limb. The subjective effects of the therapies were measured using two specially designed questionnaires. Results: A total of 40 patients were included in the study. There was no significant difference in the volume differences between the interventions, BMI categories, lymphedema, or treatment order regarding the immediate and two-day effect. Conclusions: No significant difference was found in the subjective or objective therapy efficacy of the two methods. Intermittent pneumatic compression therapy is considered a comparable therapeutic procedure when properly indicated.
... MLD has the potential to decrease swelling by encouraging the pumping action of lymphangion and redirecting lymph away from stagnant areas to functional lymphatic vessels by reducing hydrostatic pressure [14]. Some studies reported the effectiveness of MLD in decreasing lymphatic swelling in females related to breast cancer [15,16]. The application of MLD in musculoskeletal diseases has also garnered significant interest. ...
Article
Full-text available
Background Total knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR. Methods A search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence. Results In total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083). Conclusions Based on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.
... However in biomechanics, models are developed to characterize the posture and / or to quantify the torques and the reaction forces. Many models have been proposed in the literature to study postural control (12), sitting posture subjected to vibrations (13) or vehicle entry / exit (14). This model-based approach is almost non-existent in ergonomics, particularly in the interaction tasks study with a smartphone. ...
Article
Full-text available
New portable technologies such as smartphones are developing in a very important way and their use rate is increasing every year. Faced with this growth, it is relevant to consider the risks of developing musculoskeletal disorders related to their increasing utilization. The objective of this study was twofold: 1) to propose a predictive model of the upper body joint angles, torques and reaction forces during smartphone interaction in seated position based on subject’s anthropometric data, environmental conditions and interaction strategies in the sagittal plane; 2) to propose risk scales for joint torques provided by the model and which could be integrated with information on posture as part of the musculoskeletal disorders prevention. One of the original aspects of the predictive model was to consider postural strategies between the trunk and the neck during smartphone interaction. The validation was carried out by comparing experimental data collected from 12 subjects who had to perform texting and web browsing task while sitting on a chair with or without support and the data simulated by the model under the same conditions. The results showed a satisfactory ability of the model to reproduce the subjects' posture. However, more marked differences were observed for reaction forces and for shoulder and elbow flexion when trunk flexion was significant. A validity domain for each parameter was computed for different seat and support heights according to the subjects' body mass index. From these data, joint torques risk scales have been constructed, to characterize the risks incurred by the users. Key words: Predictive Model, Musculoskeletal disorders, Risk scale, Sitting, Posture, Torque/Force.
Article
Background: Lipedema is a disease characterized by an increase in extracellular fluid. In these patients, the increase in the amount of extracellular fluid may accelerate the progression of the disease. The aim of this study is to examine the effect of complex decongestive therapy (CDT) on intracellular/extracellular fluid balance. Methods and Results: Twenty-two female patients diagnosed with lipedema by a specialist lymphologist were included in the study. Patients were subjected to complex decongestive therapy and pneumatic compression therapy 6 days a week for 1 month. Extracellular and intracellular fluid volumes were assessed using bioimpedance spectroscopy before and after the treatment. A decrease in intracellular (p = 0.010) and extracellular (p = 0.002) fluid volumes was observed after the treatment. Conclusion: There is no completely curative treatment method for lipedema. Current treatments aim to slow down the progression of the disease. CDT is considered effective in reducing intracellular and extracellular fluid volume in lipedema patients. Therefore, it is thought to be effective in slowing down the progression of the disease.
Article
Context : The aim of this study was to investigate the acute effects of Swedish massage and manual lymph drainage (MLD) on performance parameters related to jumping, walking, and blood lactic acid levels after Nordic hamstring exercises. Design : This study was designed as a controlled crossover study. Methods : The study included 16 young trained men. Participants’ lactic acid levels, gait-related parameters, and jumping performance were assessed. Assessments were performed at baseline, after Nordic hamstring exercises, and after 3 different passive recovery strategies: resting, Swedish massage, and MLD for 3 weeks. Results : As a result of the study, it was observed that lactic acid levels after the MLD and massage intervention were significantly lower in both MLD and massage conditions compared with the control condition ( P < .05). There was no within- and between-conditions difference in jumping parameters after the MLD and massage interventions ( P > .05). Walking speed in the MLD condition was statistically higher following the intervention compared with both before and after exercise ( P < .05). Step time in the massage condition was statistically lower after the intervention compared with after Nordic hamstring exercise ( P < .05). Conclusions : Although MLD and massage interventions have positive effects on lactic acid levels and walking and jumping parameters, they are not superior to each other. MLD can be used as a passive recovery technique after exercise.
