Problems with lymph in the legs what to do. Effective methods of treatment of lymphostasis of the lower extremities with folk remedies. Instrumental diagnostic methods

The rhythm of life of modern people involves spending many hours on their feet. This causes swelling of the legs, and in the future, lymphostasis of the lower extremities develops. If you do not pay attention to edema in time, then lymphostasis develops over time, and its self-treatment at home can only be done at stage 1.

Lymphostasis is a violation of the outflow of fluid that moves through the lymph. It is characterized by an increase in the ankles and calves. The feet and lower legs swell so much that 42 pants need to be changed to 48. In some cases, you have to buy new wide shoes, because the swollen foot does not fit into the old shoes.

The reasons

Lymphostasis of the lower extremities is primary and secondary. At home, treatment can be both medical and non-traditional. The first form of lymphostasis affects people who are genetically predisposed to this pathology. In medicine, it is called Milroy's disease. The disease is transmitted by genes to the inheritance from parents - to children, from children - further down the generations.

Such people are born with pathologies of blood vessels and veins. The diameter of their veins is smaller than that of healthy ones. Because of this, people with congenital problematic vessels have poor blood flow. There are simply anomalies with overgrown or doubled lymphatic vessels.

An underdeveloped lymphatic system can provide a person with many diseases from the first days of his life, including lymphostasis. Congenital tumors in the places of blood flow and lymph almost 100% lead to leg problems.

Lymphostasis of the lower extremities of the secondary type develops as a result of certain processes that occur in the human body. Below is a list of these processes and states. You can get rid of some of the problems if you change your diet or contact a surgeon. Treatment at home should be carried out strictly with the constant consultation of the attending physician.

Process List:

• postoperative scars on the lymph nodes and blood vessels or injuries;
• boils in adipose tissue;
• various neoplasms in soft tissues;
• varicose veins, thrombophlebitis;
• cardiovascular, renal failure;
• bedsores;
• overweight and more.

Forms and stages of the disease

There are 2 forms of lymphostasis - primary and secondary, and stages - 3.

Stage 1 is a harbinger of lymphostasis, and it is called lymphedema. Lymphedema is a reversible process, if you give up bad habits in time and direct all your efforts to treatment.

With lymphedema, edema is localized in the area of ​​\u200b\u200bthe fingers and ankle, and has not yet risen higher.

Stage 2 - fibroedema is already irreversible due to significant damage. Constant stagnation of lymph leads to thickening of the skin and stable pain syndromes. When standing for a long time, convulsions appear. The lower leg increases in size in comparison with a healthy leg up to 50 cm.

Complications of the 2nd stage are manifested in the form of leg deformity, the skin acquires a bluish tint, often cracks, and lymph oozes from the wound for a long time. When rubbing a sore leg with rough clothes, rubbed places heal for a long time.

Lymphostasis of the lower extremities (treatment at home occurs only under the supervision of a doctor), at stage 2, sometimes affects the vessels that are located close to the epithelium, and then the skin on the legs becomes burgundy, like a solid big bruise.

Stage 3 - final. In medicine, it is called elephantiasis. With it, the limb is deformed beyond recognition, and no longer looks like a human leg. It looks like an elephant leg, without the outlines of the feet and knees. Due to thickening of the skin and excess fluid, the leg becomes so heavy and sore that it is impossible to walk with it. It hurts to step on, it hurts to sit for a long time.

People with elephantiasis move around in a wheelchair, with the help of crutches, and can walk independently for short distances within their own apartment. In some cases, the leg grows to such a size that it will not work with it to sit in a stroller.

It is impossible to live with the present pain, the leg is operated on or, in extreme cases, amputated at the request of the patients. People themselves ask to be spared from the elephant's limb, so as not to pull on the floor a leg that weighs more than its own body.

Symptoms

With lymphostasis, characteristic symptoms appear:

• The limb (or limbs) swells, become heavier in weight;
• The skin feels tight, as if it would tear;
• Feeling that the legs belong to another person;
• Pain, and sometimes they are unbearable;
• Suppuration due to recurrent infection;
• Thick skin.

When you press your finger on the swollen place, a dent remains for a while. In healthy people, the skin instantly springs back.

Diagnostics

Lymphostasis of the lower extremities (treatment at home should be postponed until a full study) requires professional diagnosis and prescription by a doctor. In order not to confuse it with temporary edema, you need to contact a phlebologist or lymphologist. A specialist in vascular diseases will do an ultrasound of the abdominal cavity and small pelvis, lymphography to determine the location of the lymphatic block.

Can pathology be cured?

With congenital pathology, surgery sometimes helps. But it all depends on the specific case. Secondary lymphostasis can be cured with medications and folk methods, in combination with massage and exercise therapy at stage 1 of the disease. Stage 2 is difficult to treat, but you can achieve a better quality of life and maintain the result for a long time.

Lymphostasis of the lower extremities (it is better not to start treatment at home before consulting a vascular surgeon) at stage 3 is not treatable.

Alas, the problem can be solved radically - by amputation, or relieve the patient's pain with medication, and physically help him in acquiring special devices for moving around the city and self-service himself in the bathroom and toilet - that is, in everyday life.

Methods of complex treatment at home

If for some reason it is not possible to visit a doctor, but lymphostasis develops due to symptoms, you can start treatment at home with remedies that are not capable of causing significant harm to health and aggravate the situation. At home, you can comprehensively drink vitamins of nicotinic acid and E, learn how to put leeches on your own in the evenings.

