Chronic Lymphedema Management: Case Series Analysis of 9 Years from a Specialized Clinic in Delhi

Chronic lymphedema is a disabling disease with functional and psychological morbidity. Despite an enormous burden of disease, there is a lack of knowledge among providers regarding treatment methodology and equipment. Our surgical care center has focused on treating patients and educating providers for lymphedema. We present a retrospective analysis of our records over the last 9 years. Patients were treated on an ambulatory basis through complex decongestive therapy (CDT). Ancillary drug therapy included benzathine penicillin every 3 weeks and anti-filarial drugs as appropriate. We emphasized limb care, including scrub washes, cleaning with warm saline, emollient applications, exercises, limb movements, and compression using bandaging and intermittent pneumatic compression (IPC) pumps. Training on bandaging was given and a complete bandage kit provided for regular reuse after washing. Surgery was required for selected cases for cosmesis and for extremely bulky, long-standing lymphedema with secondary skin changes. Subjects were longitudinally monitored using self-reported subjective criteria and objectively by limb volume measurements. In 95 patients (119 limbs), CDT and prophylactic benzathine penicillin resulted in significant decrease in swelling, reducing mean upper limb volume from 3.6 to 3.2 l (p<0.001) and mean lower limb volume from 11.0 to 9.0 l (p<0.001). The use of a pump did not significantly add to further improvement. Failures were few, and mostly related to noncompliance.Focused treatment strategies, education, pharmacotherapy, and home-based care with bandages as well as IPC have shown success in improving the outcome of chronic lymphedema.