Article
Amaç: Bu çalışma, sağlıklı kadınlarda manuel lenf drenajının (MLD) otonomik fonksiyonlar üzerindeki etkilerini incelemeyi amaçlamaktadır. Yöntem: Dahil edilme kriterlerini karşılayan 40 sağlıklı kadın çalışmaya dahil edildi. Tek kör randomize kontrollü çalışmada katılımcılar MLD, sham MLD ve kontrol grubu olarak 3 gruba ayrıldı. Katılımcıların demografik bilgileri, kan basıncı ve kalp hızı değişkenliği (KHD) değerlendirildikten sonra soğuk basınç testi uygulandı. Testin hemen ardından kan basıncı ve KHD yeniden değerlendirildi. MLD grubuna kısa boyun, karın ve lenf nodu uyarımı ve kol MLD uygulamaları yapıldı. Sham MLD grubuna sham protokolü uygulandı. Kontrol grubundan 10 dakika sırt üstü yatmaları istendi. Uygulama sonrası kan basıncı ve KHD tekrar değerlendirildi. Sonuçlar: Sistolik kan basıncı soğuk basınç testi ile her 3 grupta da düşerken, sham MLD grubunda uygulama sonrası düşmeye devam etti (p
Article
Full-text available
This study aimed to determine the effects of manual lymphatic drainage with rehabilitation exercises on edema, pain, and lower extremity function in patients with gynecological cancer after surgery. The study included 20 patients with gynecological cancer with a Numeric Rating Scale (NRS) pain score >3, who were either inpatients or outpatients in Seoul. The patients were randomly assigned to either the experimental group (n=10) or control group (n=10). The experimental group underwent manual lymphatic drainage with rehabilitation exercises, whereas the control group underwent manual lymphatic drainage with diaphragmatic breathing. Each patient was treated for 50 min twice a week for 4 weeks. Before and after the experiment, edema, pain, lower extremity function, and quality of life were evaluated using the Circumference Tape, Numeric Rating Scale, Lower Extremity Functional Scale, and Memorial Symptom Assessment Scale. The results of this study were as follows. First, the edema between the experimental and control groups significantly decreased before and after the intervention; however, there was no significant difference in the comparison between the groups. Second, the pain scores between the experimental and control groups significantly decreased before and after the intervention, and there was a significant difference in the comparison between the groups. Third, the lower extremity function between the experimental and control groups significantly increased before and after the intervention, and there was no significant difference between the groups. Forth, the quality of life between the experimental and control groups significantly increased before and after the intervention, and there was significant difference in the comparison between the group. The physical symptoms were significantly different between the groups; however, the emotional symptoms were not. The analysis of this experiment showed that, both the groups were effective in improving edema, pain, lower extremity function, and quality of life in patients with gynecological cancer undergoing surgery. In particular, manual lymphatic drainage with rehabilitation exercises was more effective than manual lymphatic drainage with diaphragmatic breathing for edema and physical symptoms of patients with gynecological cancer after surgery.
Chapter
The esthetic improvement of the thighs through liposuction remains a challenge for the plastic surgeon. The femoral region has a very particular behavior during pregnancy and lactation that the surgeon must know and anticipate when planning its contouring. Anatomically, the fatty tissue of the thighs has areas of marked adherence that, if not handled properly, can result in excessive laxity or cutaneous irregularities. Therefore, for a correct treatment, it is necessary to know in detail the different liposuction techniques that exist today as well as the advantages and disadvantages of each one. In this chapter, these points are explained in detail along with the surgical anatomy and those structures that must be preserved during surgery. All the information to be collected during the preoperative evaluation and physical examination is detailed along with the key concepts for a correct preoperative marking including the most problematic areas referred by the patients. Finally, the surgical technique and the infiltration of wetting solutions are described followed by the postoperative care measures and the most frequent postoperative complications.
