Robert Harris

Senior instructor

Dr. Vodder School - International

www.vodderschool.com

Acknowledgements / Affiliations Animations and Movie clips

Prof. Neil Piller, Flinders University: Vital Essence CD

Affiliations Dr. Vodder School International:

director and senior instructor

BCLA: Advisory Board

Canadian Lymphedema Framework: Advisory Board

Lymphedema Association of Ontario: Advisory Board

BCLA conference 6/25/11 R. Harris

Physiology behind Lymphedema Overview:

Normal fluid movement in the tissues

How fluid accumulates

What types of problems can arise

Why lymphedema occurs

How lymphedema progresses

BCLA conference 6/25/11 R. Harris

Normal fluid movement Lymph vessel system responsible for removal from

tissues of:

fluid

proteins

cell debris

waste matter

pathogens

(bacteria and viruses)

BCLA conference 6/25/11 R. Harris

Normal fluid movement• Fluid leaving blood capillaries is mostly taken up by lymph vessels

BCLA conference 6/25/11 R. Harris

Courtesy: Flinders University, Vital Essence CD

Normal fluid movement Balance in tissues

J.R. Levick: Revision of the Starling Principle: new views of tissue fluid balance. J. Physiol. 553.3 (2004) p.704.

BCLA conference 6/25/11 R. Harris

How fluid accumulates in lymphedema

•Normal amount of fluids leaving blood capillaries•Problem in lymph system•Fluid levels rise in tissues

BCLA conference 6/25/11 R. Harris

Courtesy: Flinders University, Vital Essence CD

What types of problems can arise? With reference to lymphedema:

Mechanical insufficiency of the lymph vessel system

Primary: chronic edema caused by a developmental abnormality of the lymphatic system.

Secondary: acute or chronic edema caused by obstruction, damage, trauma, inflammation

BCLA conference 6/25/11 R. Harris

Types of lymphedema Primary lymphedema:

Born with insufficiency of lymph vessels

Insufficient lymph vessels to manage normal amount of fluid being produced in tissues

Edema can develop years later or soon after birth

BCLA conference 6/25/11 R. Harris

Types of lymphedema Primary lymphedema:

Milroy’s (10%), hereditary, manifests at birth typically in feet and lower legs. Thought to be a functional impairment of lymph vessels rather than aplasia or absence of lymph vessels (F. Connell: ILF conference 2011).

BCLA conference 6/25/11 R. Harris

Types of lymphedema Primary lymphedema:

Meige’s (90%): sporadic, generalised lymphatic dysplasia (abnormal growth). Edema typically occurs in puberty or later.

BCLA conference 6/25/11 R. Harris

Types of lymphedema Secondary lymphedema:

Insufficient lymph vessels to manage normal amount of fluid being produced in tissues

An acquired cause (e.g. surgery, radiation, trauma, malignancy)

BCLA conference 6/25/11 R. Harris

Types of lymphedema Secondary lymphedema:

Acute: e.g. immediately after surgery or trauma lasting up to 6 months (Weissleder)

Chronic: can develop months or years after damage to lymph vessel system

BCLA conference 6/25/11 R. Harris

Courtesy: Flinders University, Vital Essence CD

Why does lymphedema occur?Summary

Normal amount of fluid entering tissues from blood capillaries

Either too few or abnormal lymphatics to take away fluid resulting in primary lymphedema

Damage, inflammation or blockage of lymph vessels resulting in secondary lymphedema

BCLA conference 6/25/11 R. Harris

How lymphedema progresses Latent Phase

Problems with lymph vessels but able to handle amount of fluid being produced

Decreased capacity of lymph vessels

No visible edema

BCLA conference 6/25/11 R. Harris

How lymphedema progresses Stage One

Problems with lymph vessels and not able to take away enough fluids in tissues

Transport capacity exceeded

Accumulation of proteins in tissues

Visible edema, reversible

BCLA conference 6/25/11 R. Harris

How lymphedema progresses Stage Two

As in Stage One but not reversible on elevation

Fibres laid down in tissues

Chronic inflammatory processes

BCLA conference 6/25/11 R. Harris

Courtesy: Flinders University, Vital Essence CD

How lymphedema progresses Stage Three

As in Stage Two

Thickened, hard skin

Fibrosis of remaining lymph vessels, blood vessels and nerves

BCLA conference 6/25/11 R. Harris

Conclusion Lymph vessel system removes normal fluids from

tissues

Mechanical problem with lymph vessels results in impaired drainage

Accumulating fluids and proteins results in progressive severity of lymphedema

Early intervention to prevent progression!

BCLA conference 6/25/11 R. Harris