Index. Italic numbers refer to figures. Appendix. aus: Zuther, Lymphedema Management(ISBN ) 2009 Georg Thieme Verlag KG

Transcription

1 274 Index Italic numbers refer to figures A abdomen manual lymph drainage deep abdominal treatment , 153 superficial abdominal treatment 152 abdominal breathing 218, accessory lymph nodes 21 advertising, lymphedema clinic 240 air travel air quality and humidity cabin pressure 233, 234 ambulatory venous hypertension 80 amniotic band syndrome 177 anastomoses 9, 16, 17 18, 17, 60, 258 lympho-lymphatic 60 lympho-venous 60 anchoring filaments 6, 7 angiography 258 angioma 258 angiosarcoma 58, 63, 258 ankle/brachial index 87, 87, 258 antecubital lymph nodes 25 anterior axillo-axillary (AAA) anastomosis 18 anterior inter-inguinal (AII) anastomosis 18 aplasia 49 arm see upper extremity arm sleeves, measurements for , 205 custom-made arm sleeves standard-size arm sleeves 205 arterial ulcerations therapy arteries 2, 32 axillary lymph nodes 22 axillary web syndrome (AWS) 70 72, 70 definition 70 evaluation physiology/pathophysiology 70 therapeutic approach axillo-inguinal (AI) anastomosis 18 B bacterial infection 52, 62 wound management Baker s cyst 258 bandages see compression bandages bathroom requirements, lymphedema clinic 239 beneficial activities 230, 231 benzopyrones billing CPT codes 242 bioburden 258 blood 2 circulation blood capillary pressure (BCP) 35, 40 filtration and reabsorption and 38, 39 increase in 59 blood pressure 34, 35 blood protein 270 see also protein blood vessels 2 lymph vessels in the adventitia of 61 wall structure 33 see also arteries; capillaries; veins blow-out syndrome 80 breast, compression garments 207, 207 breast cancer surgery 51 brochures, lymphedema clinic 240 broomstick exercises 219 bulla 258 bundles 24 cephalic 26 C capillaries 2 3, 32 blood capillary pressure (BCP) 35, 40 filtration and reabsorption and 38, 39 increase in 59 lymph capillaries 6 7, 6 capillary exchange diffusion 36 37, 36 filtration 38 40, 39 osmosis 37 38, 37 reabsorption 38 41, 39 cardiac edema 258 cardiac insufficiency cellulitis 62, 63, 259 cephalic bundle 26 children see pediatric lymphedema chin straps 207, 208 chip bags 181, 198 chronic venous insufficiency (CVI) 53, 54, complications thrombophlebitis ulcerations 83 definition effects on lymphatic system 80 evaluation 83 pathophysiology 80 post-thrombotic syndrome 79 stages of 80 82, 81 therapeutic approach 83 84

2 Index 275 complete decongestive therapy 84 prevention 83 see also venous insufficiencies chyle 259 circulatory system 2 4, 3, cisterna chyli 9 clothing precautions 230, 231 collateral circulation 60 collectors 8 9, 8 foot 28 forearm 25 hand 25 lower leg and knee 28 reconnection following trauma 60, 60 thigh 28 upper arm colloid 259 colloid osmosis 38 colloid osmotic pressure 38 interstitial fluid colon, lymphatic drainage 9 combined insufficiency 45 46, 45 comorbidity 259 complete decongestive therapy (CDT) 69, 74 75, 112 chronic venous insufficiency 84 components of 114 cyclic idiopathic edema 105 development of 113 goal of 113 lipedema 97 reflex sympathetic dystrophy 104 rheumatoid arthritis 103 stage 2 lymphedema 57, 57 stage 3 lymphedema traumatic edema 100 postsurgery application see also compression therapy; decongestive exercises; manual lymph drainage (MLD); skin care complex regional pain syndrome see reflex sympathetic dystrophy (RSD) compression bandages , gauze bandages 180 genital bandaging , lower extremity , , , hip attachments , self-bandaging , stockinettes synthetic padding bandages 180 upper extremity bandaging , , , washing guidelines see also compression