Before hirudotherapy, a 20-minute exercise therapy is required in combination with a drainage massage. At night, you need to make a compress (recipes from traditional medicine to help). In the morning, rub Traxevasin into the swollen limb and put on compression stockings.

During the day you need to drink plenty of water, give up salt and pepper, smoked meats. Completely reconsider your diet in favor of steamed food, without meat, but with vitamin vegetables and fruits.

Drug therapy: groups of drugs, names, instructions for use

For the treatment of lymphostasis, broad-spectrum medications are needed that can normalize the work of blood flow and lymph outflow, increase the elasticity of the walls of blood vessels and reduce their fragility and permeability.

For these purposes, drugs of the following groups are good:

• vitamins;
• Solcoseryl;
• immunomodulators;
• antihistamines;
• diuretics;
• antibiotics;
• antiplatelet agents;
• angioprotectors;
• homeopathic remedies;
• benzopyrones;
• phlebotopic agents;
• enzyme preparations.

The treatment regimen for lymphostasis of the lower extremities using the above means is compiled individually, taking into account features such as:

• The form of the disease;
• Stage;
• The condition of the kidneys, liver, heart and the presence of other serious diseases.

Individual intolerance, allergic reactions, compatibility with other drugs are also taken into account if, in addition to lymphostasis, the patient treats other diseases with medications that are not compatible with the above group.

Recipes for folk remedies for compresses

In folk medicine, lymphostasis is treated with an onion compress. It is necessary to dry several large onions in the oven, and put the cooled petals on the leg in the place of edema. Wrap gauze on top, not pinching, but not loose. You need to go to bed with a compressor, take it off in the morning. Potatoes also help. Washed, unpeeled large potatoes should be grated on a fine grater, using gauze to make a compress for 1 hour.

Decoctions for internal use

In combination with a compressor, you need to drink decoctions. Traditional medicine is rich in recipes for all diseases, so it has methods for preparing immunostimulating and diuretic decoctions. Almost all recipes from traditional medicine that contain garlic are suitable for lymphostasis.

Garlic stimulates the immune system. It is not for nothing that it is recommended as the best antiviral folk remedy during the flu season. Immunity restored with garlic suppresses most viruses and bacteria. It makes the immune system work so that it restores the body's diseases on its own, without medication.

Ginger and cinnamon have a similar effect.

Real green tea is a storehouse of antioxidants in the form of catechins. They bind to free radicals that the body cannot eliminate on its own and help to dispose of unnecessary cellular debris from the blood.

For lovers of green tea, ginger and cinnamon, a tea cocktail from the listed ingredients can act as a decoction. If you replace green tea with raspberry leaves, you can prepare a decoction and infuse it for several hours.

Infusion Recipes

Garlic crushed in a blender must be poured into 350 g of liquid honey, corked in a glass jar and left for 7 days in a dark corner at room temperature. If there is no allergy to honey, you can take a teaspoon on an empty stomach every 2 hours, but no later than one hour before a meal.

2 tbsp. l. pharmaceutical plantain should be poured into a half-liter jar of boiling water, insist for a day. It is advisable to drink the contents of the jar during the day, in 3 visits, before meals. Freshly squeezed red beet juice cleanses the lymph well. A bitter, nasty, but effective juice can be made from green dandelion and plantain leaves.

Massage: how it works, technique

Massage with lymphostasis is best entrusted to a specialist. He will be able to "squeeze out" excess fluid from the places of accumulation upwards without damaging the vessels. When conducting a massage on your own, you need to knead with rubbing movements from the bottom to the top. Visually, it looks like trying to put on invisible tights.

Hirudotherapy: features of treatment, duration

Hirudotherapy used to be part of official medicine, but over time it moved into non-traditional and folk medicine. The peculiarity of the treatment is that leeches do not drink thick blood, so nature endowed them with a coagulant. When bitten, a leech injects its enzyme into a person’s blood, and it locally liquefies at the site of the bite. Liquid blood passes through the vessels more easily.

Leeches are sold in some pharmacies, so hirudotherapy can be done at home. Enough 2 leeches a day. Apply to the place of the greatest accumulation of excess fluid. When the bodies of leeches grow in volume, they must be removed and disposed of. Or wait until they fall off on their own, but it will take a long time to wait.

Remove leeches with a cotton swab dipped in alcohol. The bite must be treated to prevent infection.

The bite site can bleed for up to 16 hours and release up to 300 ml of lymph with blood. This is due precisely to the enzyme, which continues to work and thin the blood when the leeches are flushed down the toilet. There is nothing wrong with this, but it is worth considering. That is, it is better to carry out hirudotherapy from evening to night, so that during the day you do not have to walk with bloody smudges on your legs.

Diet: rules, list of prohibited and allowed foods

Most often, overweight people suffer from lymphostasis, so treatment will be more effective when adjusting nutrition. First of all, salt must be removed from the diet, because it retains excess fluid, which must be disposed of during lymphostasis. When using salt, taking diuretic medications and infusions is completely useless, sometimes harmful.

Speaking of limiting salt, we are also talking about reviewing ready-made products from the store, which contain sodium. It makes no sense to eat fresh home-made borscht mixed with smoked sausage from the store. With lymphostasis, you need to drink plenty of clean fresh water. Not liquids like tea, coffee, mineral water and juices, but pure clear water without gas, salt, minerals.

In general, you need to stop consuming:

• soda;
• boxed juices;
• coffee;
• kvass and beer;
• tana and ayran;
• kefir and yogurt.

