Lymphoedema care: from early detection to long-term management

Lymphoedema is a chronic condition characterised by the accumulation of tissue fluid, a clear liquid that normally transfers the nutrient waste from the tissue back into the bloodstream. The condition arises as a result of damage to the lymphatic system due to surgery, radiation, and sometimes, genetic reasons. Effective management of the condition requires a systematic approach that focuses on early detection, volume reduction, and stabilisation. With appropriate self-management strategies and medical approaches, lymphoedema can be managed effectively, and progress can be halted through supermicrovascular surgery.

Early detection is key

Early detection and treatment of the condition will ensure that the disease does not progress to a severe stage, which includes hardening of the body tissues, known as fibrosis. The lymphatic system is often “subclinical,” meaning it is not always immediately observable. Close monitoring of even the slightest changes in the body parts is necessary. Symptoms, such as a slight sensory and body changes may be noticeable before the onset of swelling and lymphedema.

The following are key symptoms to watch out for:

Sensory changes: A sensation of heaviness, tightness, and pain in the limbs is the first symptom of the condition.

● Structural changes: Pitting oedema is the result of pressure on the skin that pushes the fluid away, causing an indentation. This shows that there is fluid accumulation in the space outside the cells.

● Fitting issues: The sudden tightening of rings, watches, or clothes can be taken as a measure of swelling.

Seeking the advice of a certified lymphedema therapist (CLT) immediately at these stages can prevent tissue damage. Similarly, establishing a baseline measurement is also essential, as it provides a reference point to accurately track effectiveness of the therapy and how well it is progressing. If needed, patients can consult lymphologists for further advice and management

Treatment strategies

After the diagnosis, treatment progresses to an intensive reduction phase. Complete Decongestive Therapy (CDT) acts as the chief clinical protocol in lymphedema reduction. This phase involves removing stagnant fluid from the affected areas and also involves the rearrangement of the body’s natural channels to drain the fluid. This phase consists of four different, integrated parts:

Manual Lymph Drainage (MLD): Gentle, rhythmic skin stroking encourages the flow of lymph towards functioning lymph nodes and healthy areas of lymphatic circulation, avoiding damaged areas.

Compression bandaging: Short stretch bandages are used to provide necessary to prevent re-accumulation of fluids between therapy sessions. These bandages can provide high working pressure through physical movements.

Decongestive exercises: These exercises involve the pumping of muscles to help pump the lymph fluid through the vessels. This helps to increase the effect of the bandages. Spirometer and respiratory physiotherapy also help.

Meticulous skin care: Daily cleaning and moisturising prevents infections such as cellulitis. This becomes critical since the medium in which bacteria grow consists of a high-protein fluid called lymph fluid.

Long-term stabilisation

For the long-term, the goal is to maintain the volume reduction that was attained in the CDT phase. The key to success is to ensure that the treatment is consistent and that there are no flare-ups. This is the most challenging phase, where the patient has to move from therapist-managed treatment to self-management. This phase is critical to ensuring that long-term results are achieved. The strategies involved in this phase are:

Compression garments: The use of medical-grade or pressure garments, such as sleeves or stockings, is useful in the maintenance of the size of the limbs because of the external gradient. The replacement of these garments is necessary every six months to ensure that the pressure level is maintained, because the elastic material used in the fibres of the stocking tends to lose its potency after a certain period of time.

Activity levels: Engaging in low-impact activities such as swimming or walking can help mobilise the fluid while preventing fatigue or injury to the involved area.

Infection control: Preventing needle stick injuries, using blood pressure cuffs, and avoiding scratches to the involved extremity can help prevent bacterial invasion. Any break in the skin requires immediate medical attention; local antibiotics or antifungal creams may be advised for treatment.

Microsurgery

If people do not want to wear pressure garments lifelong, they can opt for various microsurgical procedures. Surgical options become viable for particular cases when conservative treatment methods fail to deliver sufficient relief. Microvascular shunt procedures, such as lymphaticovenous anastomosis, enable better lymphatic drainage, which decreases swelling. Reduction (debulking) surgery is used to treat severe lymphoedema cases, which helps patients achieve better function and hygiene, and increased comfort. The selection of advanced interventions that suit specific requirements enables their use to improve patient results, together with standard treatment methods.

What you should know

Effective management of lymphoedema depends on both clinical care and self-care. Although lymphedema is a serious condition and poses many challenges, adherence to compression therapy, regular skin care, and decongestive exercise can effectively prevent future complications and help in proper functionality. With proactive care and management, lymphedema can be effectively controlled, enabling people suffering from the condition to achieve and maintain a good quality of life.

(Dr. G. Manokaran is a senior consultant plastic and reconstructive surgeon at Apollo Spectra, Chennai. gmano.dr@gmail.com)

Published – February 21, 2026 04:00 pm IST