Article
Background There is great potential but seemingly limited use of indocyanine green (ICG) lymphography to influence conservative lymphedema therapy clinical practice. This scoping review aimed to map existing evidence for ICG lymphography relating to conservative lymphedema therapy. Methods A 6-staged scoping review framework of Arksey and O'Malley was used to guide the study. Protocol development included key stakeholder consultation. Searches were conducted in 5 databases with specialist librarian support. A 2-phase selection process undertaken by 2 researchers identified studies for inclusion. Conflicts were resolved by consensus. A subsequent 3-phase data extraction and quality appraisal process occurred. Key findings were presented in a descriptive numerical summary. Results A total of 6316 records were identified, yielding 162 articles for inclusion. Categorization was made according to article type and purpose of ICG lymphography including lymphedema assessment (diagnosis and staging) and/or conservative therapy. Seventy-six empirical research articles with detailed reference to ICG lymphography were explored further. Conclusion Current published research about ICG lymphography in conservative lymphedema therapy describes support for its use in lymphedema diagnosis, and proposes staging systems for lymphedema severity. Despite existing work, further exploration of effect on conservative therapy planning, clinical, and patient outcomes is necessary to consider future translation to clinical practice.
Article
In an experimental study on rats and sheep we demonstrated by means of light reflexion rheography and laser doppler fluxmetry that manual lymphatic drainage therapy causes vessel narrowing followed by increased blood flow in the arterioles, capillaries and venulae of the skin as well as in peripheral arteries and an increased lymph flow in lymphatic collectors. A clinical pilot study on patients with obliterative arterial diseases who underwent eight lymph drainage treatments over a four-week period under clinical conditions confirmed this observation.
Article
Manual lymphatic drainage is used in physiotherapy of limb lymphedema in combination with other physical techniques. In order to assess the effectiveness of the method, 47 patients with upper limb lymphedema after radiosurgical therapy for breast cancer underwent lymphoscintigraphy. The examination was performed after subcutaneous injection of technicium-labeled colloid via the fourth and first interdigital space on the hand of the limb with lymphedema. The level of the technicium label was compared on scintigraphies performed before and after manual lymph drainage. Results were analyzed as a function of the clinical characteristics of the edema. Manual lymphatic drainage produced an effective progression of the label in 25 cases (53.2%), independent of radiotherapy. Contralateral lymph nodes were reached in 5 cases and the homolateral internal mammary nodes in 2. These nodes were visualized only after manual lymphatic drainage. The visualization of the drainage routes in unexpected areas demonstrated the effectiveness of the technique in stimulating accessory routes useful for resorption of lymphedema. The use of two injection sites on the hand is also discussed. This study demonstrated the effect on a single session of manual lymphatic drainage and should be completed with an assessment of a complete series of manual lymphatic drainages.
Article
A prospective randomized study was carried out to investigate whether the addition of manual lymphatic drainage (MLD) to the standard therapy could improve treatment outcome in women with lymphedema of the ipsilateral arm after breast cancer treatment. Forty-two patients were randomly assigned to receive standard therapy or standard therapy plus MLD 8 times in 2 weeks and training in self-massage. The standard therapy consisted of use of a compression garment, exercises and information about lymphedema and skin care. The efficacy of treatment was evaluated by reduction in lymphedema volume during treatment and by improvement in symptoms potentially related to lymphedema. The patients were followed-up for a total of 12 months. The study showed that both groups obtained a significant reduction in edema and that MLD did not contribute significantly to reduce edema volume.