therapy; short-stretch bandages compression garments , 126 alternative materials , 130 circular knit and flat knit garments compression levels , 125 custom-made and standard compression garments 127 measurements for arm sleeves , 205 face masks 207, 208 hand and finger compression garments , 206 neck and chin straps 207, 208 stockings and pantyhose , 203 thorax and breast 207, 207, 209 styles of , 128, 129 see also compression therapy compression therapy , 135, 137 contraindications effects of Laplace s law 123 materials , 180 pediatric lymphedema 178 resting pressure 124 traumatic edema 100 working pressure 123 see also compression bandages; compression garments computed tomography 73 congenital lymphedema 50 congestive heart failure (CHF) 260 consent form health information 253 privacy rules 252 coracoid process 260 cord bending 71 72, 72 CPT codes 242 cryotherapy, traumatic edema 100 cyclic idiopathic edema 105 cyst, lymphatic 61, 61 genital 171, 171 D debulking 78 decongestive exercises , 136, 137, lower extremity exercises with a soft ball foot and leg exercises 220 upper extremity arm exercises 218 exercises with a broomstick 219 exercises with a soft ball 219 shoulder exercises 218 deep abdominal technique, manual lymphatic drainage deep inguinal lymph nodes 30 deep popliteal lymph nodes 29 deep venous thrombosis (DVT) 79, 82 83, 260 dehiscence 260 descending hand territory 25 desquamation diabetes 66

3 276 diagnosis 66 diagnostic imaging diffusion 36 37, 36, 261 direct mailings, lymphedema clinic 239 diuretics 77, 261 diverticulitis 261 diverticulosis 261 documentation techniques , 140, 141 dorsolateral territory 28 drainage areas 8 lower extremity 155 lumbar area 150 neck 146, 147 thorax 148, 150 upper extremity 154 see also lymphatic drainage dynamic insufficiency 43 44, 44, 131 management 44 E ecchymosis 261 edema 43 cardiac 258 causes of 40, 41 cyclic idiopathic 105 high-protein edema 38 management 41 phlebolymphostatic protection active passive 42 pulmonary 271 see also lipedema; lymphedema; traumatic edema edema technique, manual lymphatic drainage 119, 119, 120 effleurage 144 elephantiasis 57 58, 94 elevation therapy 75 embryology 4 endothelium 261 epiphysiodesis 177 equipment requirements, lymphedema clinic 239 erysipelas erythema 89, 90 eschar 262 evaluation axillary web syndrome chronic venous insufficiency 83 genital lymphedema limb volume determination lipedema lower extremities 67 lymphedema evaluation form physical evaluation form 247 upper extremities 67 exercise room, lymphedema clinic 239 exercises 230, 231 see also decongestive exercises F face lymphatic drainage drainage areas 147 manual lymph drainage face masks 207, 208 fascia 262 fatty acids 6 fibrosis inguinal lymph nodes 50 lymphostatic 57, 58, 58 radiation fibrosis 61 62, 62 fibrosis technique, manual lymphatic drainage , 120 filaria 262 filariasis 52, 53, 262 filtration 38 40, 39 increased net filtration net filtration pressure 40 fingers bandages 182, 183 self-bandaging 210, 211 compression garments, measuring for , 206 gauntlets with finger stubs or closed fingers gauntlets with thumb stubs 206 decongestive exercises 218 fistula, lymphatic 61 genital 171, 171 fluid volume fluctuation 59 fluorescent microlympangiography 73 foam materials high-density foam 181 soft foam see also padding foot collectors 28 decongestive exercises 220 see also lower extremity forearm, collectors 25 see also upper extremity functional reserve (FR) 42, 42 fungal infections 62, 63 fungating ulcers 89 G gastric bypass surgery 98 gate-control theory 262 gauze bandages 180 genital bandaging female patients 198 male patients fastening system 198, 199 penis 199, 199 scrotum ,