You can drink only green tea without sugar, fresh juices and herbal infusions. Hot spices are banned. Food should become dietary, so you need to forget about the pan, and instead buy a double boiler and master recipes with baking in the oven without oil. Diet food includes a maximum of fruits and vegetables, a minimum of meat and eggs.

From protein are allowed:

• mushrooms;
• River fish;
• seafood.

Exercise therapy: a list of exercises and the technique for their implementation

The effectiveness of exercise therapy for lymphostasis depends on the stage of the disease. If the disease is at the initial stage, the swelling is weak, and the legs do not hurt when walking, then you can do active cardio training. But not all types of training are suitable, and there are limitations.

Cardio training should pump the cardiovascular system, expel excess fluid with toxins through sweat, but training should not injure the knee joints and feet. Accordingly, jumping rope and running are excluded, and classes on a stationary bike, elliptical trainer, rowing and swimming are suitable. 40 minutes a day or every other day is enough.

In all other cases, leg exercises “bike” or “scissors” are suitable. To do this, you need to lie on the floor and with your feet on weight depict pedaling or crossing the scabbard. The toes need to be kneaded, so they can make flexion-extension movements.

We must not forget about the ankles. They need to rotate clockwise and counterclockwise. You can practice from 20 to 60 minutes a day, preferably without gaps. At the initial stage of the disease, you can combine cardio training with home gymnastics on the floor, and at an advanced stage, cardio training in the form of swimming. They can be carried out on days when swelling is minimal and the legs do not hurt.

Possible Complications

If you do not follow a diet, self-medicate with drugs that are not suitable for a particular organism or have intolerance due to a number of other diseases, aggravate all this by running at the last stage of the disease and massage, after which bruises remain, then you can bring your limbs to elephantiasis and trophic ulcers. In severe cases, you can lose your legs.

Forecast

It is difficult to make predictions for the successful treatment of the disease, because lymph stasis affects other diseases that further aggravate lymphostasis. In treatment, it is important that the patient himself understands his problem, and complies with all the doctor's instructions. He did not break into eating sweets and smoked meats, he gave up smoking and alcohol, regardless of nicotine and alcohol addiction.

And if the patient's work is associated with spending the working day on his feet, lifting weights or sitting at the computer for 12 hours without getting out, then, understanding all the impossibility of combining such work and treatment, agreed to a job change. Money plays an important role.

It is cheaper to eat sausage for a promotion than vegetables and fruits in winter, pine nuts and high-quality seafood. Making infusions and freshies cost money. The patient must be able to provide financially high-quality treatment and nutrition. Under such conditions, getting rid of the initial stage or minimizing the consequences of the advanced stage becomes more real.

Prevention

Any disease is better to prevent than to treat its consequences.

1. The main enemy of all mankind is nicotine. It is capable of causing all fatal diseases, in which lymphostasis of the lower extremities will become one of the symptoms in the chain of more serious diseases.
2. Heels. Wearing high and thin heels in youth seems to be commonplace. But the legs under the uneven distribution of body weight suffer. From the load, small vessels burst, veins increase. The feeling of mild and barely noticeable discomfort can last from 5 to 20 years, but one day this condition will begin to progress. Not every woman can guess that lymphostasis of the legs at the age of 40 is the result of many hours of defile in high heels at the age of 20.
3. Excess weight. As with heels, gaining weight at a young age seems like harmless overeating of sweets. But the process has already started, because because of the ugly diet and bad habits, metabolism is disturbed. It needs to be restored from a young age so that in old age one does not suffer from obesity, edema, and sore legs.

Lymphostasis of the lower extremities can be avoided by wearing compression clothing made from natural materials. If you choose tight pants, then they should be made of breathable elastic material. Pants should not be synthetic and disrupt blood flow so that the treatment of edema at home is not included in everyday life. Their skin needs to breathe.

Video about lymphostasis, its symptoms and treatment methods

More about leg lymphedema:

Treatment of lymphedema:

What it is? Lymphostasis is the development in the body of stagnant lymph processes in the extracellular space of tissues. In addition to the characteristic localizations of the pathology of lymphostasis (in the limbs), other variants of the manifestation of functional disorders of the lymphatic system are also known - in the tissues of the breast, face or scrotum.

According to statistics, more than 200 million people worldwide are subject to lymphostasis, and their main category is women (the age of Balzac's heroines). And the lion's share of violations of the lymph flow is due to localization in two or one lower limb (in almost 90% of cases).

The development of lymphostasis begins with pathological processes that disrupt the functions of small vessels of the lymph system (capillaries, collectors), which is manifested only by subtle swelling in the legs. Gradually, large vessels are involved in the process, leading to trophic changes in the limbs and an increase in their volume, manifesting as elephantiasis.

Genesis of development

Lymphatic outflow disorders can develop due to many reasons. The main ones are due to:

The main genesis of the development of the disease is the accumulation of lymphoid fluid in the intercellular structure of tissues, provoked by an increase in intra-lymphatic pressure caused by an imbalance in the formation and outflow of protein-rich lymph.

This process causes limited or widespread localization of tissue edema. With such edema in lymphostasis of the legs, you can successfully fight, since swelling does not cause thermodynamic (irreversible) tissue changes.

But, when changes in the form of protein destruction begin in the lymphoid fluid, fibrin and collagen fibers develop in the skin and fiber structure, muscle and fascial tissues.