Article
Hintergrund: Nach der Operation und Bestrahlung von Kopf-Hals-Tumoren kommt es in diesem Bereich häufig zur Ausbildung von sekundären Lymphödemen, die durch ihre exponierte Lokalisation die Lebensqualität der Patienten stark mindern. Als Therapie kommt die manuelle Lymphdrainage in Frage, deren Einsatz wegen theoretisch möglicher Tumorzellverschleppung aber kontrovers diskutiert wird. Patienten: In einer retrospektiven Studie wurden 191 Patienten, die wegen Kopf-Hals-Tumoren behandelt worden waren, anhand eines Fragebogens auf den Einsatz der manuellen Lymphdrainage und den Erfolg der Behandlung untersucht. In die Auswertung gingen die Rezidivrate, das Tumorstadium, die Histologie und die in sano/non in sano Resektion des Primärtumors ein. Ergebnisse: Von den 191 Patienten hatten 100 manuelle Lymphdrainage nach der onkologischen Therapie erhalten, 91 zählten zum Kontrollkollektiv. 37 Patienten hatten ein loko-regionäres Rezidiv, von denen 18 manuelle Lymphdrainage erhalten hatten. Die Inzidenz war bei Tumoren der Tumorstadien 3 und 4 in beiden Gruppen am höchsten. Besonders häufig rezidivierten Tumoren mäßiger und vor allem geringer Differenzierung, mit Lymphangiosis carcinomatosa und bei non in sano Resektion des Tumors. Dabei bestand zwischen der Therapie- und Kontrollgruppe kein signifikanter Unterschied, eine erhöhte Rezidivrate durch Anwendung der manuellen Lymphdrainage ergab sich nicht. Schlußfolgerung: Zurückhaltung beim Einsatz der manuellen Lymphdrainage ist bei einer Lymphangiosis carcinomatosa und der non in sano Resektion des Tumors zu empfehlen, da hier eine Verschleppung von Tumorzellen und eine Aktivierung des Tumors denkbar ist. Bei allen übrigen in sano operierten Kopf-Hals-Tumoren ist die manuelle Lymphdrainage eine für die Lebensqualität gewinnbringende Maßnahme und wichtiger Bestandteil in der Rehabilitation der Patienten. Summary Background: Secondary lymphedema of the head and neck can develop as a result of obstruction of lymphatic channels following the surgical removal of lymph nodes and fibrosis due to irradiation. This can be treated with manual lymphatic drainage. An increase of tumor recurrence due to this therapy is at controversial discussion. Patients: In a retrospective study 191 patients treated for head and neck cancer were questioned on occurrence of lymphedema and therapy with manual lymphatic drainage. Results: 100 patients had received lymphatic drainage, whereas 91 patients belonged to the group without lymphatic drainage therapy. In 37 cases a tumor recurrence or local metastases were reported, 18 of whom had received lymphatic drainage and 19 belonged to the control group. Among these 37 patients neither the group with lymphatic drainage nor the control group differed significantly concerning stage of cancer, histopathological grading, the in sano/non in sano resection of the primary tumor and a lymphangiosis carcinomatosa. An increased recurrence rate among patients who underwent a lymphatic drainage therapy could not be found. Conclusion: A lymphatic drainage therapy for patients presenting with lymphedema after the oncological therapy does not increase the rate of local recurrencies. Moreover it improves the quality of life after the cancer therapy. As only few data are available for cases with non in sano surgery and tumors with lymphangiosis carcinomatosa these cases should be excluded from a lymphatic drainage therapy. A spreading of occult tumor cells in these patients might be possible.
Article
Selon son origine, un oedeme peut etre traite par medicament ou par diete. Dans certains cas, principalement en cas d'oedemes combines, un drainage lymphatique manuel peut etre efficace. Dans certaines formes d'oedemes, seul un drainage lymphatique d'apres Vodder, Asdonk et Kuhnke est indique puisque les medicaments n'ont pas d'effets sur le systeme lymphatique. Le drainage lymphatique manuel est une methode speciale de massage. Ce travail traite des lymphoedemes primaires ou secondaires de la sphere oro-faciale. Les lymphoedemes secondaires sont causes par un traitement chirurgical ou antitumoral, par une irradiation ou par une tumeur respectivement par une metastase. Le drainage lymphatique manuel est palliatif selon la maladie primaire.