The standard of care for lymphedema: current concepts and physiological considerations.

The standard of care for lymphedema encompasses risk reduction, early detection, Phase-I Complete Decongestive Therapy in a clinical setting, and Phase-II Self Management at home. This review discusses these lymphedema treatment components, including relevant physiological aspects that form the basis of treatment and an understanding of which are critical to successful outcomes. Phase-I therapy includes manual lymphatic drainage (MLD), short-stretch compression bandaging, decongestive exercise, skin care, and sometimes intermittent pneumatic compression (IPC). Home management includes many of the same elements, with adaptations for home treatment. Significant to the success of Phase-I and Phase-II care is effective bandaging and lymphatic drainage treatment via manual (MLD) or automated (IPC) processes. Truncal clearance plays a key role in facilitating lymphatic drainage from affected limbs by achieving effective pressure gradients, reducing lymphatic network resistance, and stimulating lymphatic contractility. The transition from Phase-I to Phase-2 presents challenges to patients and clinicians. Poor patient compliance with time-consuming technique dependent-home care regimens contribute to losing gains achieved in the clinic. Ineffective treatment results in complications, including increased pain, reduced range of motion and mobility, increased risk of infection, and other physical and psychological sequelae. The use of an advanced programmable IPC device for lymphedema treatment may support successful home management by addressing some of the home treatment barriers. Device selection requires careful consideration of the mode of action and device functionality. An advanced programmable device that provides truncal and proximal clearance and low applied pressure represents the current choice for such in-home devices.