Lymphedema - a surgical pathology, characterized by the fact that as a result of certain violations of the normal flow of lymph in its vessels is broken, and instead aspire to following in its path sections, itIt accumulates in certain places .Such an accumulation of lymph in the lymphedema cause deformation of body parts (usually legs).
Lymphedema can be either primary or secondary.Primary lymphedema is extremely hereditary.Her reason is the structure of inborn errors of lymphatic vessels.Secondary lymphedema - is often a consequence of certain diseases, as well as the impact of certain factors (eg, surgery).The most common manifestation is secondary lymphedema occur in clinical practice.
Lymphedema is a difficult enough curable disease.Complete its elimination is possible not only with the correct assignment of the drugs, but also subject to certain patients regime and the rhythm of life.
Lymphedema of lower extremities Lymphedema
lower limbs is the most common form of ly
Causes of this disease are different: they can be both primary and secondary.The primary causes of lymphedema solely genetic.Further signs of "primary" causes of the disease will appear only in a specific symptom.This symptom will include lymphedema in the feet, legs and hips, which will be accompanied by hypoplasia of the external genitalia, infantilism, and delayed mental and physical development.Lymph edema in this type of lymphedema of the lower extremities can vary from minor swelling in the legs to the increase in its volume of the entire lower extremity.
causes of secondary lymphedema of the lower extremities is different.This may be the consequences of certain physical conditions (e.g., pregnancy), as well as certain diseases.Most other lymphedema can generate local infections and traumatic injury.In addition to these diseases, there is another disease that is the most favorable factor for the development of lymphedema - is erysipelas.
important to correctly distinguish between the first clinical signs of the two subspecies of lymphedema among themselves and the primary and secondary due.Their main distinguishing feature is the nature of the appearance of the first changes in the areas with disturbed limfottokom.Thus, the manifestation of primary lymphedema of the lower limbs of the patient begin with edema in the distal (farthest from the center) Structure: feet, legs.A second version of the disease due to start its activities with the proximal (near the center) structures.Most often, the lower extremities - femur it.
Besides the initial lesions is located proximal portions of the lower limb secondary lymphedema symptoms characteristic localization of lymph edema: they will be located slightly below or at the level of damaged lymph departments.Also plays an important role symmetry lymph defeats: the disease is most often the primary lesion is symmetrical on both lower extremities, and the secondary genesis struck most often be only one limb.
first signs of lymphedema of the lower limbs begin with complaints of pain in the affected area of the lower limb.First, the pain will only occur during exercise, and then spontaneously without any preconditions.The same tactics will display and edematous manifestations: the first stages they may even disappear with rest and give the final horizontal or exalted position.Another interesting feature of lymph edema: they are most strongly manifested during the summer when exposed to high temperatures.This swelling will gradually capture the entire limb, moving according to their order: from the bottom up in the primary version of the development;or downwards in the secondary.Such extensive swelling of the affected limb is deformed.The skin on it becomes shiny, stretched and pale, with no apparent pattern of blood vessels.
By the way, in contrast to the secondary, primary lymphedema of the lower limbs are not always develops so fast and can enter the so-called "stasis" (steady state) at any stage and for a long time, no further progress.
Causes of lymphedema is very different, because this disease is multifactorial (so, where it can cause the appearance of different and often unrelated reasons).As mentioned above, lymphedema can be primary and secondary.It is based on these subspecies is easiest to explain and to remember the basic and important reason for the appearance of lymphedema.
But besides the main reasons for the understanding of the disease is also necessary to understand the principles of normal outflow of lymph through the lymph vessels.
Normally, the lymphatic network has a certain structure, which is somewhere similar to the circulatory structure.The basic structural unit of the lymphatic network are lymphatic capillaries and lymph nodes.Limfokapillyary perform a collective function: they collect lymph from different structures of the body.According to this feature, they have two subspecies: superficial lymph vessels and lymph vessels deep order.The first lymph vessels pick up the lymph from the skin and underlying subcutaneous tissue.The second type of vessels involved in that collects lymph from the tissue structures.Each type of lymphatic vessels is accompanied by his course of certain veins.Usually superficial lymphatic vessels accompany the saphenous veins and blood vessels deep order entwine big deep vessels.Lymph nodes are also the peculiar peripheral centers of the lymphatic system, in fact they are the final development of the main cells that make up the immune system.Lymph nodes are located in certain places around the human body, and that they fall into lymphatic capillaries.However, lymph nodes and vessels form larger units - the lymph ducts.
main cause of lymphedema - a violation of lymphatic drainage and promotion of its vessels.This disorder can occur in two ways: congenital disorders and hypoplasia of the lymphatic vessels, or the impact on the initially normal blood vessels of various factors.
