MLD FOR LYMPHEDEMA

lymphedema

Manual lymphaticdrainage (MLD) is a gentle massage technique that is recognised as a keycomponent of decongestive therapy. MLD aims to encourage fluid away fromcongested areas by increasing activity of normal lymphatics and

bypassingineffective or obliterated lymph vessels.

MLD remainsa specialist skill that needs

regularpractice in order to maintain competence. Deep, heavy-handed massage should beavoided because it may damage tissues and exacerbate oedema by increasingcapillary filtration.

Indications

MLD may beindicated as part of intensive

therapy,transition management, long-term

managementor palliative care .

MLD on itsown is not sufficient treatment

forlymphoedema; it should be combined

with compressiontherapy to support and

maintain itseffects. However, where

compressionis difficult or is not well

tolerated,eg. in lymphoedema of the head,

neck, trunk,breast and genitalia, MLD may

be the onlyrealistic option.

Contraindications

Generalcontraindications

■Acute cellulitis/erysipelas

■Renal failure

■Unstable hypertension

■Severe cardiac insufficiency

■Hepatic cirrhosis with abdominal fluid

(ascites)

■Superior vena cava obstruction

■Untreated tuberculosis or malaria

Localcontraindications

■Untreated thyroid dysfunction

■Primary tumours

■Metastases

Technique

A number ofdifferent techniques exist for

MLD.However, there is little evidence to

demonstratewhich is the most effective and

for whatclinical indications. Essentially,

MLD is agentle massage technique that

follows thelymphatic pathways. The

differentmethods have several aspects in

common:

■performed for up to an hour daily

■usually performed with the patient in the

lyingposition, unless for lymphoedema of

the head andneck

■starts with deep diaphragmatic breathing

■treats the unaffected lymph nodes and

region ofthe body first

■moves proximally to distally to drain the

affectedareas

■movements are slow and rhythmical

■uses gentle pressure – if thepressure is

too hard itstimulates blood flow, the skin

becomes red,and more fluid is

encouragedto move into the tissues

■ends with deep diaphragmatic breathing.

MLD may beconducted daily (or sometimes

twice daily)or three times weekly. A course

of therapymay last three or more weeks,

and may berepeated at intervals of three

months toone year. However, the ideal

frequencyand length of course for MLD

remains tobe defined.

MLD isconducted by practitioners with

trainingat specialist.

SIMPLELYMPHATIC DRAINAGE

Simplelymphatic drainage (SLD) is a

simplifiedself-administered version of MLD

thatpatients and carers can learn and apply

themselves.Ideally, all patients should

be taughtSLD, unless contraindicated . While there may be benefits, some

patientsfind it difficult to learn, memorise

andeffectively incorporate this treatment

into a dailyregimen. Patients who have MLD

may find iteasier to learn SLD.

Technique

In commonwith MLD, there is little robust

evidence tosupport the use or effect of SLD.

There is nodefinitive technique for SLD, but

it issimilar to MLD and is conducted for

10-20minutes daily.

For SLD tobe effective, the healthcare

professionalmust ensure that:

■the patient/carer is motivated

■the patient/carer is sufficiently dextrous

to performSLD

■time is allocated for initial teaching

■teaching is progressive and enables the

patient orcarer to become skilled

■written instruction is given and technique

is observed

■competence in the procedure and the

patient'sability to cope with treatment

are checkedregularly.

SLD isconducted and taught by

practitionerswith appropriate training.

conclusion

Provision ofcomfort and pain relief when other

physicaltherapies are no longer appropriate

■Adjunctive treatment to pain management

At bankers vascular hospital we have our lymphedema management team which guideyou in proper direction .

Here wetake assessment and identification of ideal patient . In lymphedema observationis mu