Lymphedema: a therapeutic approach in the treatment and rehabilitation of cancer patients.

Lymphedema therapy has gone by many names in the recent past, being referred to as complex decongestive therapy, complex physical therapy, or decongestive lymphatic therapy, among others. There are two phases of lymphedema treatment: the acute "intensive" phase and the maintenance phase. In the acute phase of treatment, the individual is typically wrapped with medical short-stretch compression bandages; receives a therapeutic exercise routine, skin care, and education; and undergoes manual lymphatic drainage by a specially trained physical therapist or healthcare professional. In the maintenance phase, the goals are for the individual to be able to wear a well-fitted appropriate gradient pressure garment during the day and compression bandaging (or a device that serves as an alternative to bandaging) at night, to maintain good skin care, to continue with therapeutic exercise, and to self-perform manual lymphatic drainage (or use a mechanical device that can perform manual lymphatic drainage) for the area of the body with impaired lymphatics. The effectiveness of the various components in each phase, as well as the motivation and compliance of the patient, differs. Further randomized trials are required to determine which component or combination of components in complex decongestive therapy works most effectively. It is recommended for patients not only to maintain physical activity for its many health benefits but also to facilitate muscle pumping to move lymphatic fluid throughout the body. Knowledge of some of the pathophysiologic mechanisms involved in the development of lymphedema is increasing, and it is possible that current modes of treatment of lymphedema will be augmented by molecular therapies in the future.