The rapid growth of connective tissue leads to thermodynamic changes in the affected tissues, in the form of cicatricial neoplasms that inhibit blood flow, disrupt trophism, and provoke the development of inflammatory reactions. In accordance with the causative factor, two forms of lymphostasis are distinguished in the development of the disease:

1. Primary, due to congenital anomalies in the development of the ducts of the lymphatic system, with the manifestation of symptoms from early childhood, or in early puberty.
2. Secondary, characterized by the development of the disease due to various pathological conditions. In addition to lymphedema affecting the lower and upper limbs, this group also includes lymphostasis of the hand after mastectomy.

Symptoms of lymphostasis by stages and localization

lymphostasis, photo of symptoms after breast removal

In principle, the pathological signs of the primary and secondary forms of lymphostasis do not have any special differences. In the secondary variant, the symptoms of lymphostasis of the lower extremities manifest themselves in accordance with the severity of clinical manifestations due to the stages of the disease:

1) The beginning of the primary stage of lymphostasis is marked by the formation of a persistent and growing edema during the day on the back of the feet. The skin is stretched and shiny. Light pressure leaves a depression, which soon straightens out.

In addition to a slight discomfort in the form of bursting, the patient does not feel. There are no pain symptoms - since the swelling disappears by morning, the patients have no particular concerns, and no one is in a hurry for medical help. Although it is in this period that the treatment of lymphostasis gives the most effective result.

2) Signs of the second stage are characterized by fibrotic changes in edematous tissues. The consistency of edematous tissues is dense, with pressure, pain is noted, a deep trace remains for a long time. The skin over the edema is hypersensitive and has an unattractive appearance.

Its surface is dry, covered with cracks and folds that do not level out when stroked. At this stage of lymphostasis, there are no clear symptoms of traffic disorders yet, but inflammatory reactions are noted that appear on the skin in the form of small hyperemic spots. Often there are muscle cramps.

3) In the third stage of lymphostasis, noticeable changes occur in the skin. It is cracked, dry, and severely stretched. Massive swelling is very noticeable, which visually increases the size of the affected limb. A diffuse red spot appears on the skin - evidence of the development of inflammation reactions and infection. Over time, obvious signs of trophic damage to the skin cover appear.

4) At the fourth, last stage of the development of the disease, it manifests itself with extensive signs of damage to the limbs, spreading to the lower leg and femoral zone. Pathological changes cover the joints and bones, causing their deformation.

The limb loses its original size, greatly increasing. In tissue structures, areas of induration (compaction) and fibrosis with an unnatural bluish tint are noted. In the absence of treatment of lymphostasis, warty neoplasms and oozing ulcers (trophic) may appear.

- often a phenomenon - the loss of part of the lymph nodes, along with the tissues of the gland itself, its fiber and muscle tissue, does not stop the function of the lymphatic system, resulting in the accumulation of lymphoid fluid in the tissues, forming edema. Its excess can seep through the surgical sutures, which is often regarded by patients as the release of postoperative ichor.

Puffiness, after surgery, develops on the arm from the side of the pathological process. The symptomatology corresponds to the general signs that appear at different stages of lymphostasis.

The most terrible complication at the last stage of the disease is sepsis or the development of dense swelling (fibriderm) - this is an irreversible process that cannot be reversed.

In the vast majority, lymphostasis of the hand after mastectomy does not require treatment, it goes away on its own for six months. Facilitate the situation of self-massage manipulation, and special therapeutic exercises recommended by the doctor.

Treatment of lymphostasis - drugs and methods

Unfortunately, there is no single protocol for the treatment of lymphostasis today, although therapy is being carried out. Its purpose is due to:

1. Stopping the progression of the disease;
2. Normalization of metabolic processes;
3. Preventing the development of deep lesions and complications.

Treatment is individual and complex, due to the different genesis of the pathology. First of all, it begins with the elimination of the causative factor (sometimes by an operative method that eliminates neoplasms that impede the movement of lymph).

The use of drug therapy in the treatment of lymphostasis of the lower extremities is advisable only in the early stages of its manifestation, when there are still no structural changes in the tissue and skin structure, or as an addition in the postoperative period. Its goal is to reduce the secretion of lymphoid fluid and restore its free movement with the help of various medications:

• Drugs that improve the processes of lymphatic circulation - "Detralex", "Venoruton", "Troxevasin".
• Normalizing blood circulation in micro-vessels - "Trental" and peripheral vessels - "Theonicol", "Drotaverine" or "No-shpy".
• Providing the withdrawal of lymph from the interstitial space - "Nicotinic acid" or "Coumarin".
• Means that ensure the normalization of metabolic processes and tissue traffic - Troxerutin, Hyaluronidase and Reopirin.
• Means that thin the blood - "Kurantila" and stimulate immune functions: "Succinic acid", "" and various vitamin complexes.
• Antibiotics, with the addition of erysipelas.

In addition to conservative treatment, methods of physiotherapeutic treatment are prescribed in the form of electro, magneto, laser stimulation and pneumomassage. That allows you to speed up metabolic processes and normalize the flow of lymph through the system. Together with drug treatment of lymphostasis, these procedures contribute to the normal restoration of lymphatic outflow and strengthening of the vascular walls.

When therapeutic treatment fails, numerous surgical techniques are used. Of all the options, liposuction, lymphangiectomy, lymphatic drainage, and combinations thereof are the most commonly used.