When congenital disorders are usually disrupted their shape or the number of lymph vessels.Exactly the same changes can occur and lymph nodes: can be violated both their form and development.Underdeveloped blood vessels and lymph nodes can not convey even a normal lymph flow: the lymphedema can be significantly narrowed their lumen, and some channels may even be absent.As a result, all lymph can not pass into the lower part of the vessels and it is delayed.
Also, another factor that may be associated with disorders of the structures and functions of the lymph units or work separately, is innate overproduction of tissue fluid.This liquid is also the ancestor of the lymph, and increased its number respectively, will increase the number of lymph in the mainstream.Lymphatic vessels are oriented to the normal amount of lymph, and can not provide normal transport increased its volumes.As a result, a separate amount of liquid is not transported further and is retained in certain areas, gradually accumulate and increase swelling.
in the secondary lesions caused by lymph vessels of the lymphatic system initially have the normal structure and function.But when exposed to certain conditions, the fulfillment of their functions can be disrupted.Most often it is disturbed permeability of lymphatic vessels.The main reasons that can cause such changes, according to traumatic injuries, chronic inflammation, and radiation exposure.Particularly important factors considered limb injuries and operations (after radical surgery for breast cancer processes and there is a so-called lymphedema after mastectomy lymphedema or hands).In case of injury can happen one of two important mechanisms: there will break or damage the lymphatic vessels of the network due to injury or damaged lymphatic vessel reflex spazmiruyutsya and off from the general system of lymph circulation.
also the second most important factor, which comes after the traumatic causes for the development of lymphedema believe erysipelas.Most often they appear already in the background of primary disorders of lymphatic vessels.This is because in the damaged vessels poor lymph flow, and gradually accumulate in these areas pathogens.Accumulation in places of stagnation nutrient - proteins and fats, is a great environment for their development and revitalization.In addition, often paired with an impaired lymph flow is reduced immunity, and that helps the bacteria to start their pathogenic effects.
Each type of lymphedema its key symptoms and signs.But there are also signs that will certainly appear in any variant of the disease.
first mandatory feature of lymphedema is a dense edema, which appears due to the stagnation of lymph in the affected area.Due to prolonged exposure lymphatic edema of the surrounding tissue, there are portions of the connective tissue and the pathological tissue site undergo fibrotic changes.As a result of this swelling becomes dense.
Most often lymphoedema develops rather slowly, gradually spread to the entire limb.Patients complain of discomfort at first.Then he replaced the pain and discomfort that fall under the provisions that improve lymph flow in the affected limb or organ.After a while the pain is not amplified and the above processes are stopped.Also the pain at this stage accompanied by fairly strong convulsions.
following mandatory symptom is edematous limb deformity.This is due to the fact that a particular lymph station also continues to accumulate all.This means that just as well continue to increase, and clinically manifested swelling, gradually changing the shape of the limb.By the way, lymphoedema can damage and distort not only the course, but also individual organs.Most often, this exposed vulva (scrotal lymphedema).
third sign will be skin disorders.Due to the swelling of the affected area of the skin is stretched, it is shiny and pale.Besides stretching the skin thickens and therefore it is practically impossible to find the pattern of subcutaneous venous network.In addition, in some places the skin takes the form of "orange skin" - dense with large and dilated pores.
But besides the general symptoms are also some symptoms characteristic of his subspecies lymphedema.Since its initial form has 2 types of flow: early and "retarded."An early form will manifest itself in almost the first days of life and is often a part of the above-described genetic disorder, combined with mental and nervous development."Lagging" form will appear only after 35 years.Besides congenital lymphedema can be a long time to develop and will start only at higher loads inside the body: such as puberty or pregnancy.For the second time due to lymphatic lesions is characteristic of the prior existence of the disease.Its presence can be determined by diagnostic procedures based or history of the disease.
is important to note that lymphedema can develop gradually and slowly for a very long time.Also, in certain diseases of the disease may remain at a certain stage and develop further.All terms of development depend exclusively on the reasons that cause it.So at the root causes of malignant lymphedema is quick and rapid development, and in the primary genetic cause can develop over several decades.
Lymphedema Treatment Lymphedema
initially treated by conservative methods.All methods will be directed to remove its root causes, primary or "mother" of the disease.In addition, patients assigned strict implementation of a particular mode: a constant hygiene control the purity of affected areas, restrictions on fluid intake and give the final horizontal position.Also good effect has a permanent tight elastic bintovanie limbs.
If these treatments do not help lymphedema, it must go to perform surgical benefits.Normally the operation is performed to improve the lymphatic drainage of the superficial lymphatic vessels.For this purpose the top layer peeled from the flap is moved into the space below the intermuscular fascia.Thus, unmodified superficial lymph vessels to replace damaged and restore the flow of lymph.