[Diagnosis and treatment of primary and secondary lymphedema]. / Diagnostiek en behandeling van primair en secundair lymfoedeem.

ABSTRACT

Chronic edema is caused by lymphatic impairment due to either overload of interstitial fluid or anatomic/functional lymphatic failure in any part of the body. Lymphatics play a crucial role in interstitial homeostasis, immune surveillance and fat absorption in the gut. Lymphedema is a clinical sign with swelling and not a diagnosis. In the latter stages inflammatory processes lead to fat formation and fibrosis. Untreated lymphedema has an increased risk for erysipelas, physical dysfunction and tends to worsen. Obesity and reduced physical activity are the main influenceable risk factors after oncological treatments in patients with impaired lymphatics. Prior to a multidisciplinary treatment program, a proper diagnosis with health profile is made. Treatment exists of two phases an initial treatment phase and a maintenance phase in which the focus is on compression, self-management, exercise, minimizing risk factors and creating a healthy lifestyle. Clinimetrics are important for monitoring in both phases.