In the treatment of lymphedema in the lower extremities, including the treatment of lymphostasis after mastectomy, along with drug therapy and physiotherapy, it is mandatory to bandage the extremities with an elastic band and use compression therapy (use of compression underwear).

How can you help yourself?

massage and compression underwear

Treatment of lymphostasis of the lower extremities at home is possible only at the initial stage of the development of the disease. Various methods of kinesiotherapy (active and passive) recommended by a doctor can be used - active kinesiotherapy in the form of therapeutic exercises selected by a specialist and passive techniques in the form of massage. Therapeutic massage can be carried out independently, or with the help of household members.

1) Massage should begin with light circular strokes of the limb only with upward movements. Since the lymphatic system does not have a valve apparatus, the movement of the lymph provides a pressure difference, and this is precisely the function that the hands should perform.

2) Then there are not too zealous kneading, patting and rubbing. Massage movements alternate with stroking actions.

3) Stroking and finishing the massage session.

Massage with lymphostasis is carried out in a course of two weeks, taking breaks between courses for 1-2 weeks. It should be remembered that exercise therapy exercises should only be done in compression underwear (stockings, leggings, golfs).

As an addition to treatment, it is possible to use traditional medicine recipes, in the form of compresses from cabbage leaves, plantain, birch and immortelle, brewed and infused for half an hour.

About food and diet

Treatment of lymphostasis will not be successful even at its initial stage, if the diet is not corrected, aimed at reducing the patient's excess weight, which aggravates the clinical picture and restores normal processes in the vascular system. For this, the diet recommended by the scientist M.I. Pevzner is suitable, the diet of which consists of a balanced and complete piranha, which has a beneficial effect on circulatory functions.

At the same time, you should abandon solarium procedures, visiting saunas and public baths, uncomfortable and tight shoes and clothes, avoid lifting weights, avoid situations where you need to stand for a long time, or sit in an uncomfortable position.

Treatment prognosis

The result of the untimely start of treatment of lymphostasis is disability. In addition, the timeliness of identifying the causative factor and adequate treatment can protect patients from the development of infectious processes, the prerequisite for which are erosions, ulcers and ordinary wounds on the edematous surface of the skin.

• Vitiligo - what is it? Photos, causes and treatment, ...

- This is a pathology of the lymphatic system, accompanied by impaired lymph circulation and retention of lymphatic fluid in the tissues. With lymphostasis, tissue thickening, persistent edema and a noticeable thickening of the limb (lymphedema), skin ulcers occur. Determination of the cause of lymphostasis requires ultrasound of the small pelvis, abdominal cavity, vessels of the extremities, chest x-ray, lymphography, lymphoscintigraphy. Treatment of lymphostasis can be non-surgical (massage, compression therapy, hirudotherapy, medicines) and surgical (reconstruction of lymphovenous anastomoses).

ICD-10

I89.0 Q82.0

General information

Lymphostasis (lymphatic edema, lymphedema) develops when the processes of lymph formation and its outflow through the capillaries and lymphatic lines from the organs and tissues of the extremities to the main lymphatic collectors and the thoracic duct are disturbed. According to WHO statistics, about 10% of the world's population suffers from lymphedema. With lymphostasis, there is a constant progressive swelling of the limb and its increase in volume, thickening of the subcutaneous tissue, coarsening of the skin, hyperkeratosis, cracks and ulcers. The progression of lymphostasis to the development of elephantiasis (hypertrophy of the limbs) causes psychological and physical suffering of the patient and leads to disability. Treatment of lymphostasis is carried out by specialists in the field of phlebology and lymphology.

Causes of lymphostasis

The development of lymphostasis can be due to a wide range of factors. Violation of lymphatic circulation with lymph retention in the tissues occurs with heart failure, kidney pathology, hypoproteinemia, when the lymphatic lines cannot cope with the outflow of lymph. Lymphostasis may be a consequence of chronic venous insufficiency in decompensated forms of varicose veins, post-thrombophlebitis syndrome, arteriovenous fistulas. The removal of an excess amount of tissue fluid leads to a compensatory expansion of the lymphatic vessels, a decrease in their tone, the development of valve insufficiency and lymphovenous insufficiency.

The causes of lymphostasis can be malformations of the lymphatic system, obstruction of the lymphatic vessels when they are damaged (mechanical and surgical injuries, burns), compression by tumors or inflammatory infiltrates that prevent lymph flow. With lymphadenitis and lymphangitis, obliteration of some lymphatic vessels leads to expansion and valvular insufficiency of others, which is accompanied by lymph stasis.

X-ray lymphography, lymphoscintigraphy with Tc-99m, MRI, CT are used to determine the location of the lymphatic block and the patency of the vessels. These techniques make it possible to judge changes in the lymphatic bed, identify areas of tortuosity, lymphangiectasia, and valvular insufficiency.

Lymphostasis is differentiated from deep vein thrombosis and postphlebitic syndrome, in which the lymphedema is unilateral, the edema is soft, the presence of hyperpigmentation, varicose eczema and varicose veins is determined. To exclude venous pathology, ultrasound of the veins of the extremities is performed.

Treatment of lymphostasis

The goal of treating lymphostasis is to restore the outflow of lymph from the limbs or other organs. With lymphostasis, the appointment of manual lymphatic drainage massage, hardware pneumocompression, physiotherapy (magnetic therapy, laser therapy, hydromassage), selection and wearing of compression stockings is indicated. The patient is advised to follow a diet with salt restriction, exercise therapy, swimming, Nordic walking. From drug therapy, phlebotonics with lymphotropic action, enzymes, angioprotectors, immunostimulants are used. With trophic ulcers and eczema, their local treatment is carried out.

