Biology of Lymphedema

Abstract

This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.

Outcomes of lipectomy in patients with advanced unilateral upper extremity lymphedema with regard to the difference in time required for indocyanine green to reach the axilla: A retrospective cohort study in a single center

“…[8,9] The goal of surgical treatment for lymphedema is to reduce the accumulated fluid or fat or induce lymphatic drainage through an alternative pathway. [1] Lymphaticovenous anastomosis (LVA) or vascularized lymph node transfer (VLNT) aims to induce physiological lymphatic drainage. In contrast, lipectomy is a surgical method that can be used in patients with advanced fibroadipose hypertrophy and induces reduction.…”

Cell therapy as a treatment of secondary lymphedema: a systematic review and meta-analysis

“…Lymphedema is a chronic edema, lasting more than three months, due to the accumulation of interstitial fluid caused by poor lymphatic drainage [ 2 ]. Secondary lymphedema is due to obstruction or infiltration of the lymphatic vessels by tumors, infections (recurrent lymphangitis), obesity, surgery or overload and saturation of the lower limb venous system [ 3 ]. The most frequent cause in undeveloped countries is filariasis, while in developed countries, it is iatrogenic due to radiotherapy or surgery related to the management of malignant neoplasms (breast cancer, malignant melanoma, gyneco-urological cancer) [ 4 ].…”

Hemodynamic Responses in Lower Limb Lymphedema Patients Undergoing Physical Therapy

“…The lymphatic vessels transport several liters of lymphatic fluid throughout the whole body every day [7][8][9]. As a result, any malfunction in this system might result in fluid accumulation within the tissue [10]. A chronic and progressive disease, known as lymphedema, may develop [10,11].…”

“…As a result, any malfunction in this system might result in fluid accumulation within the tissue [10]. A chronic and progressive disease, known as lymphedema, may develop [10,11]. Characteristic for this disease are severe tissue swellings, usually occurring in the upper or lower extremities due to a stasis in lymph flow.…”

“…In lymphedema patients, cardio-postural control might be affected due to different fluid volumes in the lower limbs, pre-and post-therapy, as well as due to plasma volume changes during physical therapy [10,13,15,16]. However, to our knowledge, there is no previous study focusing on investigating orthostatic intolerance during lymphedema therapy.…”