4 Index 277 genital lymphedema 64, , 169, 171 classification clinical picture 170 drainage directions 171 evaluation treatment see also genital bandaging H hand collectors 25 compression garments, measuring for , 206 gauntlets with finger stubs or closed fingers gauntlets with thumb stub 206 decongestive exercises 218 see also upper extremity head lymph nodes 20 lymphatic drainage 18 19, 176 treatment sequences health information consent form 253 heart 2, cardiac insufficiency heat avoidance , 231 hemodynamic insufficiency 44 hereditary, definition 262 high-density foam 181 see also padding high-protein edema 38, 44 high-risk activities 230, 231 high-volume insufficiency 43 hilum hip attachments , homeostasis 263 horizontal watershed 15 hyperemia 59 hyperkeratosis 62, 263 hyperplasia 49, 92 hypoplasia 49 hypoproteinemia 263 hysterectomy 263 I ileus 263 immobility 53 immune function 13 infants see pediatric lymphedema infection 52, 62 fungal 62, 63 skin and nail care 133, 134, 135 wound management inflammation 52, effects on lymphatic system 99 inflammatory rheumatism see rheumatoid arthritis (RA) inflammatory ulcers inguinal lymph nodes 26 deep 30 fibrosis 50 superficial initial lymph vessel plexus 7 insufficiencies combined insufficiency 45 46, 45 dynamic insufficiency 43 44, 44, 131 mechanical insufficiency 44 45, 45, 131 see also chronic venous insufficiency (CVI); venous insufficiencies insurance companies 240 internal jugular lymph nodes 21 internal mammary lymph nodes interstitial fluid colloid osmotic pressure interstitial fluid pressure (IP) 40 intraterritorial anastomoses 9, 16, 17 18, 17 isotope lymphography 73 J jugular trunk 11 K Kinmonth syndrome 50 Klippel Trenaunay syndrome (KTS) knee collectors 28 L Laplace s law 123 latency stage 56 lateral upper arm territory 26 leg see lower extremity letter of medical necessity 254 limb volume determination lipectomy 97 98, 263 lipedema 95 98, 97, 263 definition 95 etiology evaluation pathology/pathophysiology 96 stages 96 therapeutic approach complete decongestive therapy 97 invasive modalities pneumatic compression pumps 97 lipodermatosclerosis 82 lipolymphedema liposuction 78, 97 98, listings, lymphedema clinic 239 lotions 179 low-volume insufficiency 44 lower back exercises 220 lower extremity circumferential measurement chart 141, 249 compression bandaging , hip attachments , self-bandaging ,

5 278 lower extremity decongestive exercises do s and don ts evaluation 67 lymphatic drainage 26 30, 28 deep layer drainage areas 155 superficial layer manual lymph drainage anterior leg , 155 posterior leg , 156 self-mld , treatment sequences bilateral primary lymphedema bilateral secondary lymphedema , 164 unilateral primary lymphedema unilateral secondary lymphedema , 162 venous dynamics 79 80, 79 lower leg collectors 28 lumbar area drainage areas 150 manual lymph drainage lumbar lymphatic trunks 9 lumpectomy 51 lymph 4 5, 264 formation 7 thickening of lymph angion 8, 8 lymph nodes 12, 13 14, 13, 14,266 accessory 21 antecubital 25 axillary 22 dissection 50 functions head 20 inguinal 26 deep 30 superficial internal jugular 21 neck 20 occipital 19 parasternal (internal mammary) parotid 18 pelvic 27, 27 popliteal 28, 29 deep 29 posterior auricular 18 sentinel lymph node biopsy submandibular 18 submental 18 supraclavicular 21 trunk 24 lymph sacs 4 lymph time volume (LTV) 42 lymphadenitis 52, 264 lymphangiectasia 49, 264 lymphangiogram 264 lymphangiography 264 lymphangioma lymphangiomotoricity 8, 59 lymphangiopathy 56 lymphangitis 52, 265 lymphatic cysts 61, 61 genital 171, 171 lymphatic drainage 