With lymphostasis, it is necessary to carefully care for the feet in order to prevent the development of lymphangitis. For this purpose, it is better to perform a medical hardware pedicure using special products for hygienic and therapeutic foot care. With the development of a fungal infection, antimycotic agents are prescribed, treatment of the legs with antifungal drugs.

The grounds for surgical treatment of lymphostasis may be the ineffectiveness of complex conservative therapy, the progression of lymphedema, the presence of severe fibrosis and deforming lymphatic sacs. With lymphostasis, they resort to microsurgical creation of lymphovenous anastomoses, liposuction and dermatofasciolipectomy.

In the case of primary lymphedema, transplantation of a full-fledged tissue lymphoid complex is indicated. With severe elephantiasis, which excludes the possibility of radical operations, tunneling of the affected areas is performed to divert lymph into healthy tissues, resection interventions.

Forecast and prevention

Failure to treat lymphedema contributes to even greater lymphatic tissue edema, impaired limb mobility, and the development of chronic infection. Regardless of the stage at which lymphostasis was diagnosed, patients require supervision by an angiosurgeon. Course maintenance therapy for lymphostasis should be carried out for life.

Careful care of the skin of the hands and feet, timely treatment of any wounds and prevention of their infection can prevent violation of lymph circulation in the limbs. Treatment of diseases of the kidneys, heart, venous vessels should be carried out in order to avoid decompensation of the pathology. To prevent the development of postoperative lymphedema, in recent years, mammology has abandoned total lymph node dissection during radical mastectomy and is limited to the removal of sentinel lymph nodes.

Lymphostasis of the lower extremities is a disease caused by a violation of the outflow of lymph, which is manifested by constant swelling of one or both legs and is the cause of complications that are difficult to treat. Left untreated, lymphedema leads to gradual disability and severe disfiguring thickening of the legs.

The lymphatic system is a network of specialized vessels (lymphatic vessels) of the body, the purpose of which is to collect excess tissue (lymphatic) fluid with proteins, lipids and tissue waste products. This fluid is then collected in the lymph nodes, which filter out waste products and infection using specialized lymphocyte cells. The filtered lymph is eventually diverted into the general circulation.

Blockage of lymphatic vessels or lymph nodes leads to stagnation of lymph, swelling of the subcutaneous tissue and the development of cicatricial process and elephantiasis. The disease most often affects one leg, but in rare cases both limbs are affected. Chronic lymphostasis of the leg is called lymphedema. The presented photo shows that with lymphostasis, thickening of the fiber and expansion of the lymphatic vessels occurs.

Causes of lymphostasis of the lower extremities and risk factors

Primary lymphedema

Primary (congenital) lymphedema is a rare hereditary disease. It is a consequence of anatomical abnormalities of the lymphatic vessels or lymph nodes. Congenital (primary) lymphostasis of the leg is most often associated with underdevelopment of the lymphatic drainage system, sometimes there are cases of congenital amniotic constrictions (scars) that compress the superficial lymphatic vessels. There are cases of a hereditary form of the disease, which manifests itself in several members of the same family at once.

Primary lymphedema is a pathology of the human lymphatic system. Depending on the age at which symptoms develop, three forms of congenital lymphedema have been described.

• Congenital lymphedema presenting at birth is more common in women and accounts for approximately 20% of all cases of primary lymphedema. This lymphedema is called Milroy's disease.
• Lymphedema parecox is the most common form of primary lymphedema, most commonly seen in women. It is defined as a disease that becomes apparent during puberty and before the age of 35 years.
• Tarde's lymphedema becomes apparent after 35 years of age. It is less common than other forms.

Secondary lymphostasis

Other reasons:

• soft tissue tumors
• Postoperative scars in the groin area
• Inflammatory or tumor processes in the lymph nodes
• Surgical removal of inguinal and pelvic nodes
• Traumatic damage to the lymphatic pathways
• Radiation therapy
• Inflammatory processes in the skin, subcutaneous tissue, lymph nodes.

The course of the disease

Lymphedema is a continuously progressive disease that leads the patient to disability. If in the early stages lymphedema brings only aesthetic inconvenience, then later the disease - lymphostasis makes life difficult for patients.

An increase in the volume and weight of the affected limb leads to an increased load on the affected leg. Often, these patients develop arthrosis of the hip and ankle joint, which leads to limited physical activity and contributes to weight gain. Lymphostasis of the legs causes symptoms, the treatment of which requires great effort from the patient and doctors.

Patients with lymphostasis are characterized by the frequent development of erysipelas of the skin, accompanied by high fever, pain when touched. Although erysipelas is well stopped by modern antibiotics, each episode of inflammation aggravates the course of lymphedema and leads to an increase and induration of edema.

At the extreme stage of lymphedema, the outflow of lymph from cracks in the skin and the formation of extensive trophic ulcers develop. This condition is potentially dangerous by the development of a general blood poisoning (sepsis) and requires active treatment in a hospital.

Treatment of lymphostasis in the Innovative Vascular Center

In the Innovative Vascular Center, the best treatment scenario for lymphostasis is currently used. Our clinic combines a network of lymphology rooms in outpatient vascular centers, a lymphology clinic with conservative treatment of lymphedema, and a surgical hospital where microsurgical operations are performed to improve lymph outflow.

