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Management

Prevention

Education

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Ideally, prevention should begin before treatment, by educating the patient and family in a sensitive fashion about the potential risk of developing lymphedema. Proceeding in this way may diminish a breast cancer survivor's dissatisfaction with the educational information received about lymphedema, and could serve as a foundation for making decisions and coping with lymphedema, should it develop later.[1] Patients should be taught to recognize the early signs of edema because treatment outcomes may be significantly improved if the problem is detected early.[2]

Exercise

Refer to the Exercise does not increase risk of lymphedema onset subsection in the Risk Factors section of this summary for more information.

Other preventive measures

Generally anecdotal recommendations for taking preventive measures include the following:

Hygiene: Skin and Nail Care

  • Maintain meticulous skin hygiene and nail care to prevent a portal of entry for infection which may result in cellulitis.
  • Cut toenails straight across; see a podiatrist as needed to prevent ingrown nails and infections.
  • Use skin moisturizers and topical antibiotic solutions after small breaks in the skin, such as paper cuts.
  • Use sunscreen and suntan gradually.
  • Wear cotton socks; keep feet clean and dry.
  • Wear gardening and cooking gloves and use thimbles for sewing.
  • Avoid going barefoot outdoors.
  • Avoid blood draws (including finger sticks), vaccinations, or intravenous lines in the affected arm.
  • Use the unaffected extremity to test temperatures (e.g., for bath water or cooking), as sensation may be diminished.
  • Be aware of the signs of infection (fever, swelling, redness, pain, and heat) and see a physician for evaluation immediately.

Extremity Positioning

  • Keep the arm or leg elevated above the level of the heart when possible.
  • Avoid constrictive pressure on the affected arm or leg.
    • Do not cross legs while sitting.
    • Wear loose jewelry and clothes with no constricting bands.
    • Carry a handbag on the opposite arm.
    • Do not use elastic bandages and stockings with constrictive bands.
    • Do not sit in one position for longer than 30 minutes.

Avoiding the Pooling of Blood in the Involved Extremity

  • Avoid rapid circular movements that cause centrifugal pooling of fluid in distal parts of the limb.
  • Avoid local application of heat to the limb, which may increase blood flow.
  • Do not maintain the limb in a gravity-dependent position for long periods of time.
  • Avoid tight-fitting clothing or blood pressure monitoring in the affected arm, which could cause a tourniquet effect and obstruct lymph flow.

Treatment

The goal of lymphedema treatment centers on controlling limb swelling and minimizing complications; the underlying lymphatic vessel interruption cannot be corrected. Because clinical trials evaluating pharmacologic measures are generally not found to be effective, nonpharmacologic measures are the mainstay of treatment, with the goal of maximizing the activities of daily living, decreasing pain, increasing range of motion, and improving function.

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