18 30, 19 lower extremity 26 30, 28 deep layer superficial layer mammary gland 22 23, 23 neck anterior group 19 lateral group 21 scalp and face trunk 21 23, 22, 23 upper extremity 24 26, 25 deep layer 26 superficial layer see also drainage areas; lymph nodes lymphatic fistula 61 genital 171, 171 lymphatic loads 5 6 cells and particles 6 fatty acids 6 protein 5 water 5 6 lymphatic reflux 8 lymphatic return 5, 9 lymphatic safety factor 8, 42 43, 43, lymphatic system 3 14, 10, 265 components 4 14 lymph fluid 4 5 tissues 11 14, 13 vessels 6 11, 13 development 4 discovery of 112 functional reserve (FR) 42, 42 insufficiencies combined insufficiency 45 46, 45 dynamic insufficiency 43 44, 44, 131 mechanical insufficiency 44 45, 45, 131 physiology topography 4 transport capacity (TC) 42 lymphatic territories 8 9, 16 lymphatic vessels 6 11, 13 capillaries 6 7, 6 collectors 8 9, 8 precollectors 7 8 trunks 9 11, 11 lymphatic watersheds 9, 14 17, 15, 16 between trunk and extremities horizontal watershed 15 sagittal watershed lymphedema 44 45, 48 78, associated conditions 64 cardiac insufficiency diabetes 66 obesity 65

6 Index 279 orthopedic problems 65 orthopedic venous insufficiencies 65 66, 65 avoidance mechanisms collateral circulation 60 lymph vessels in adventitia of blood vessels 61 lympho-lymphatic anastomosis 60, 60 lympho-venous anastomosis 60 macrophages 61 safety factor children see pediatric lymphedema complications congenital 50 definition 48 diagnosis 66 diagnostic imaging documentation techniques , 140, 141 etiology 49 55, 49 primary lymphedema 49 50, 49, 51 secondary lymphedema 49, 50 55, 51 evaluation form genital see genital lymphedema grading 58, 59 incidence precipitating factors 59 stages of 55 58, 55, 74 stage 0 56 stage 1 56, 56 stage stage , 58 therapy 41, 46, 73 78, 74 elevation 75 massage 75 medication nutritional aspects 77 pneumatic compression pump surgical 78 thermo therapy 75 two-phase approach see also complete decongestive therapy (CDT); manual lymph drainage (MLD); treatment sequences lymphedema clinic equipment 239 marketing issues personnel 238 space required lymphedema praecox 50 lymphedema program lymphedema tarda 50 lympho-lymphatic anastomoses 60 lympho-venous anastomoses 60 lymphocele 266 lymphocytes 13, 266 lymphography direct 73 indirect 73 isotope 73 lymphoma lymphorrhea 267 lymphoscintigraphy 73 lymphostasis 267 lymphostatic elephantiasis lymphostatic fibrosis 57, 58, 58 M macromolecule 267 macrophages 61, 98 99, magnetic resonance imaging (MRI) 73 malignant lymphangiosis 63, 64 malignant tumors 53, 54, 63 mammary gland lymphatic drainage 22 23, 23 manual lymph drainage (MLD) 69, , , abdomen deep abdominal treatment , 153 superficial abdominal treatment 152 basic strokes pump 115, 116 rotary , 118 scoop , 117 stationary circles 115, 116 contraindications cyclic idiopathic edema 105 deep abdominal technique development of 113 edema technique 119, 119, 120 effects of face fibrosis technique , 120 genital area lower extremity , , anterior leg , 155 posterior leg , 156 lumbar area neck abbreviated neck sequence 146 lateral neck and submandibular area , 145, 146 posterior neck and occipital area pediatric lymphedema 178 reflex sympathetic dystrophy 104 self-manual lymph drainage 137 self-mld lower extremity , upper extremity , manual lymph drainage (MLD) thorax anterior , 151 posterior , 149 traumatic edema upper extremity , 154, , vasa vasorum technique 121, 121 marketing issues, lymphedema clinic massage 75 mastectomy 51 materials compression therapy , 188 lymphedema program