For the first time, the innovative vascular center was able to transfer the experience of the leading lymphological clinics in Germany to our country. The lymphologists of our center have been trained in one of the leading clinics for the treatment of lymphostasis in Germany and are well aware of how lymphostasis of the affected lower extremities can be treated with modern methods.

The Rehabilitation Department of Lymphedema has comfortable rooms with all amenities. The sanatorium is located in a forest area, has everything for rest and treatment. For physiotherapy exercises, special routes through the forest with ups and downs are organized. The method of treatment and diet are specially selected according to the recommendations of the doctor of medicine F.-J. Schingale is a recognized specialist in the treatment of lymphedema.

The specialists of our center can treat lymphostasis with the help of modern microsurgical technologies. We have introduced into Russian clinical practice microsurgical operations of lymphovenous anastomoses for lymphedema of the legs, transplantation of lymph nodes. Our surgeons have extensive positive experience in reconstructive plastic surgery for elephantiasis. Every year, our surgeons make life easier and restore health to dozens of patients with severe chronic lymphostasis.

The Innovative Vascular Center is the only medical organization in Russia that has an inpatient department for the treatment of lymphedema. All modern methods of conservative and surgical treatment allow achieving impressive results in treatment. Only a stationary approach, followed by outpatient monitoring and treatment, allows you to achieve the best results in lymphostasis of the legs.

Treatment is carried out in clinics:

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Advantages of treatment in the clinic

The experience of German clinics transferred to Russia

Top MLD Specialists

Complete rehabilitation program

Surgery for elephantiasis

Lymphatic venous microanastomoses

Lymph node transplants

Diagnostics

Signs of lymphostasis of the legs

The constant accumulation of fluid and proteins in the tissues leads to inflammation and subsequent scarring of the tissues, resulting in a hard, tight swelling. The skin in the affected area thickens, becomes bumpy with papillary growths. Scales and cracks appear through which a secondary bacterial or fungal infection can join. Affected areas of the skin can become inflamed and hurt, trophic ulcers often form. Lymphostasis can cause deformations of the soft tissues of the legs, which leads to a decrease in the range of motion in the joints and impaired mobility of the patient. Lymphostasis has the following stages:

First stage- characterized by the occurrence of edema in the ankle joint, the base of the fingers and on the back of the foot. Symptoms of lymphostasis of the lower extremities of the initial stage: mild and painless swelling, which disappears some time after rest. The skin over the edema may fold.

Second stage- the edema does not completely disappear, however, with a long stay of the patient in a horizontal position, it may decrease. Compaction of the subcutaneous tissue is not observed. However, if the conditions causing lymphostasis persist, thickening of the connective tissue begins to develop and treatment becomes more difficult. Swollen feet and fingers can draw the attention of others.

Third stage- Fibredema stage. This stage develops slowly. Fibredema is characterized by constant and dense swelling and does not go away with prolonged rest, the skin cannot be folded. The swollen leg is deformed, increases in volume, its physical capabilities worsen. With a long duration of the disease, hyperpigmentation of the skin, hyperkeratosis, warty formations on the feet develop. At this stage, most patients are already thinking about how to treat lymphostasis of the affected limbs.

Fourth stage- The formation of ulcers and cracks on the skin, accompanied by abundant outflow of lymph, worsens the course of the disease. The difference in the volume of the affected and healthy limbs can be more than 50 cm. The patient may be disabled due to the inability to walk and bend the joints.

To establish the correct diagnosis, it is necessary to examine a lymphologist with a thorough history taking, measuring the volume of the limb at different levels, assessing the density of the subcutaneous tissue, and the presence of trophic changes. The color, presence of hair, visible veins, size, and any ulcers or lymphatic leakage are noted. Lack of hair may indicate a problem with arterial circulation. The circumference of both limbs is measured at various levels.

Diagnosis is usually based on an objective measurement of the difference between the affected or at-risk limb and the opposite, unaffected limb, such as volume or circumference. After detecting edema, it is necessary to conduct a differential diagnosis with other diseases.

Chronic venous insufficiency can mimic early lymphedema, however, in this pathology, the volume is increased due to deep tissue edema, and there is no symptom of a fossa when pressed. Leg lymphedema should be distinguished from edema in heart failure. They are usually bilateral and are accompanied by fluid accumulation in the abdominal and thoracic cavities, shortness of breath, and cyanosis. Local accumulation of adipose tissue - lipedema can also mimic lymphedema. Lipedema is common in overweight women.

Instrumental diagnostic methods

In order to plan surgical interventions, additional diagnostic methods are carried out. Ultrasound examination of the veins makes it possible to exclude venous pathology as the cause of edema. To determine the nature of changes in the subcutaneous tissue, a study of soft tissues is carried out. Ultrasound reveals the accumulation of lymph in the subcutaneous tissue, thickening of the superficial fascia. With lymphedema, free "lakes" of fluid in the subcutaneous tissue can be determined. Using ultrasound, you can evaluate the effectiveness of conservative and surgical treatment.

Lymphography is a method of contrast study of lymphatic vessels. It implies direct injection of contrast into a peripheral vessel and X-ray control over the movement of the contrast agent. Lymphography allows you to identify the level of block lymph flow. Lymphography is a mandatory method before planning a surgical intervention.

Lymphoscintigraphy is a method of isotopic research, which determines the level of the lymphatic outflow block and the condition of the lymph nodes. The method does not allow to finally determine the surgical tactics. We do not use it in preparation for surgical treatment.

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Since lymphostasis is a chronic disease, its treatment must be persistent. The meaning of the treatment is to eliminate excess fluid from the subcutaneous tissue and prevent its subsequent accumulation. Effective treatment stops the progression of the disease and prevents the development of complications. Persistent conservative therapy allows you to keep the volume of the limb at a normal level.

In case of severe changes in the subcutaneous tissue and the ineffectiveness of conservative therapy, our clinic performs the most complex microsurgical operations to improve lymphatic outflow, from lymphovenous anastomoses to lymph node transplantation.

Treatment of lymphedema in the Innovative Vascular Center without surgery

The course of treatment of lymphostasis of the legs during the initial treatment should be at least 14 days, and preferably 21 days. During this time, it is possible to remove most of the edema and select a special compression stocking for the leg. The calculation of some patients that the edema will go away faster is unjustified. Untimely termination of active therapy leads to rapid accumulation of fluid. The task of the specialist is to minimize the volume of the limb so that the use of compression stockings becomes possible. Without it or a good bandage, a relapse is inevitable in the shortest possible time.

Manual and machine lymphatic drainage massage (MLD)

A special massage technique that allows you to completely remove swelling from the affected tissue and prepare the limb for wearing compression products for long-term control. Regular courses of manual drainage can effectively prevent the progression of lymphedema. Pneumatic Compression Devices: These are sleeves or stockings connected to a pump that provides progressive compression from the end of the limb to the body. They can be used in the clinic or at home and are helpful in preventing scarring of the skin.

Compression therapy (volume retention)

A special technique of compression bandaging is called bandaging. It is used in conjunction with manual lymphatic drainage to consolidate the result after the removal of edema between sessions. The goal of conservative treatment is to completely remove the edema so that later the result can be maintained with the help of special compression stockings. Elastic sleeves or stockings for maintaining the effect after conservative therapy have a special structure and provide a pressure gradient from the bottom up to promote effective outflow of tissue fluid.

Physiotherapy

Physical activity and a set of special exercises in the air and in the pool can improve the results of conservative treatment of lymphedema. This complex prevents the development of stiffness in the joints, improves lymphatic drainage and promotes weight loss in patients. Our center has developed a set of special exercises to stimulate physical activity and improve the results of treatment of leg lymphostasis.

Surgery

Modern surgical methods for the treatment of lymphostasis are aimed at improving the outflow of lymph, or removing excess fibrous tissue. In our clinic, microsurgical methods for restoring the patency of the lymphatic tract and transplantation of lymph nodes are actively used. Lymphatic venous anastomoses - an operation to create an outflow of lymph into the smallest veins, which leads to the correction of venous outflow. The innovative vascular center has unique and exclusive technologies for the surgical treatment of lymphedema.

In the case of elephantiasis, resection methods of treatment are used - removal of altered skin and subcutaneous tissue (dermatofasciolipectomy) followed by skin grafting. Such operations can reduce the volume of the limb.

Prognosis for lymphedema

Modern medicine does not allow counting on a complete cure for lymphedema. The goal of treatment is to reduce edema, prevent erysipelas and trophic ulcers, and maintain patient mobility. Even the slightest effort to change lifestyle and control allows us to hope for a good prognosis of stopping the progression of the disease.

Conservative treatment (lymphatic drainage and bandaging), as well as elastic compression, can keep the edema at an acceptable level and prevent the progression of the disease. This can be achieved with regular treatment from specialists. This method does not cure lymphedema, but is a necessary tool to prevent severe complications. Patients under the control of a lymphologist have the ability to maintain the volume of the limb.

Surgical treatment can significantly reduce the severity of lymphedema without resorting to the constant use of lymphatic drainage and compression stockings, but does not completely exclude its use. After successful operations of lymphovenous anastomosis, significant clinical improvement is achieved in 70% of patients.

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Treatment results

The result of conservative treatment of severe lymphedema of both legs in our clinic of lymphology is presented. A 54-year-old patient has been suffering from lymphostasis for more than 25 years. The disease is constantly progressing. She was treated with pneumocompression and elastic stockings, but without effect. Contact our center. Ultrasound examination revealed no pathology of deep veins and arteries. There is fibrosis and fluid accumulation in both legs. It was decided to conduct conservative therapy.

A 46-year-old patient with grade 3 lymphedema of the right leg. The disease began to develop after a gynecological operation and within 10 years led to a disabling edema that interfered with normal life and movement. We contacted our clinic. A course of manual lymphatic drainage and bandaging (14 days) was prescribed, which led to a good regression of edema. Subsequently, fasciolipectomy was performed and the volume of the leg decreased significantly.

A 38-year-old patient with lymphedema of the right leg. Repeated cases of erysipelas on the right leg. He wore compression stockings that didn't hold back the swelling. In our center, complex therapy was carried out, including manual lymphatic drainage massage, bandaging and pneumocompression. As a result of treatment, edema significantly decreased after 14 days. The patient is fitted with a flat-knit compression stocking. Recommendations on lifestyle and further treatment are given.

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Price

The cost of outpatient treatment of lymphedema consists of the cost of materials for bandaging, the labor of a doctor and masseur, depreciation of rehabilitation equipment.

Treatment at the lymphology clinic includes material for bandaging, the work of a doctor and a massage therapist, a course of exercise therapy and a stay in a country clinic with food and treatment. For convenience of assessment and calculations, the cost of one day of treatment is estimated.

The cost of surgical operations and treatment in a surgical hospital is paid separately.

Expert advice

Ultrasound diagnostics