7 280 measuring board 139 mechanical insufficiency 44 45, 45, 131 management 45 medial upper arm territory median forearm territory 25 medication medium-risk activities 230, 231 megalymphatics 49 Meige s disease melanoma mesothenar territory 25 Milroy s disease 176 modified radical mastectomy 51 monocyte 269 N nail care 133, 134, 136 National Lymphedema Network 239 neck exercises 218 lymph nodes 12, 20 lymphatic drainage 19 21, 176 anterior group 19 drainage areas 146, 147 lateral group 21 manual lymph drainage abbreviated neck sequence 146 lateral neck and submandibular area , 145, 146 posterior neck and occipital area neck straps 207, 208 treatment sequences necrosis 89 wounds negative-pressure therapy 94, 95 nephrotic syndrome 269 net filtration pressure 40 net reabsorption pressure 40 Noonan s syndrome 177 nutritional aspects 77, 230, 232 O obesity 65 occipital lymph nodes 19 open junction 7 orange peel skin 96 orthopedic problems 65 osmosis 37 38, 37, 269 colloid 38 osmotic pressure colloid 38 P padding materials 180 lower extremity 190, , , foot , 197 self-bandaging 214, 214 upper extremity , , 187, 188, 189 self-bandaging , 211 palliative care 270 pannus 102 pantyhose, measurements for , 203 custom-made pantyhose 204 standard-size pantyhose 204 papillomas 69, 270 paralysis parasternal (internal mammary) lymph nodes parasternal trunk 11 paresis Parkes Weber syndrome (PWS) 177 parotid lymph nodes 18 patient education decongestive exercises lower extremity upper extremity information of lymphedema precautions lower extremity upper extremity self-bandaging lower extremity , upper extremity , self-manual lymph drainage lower extremity , upper extremity , patient information form 244 pediatric lymphedema compression therapy 178 home care 179 manual lymph drainage 178 pelvic lymph nodes 27, 27 penis, compression bandaging 199, 199 pericervical lymphatic circle perometer 138, 138 personnel requirements, lymphedema clinic 238 phlebolymphodynamic insufficiency 81 phlebolymphostatic edema phlebolymphostatic insufficiency 81 photography release form 251 physical evaluation form 247 pneumatic compression pumps lipedema 97 popliteal lymph nodes 28, 29 deep 29 post-thrombotic syndrome (PTS) 79 posterior auricular lymph nodes 18 posterior axillo-axillary (PAA) anastomosis 18 posterior inter-inguinal (PII) anastomosis 18 precapillary sphincters 35, 40 precollectors 7 8 pressure changes 59 prestage 56 privacy rules consent form 252 progress notes form 250 protein 270

8 Index 281 lymphatic load 5 lymphatic return 5, 5 pulmonary circulation 32, 32, pulmonary edema 271 pulmonary embolism (PE) 82, 83 pump stroke 115, 116 pyoderma gangrenosum (PG) R radial forarm territory 25 radial hand territory 25 radiation fibrosis 61 62, 62 radiation therapy secondary lymphedema and 50, 52 skin changes radical mastectomy 51 reabsorption 38 41, 39 increased net reabsorption 41 net reabsorption pressure 40 reception area, lymphedema clinic 239 rectum, lymphatic drainage 9 reflex sympathetic dystrophy (RSD) , 271 definition lymphatic involvement 104 pathology and stages 104 therapeutic approach 104 reflux 61 reimbursements reversible stage 56 rheumatoid arthritis (RA) definition 101 effects on lymphatic system pathophysiology therapeutic approach 103 right lymphatic duct 11 rotary stroke , 118 S safety factor 8, 42 43, 43, sagittal watershed scalp lymphatic drainage scars scoop stroke , 117 scrotum, compression bandaging 198, , sebaceous 272 self-bandaging techniques 135 self-induced lymphedema 53 55, 55 self-management sentinel lymph node biopsy sequential intermittent pneumatic compression (SIPC) 76 serum sickness 272 short-stretch bandages 181 lower extremity , self-bandaging , upper extremity , self-bandaging , wide-width short-stretch bandages 181 shoulder exercises 218 shower requirements, lymphedema clinic 239 sickle-cell anemia 89 skin care 133, 134, 136, 230, 232 skin lesions avoidance , 231 types associated with lymphedema failed surgical sites 91 radiation-related skin changes tears/excoriations ulcerations see also wounds skin traction 71, 71 soft ball exercises 219, space requirements, lymphedema clinic spontaneously irreversible lymphedema 56 Starling, Ernest Henry 38 stationary circles technique 115, 116 Stemmer sign 56, 57, 69 stent 272 Stewart-Treves syndrome 58, 63, 84 stockinettes lower extremity 190, 190 self-bandaging 213, 214 upper extremity 182, 183 self-bandaging 210 stockings, measurements for , 203 custom-made knee-high stockings 203 custom-made thigh-high stockings 204 standard-size knee-high stockings 203 standard-size thigh-high stockings 204 storage room, lymphedema clinic 239 stretched-pore phenomenon 80 subclavian trunk 11 subclinical stage 56 submandibular lymph nodes 18 submental lymph nodes 18 superficial inguinal lymph nodes supraclavicular lymph nodes 21 supraclavicular trunk 11 surgery debulking 78 liposuction 78 lymphedema therapy 78 secondary lymphedema and 48 49, 50 51, 59 synovial joint anatomy 101, 102 systemic circulation 2 4, 32

9 282 T telangiectasia 61, 62 thermo therapy 75 thigh collectors 28 thoracic duct 9 11 thorax drainage areas 148, 150 manual lymph drainage anterior thorax , 151 posterior thorax , 149 thrombophlebitis 82 83, 272 deep veins superficial veins 82 thymus tight junction 7 toe bandages 190, 191 self-bandaging transport capacity (TC) 42 reduced 50 trauma 52, 59 traumatic edema definition 98 inflammation effects 99 pathophysiology 98, 99 therapeutic approach travel precautions 230, 232 air travel treatment see specific types of treatment treatment rooms treatment sequences, lymphedema management bilateral primary lower extremity bilateral secondary lower extremity , 164 bilateral secondary upper extremity , 160 genital lymphedema head and neck lymphedema lipolymphedema phlebolymphostatic edema unilateral primary lower extremity unilateral secondary lower extremity , 162 unilateral secondary upper extremity , 158 tributary areas 8 trophic 273 trunk lymph nodes 24 lymphatic drainage 21 23, 22, 23 Turner s syndrome 177 U ulcerations 83, arterial fungating wound/malignant ulcerations 89 inflammatory vascular venous 86 ulnar forearm territory 25 ulnar hand territory 25 ultrafiltration 273 upper extremity circumferential measurement chart 140, 248 compression bandaging , self-bandaging , decongestive exercises do s and don ts evaluation 67 lymphatic drainage 24 26, 25 deep layer 26 drainage areas 154 superficial layer manual lymph drainage , 154 self-mld , treatment sequences bilateral secondary lymphedema , 160 unilateral secondary lymphedema , 158 urticaria 273 V vasa vasorum technique, manual lymphatic drainage 121, 121 vasculitis 88 vasodilation 35, 40, 41 active 59 passive 35, 41, 59 veins 2, 3, valves 3, 33 venous dynamics in lower extremities 79 80, 79 see also venous insufficiencies venous Doppler imaging 73 venous insufficiencies 65 66, 65 phlebolymphostatic edema and 172 see also chronic venous insufficiency (CVI) venous ulcerations 86 ventromedial territory 28, 29 venules 3 vests, compression 207, 209 measurements for 207 W water, lymphatic load 5 6 watersheds see lymphatic watersheds Web site listings, lymphedema clinic 239 weight gain fluctuation 59 wounds types associated with lymphedema 85 91, 85 wound bed preparation bacterial control moisture balance 94 95, 94 wound necrosis see also skin lesions