Lymphödem

Was ist neu?

Kompression

Der Verzicht auf Kompression in der Therapie chronischer Extremitäten-Lymphödeme steigert das Risiko erysipelbedingter Komplikationen und führt zu einer hohen gesundheitsökonomischen Belastung. Nächtliche Kompressionsverfahren zeigen Vorteile und eine hohe Therapieadhärenz.

Erysipel

Aufgehoben wurde die Empfehlung, bei Erysipel auf Kompression zu verzichten. Im Gegenteil, Kompression ist explizit erwünscht.

Lymphödemassoziierte Malignome

Lymphödembetroffene Extremitäten zeigen im Vergleich zu nicht betroffenen Extremitäten eine starke Assoziation zu malignen Hauttumoren.

Anatomie und Schweregrad

Mittels ICG-Lymphografie wurden 4 verschiedene anatomische Lymphbahnregionen am Bein differenziert, deren funktioneller Ausfall je nach betroffenem Bündel mit dem Schweregrad des Lymphödems korreliert.

Lymphchirurgie

Dem vaskularisierten Lymphknotentransfer wurde bezüglich Volumenreduktion, Funktionalität und Lebensqualität hinreichend Evidenz bescheinigt.

Adipositasassoziierte Lymphödeme

Je höher der BMI, umso höher das Risiko für Lymphödeme.

Bewegung und Selbstmanagement

Metaanalysen belegen den Nutzen eines aktiven Lebensstils mit Bewegung und sportlichen Aktivitäten, in Einheit mit umfassender Patientenedukation. Tragbare apparative Kompressionssysteme sind eine vielversprechende Alternative zu bisherigen pneumatischen Kompressionsapparaten.

Algorithmus für primäre Lymphödeme

Das St.-George’s-Klassifikationssystem zeigt erstmals umfassend Zusammenhänge zwischen primären Lymphödemen und systemischen bzw. syndromalen Erkrankungen sowie vaskulären Malformationen. Als „Work-in-progress“-Algorithmus ist es eine wertvolle Hilfe zur Diagnosesicherung und um therapeutische Ansätze zu finden. Klassifikationen, die sich an der zeitlichen Manifestierung primärer Lymphödeme orientieren, wurden verlassen.

Abstract

The 5 most important pillars of conservative lymphoedema therapy are (1) compression, (2) manual lymphatic drainage (MLD), (3) exercise, (4) skin and wound care, and (5) self-management. Without compression therapy the risk of cellulitis is increased and causes an elevated health/economic burden. The use of nocturnal compression shows advantages and a high degree of treatment adherence. The previous recommendation that compression should not be used for cellulitis has been cancelled. On the contrary, compression therapy is explicitly desirable for inflammatory dermatoses. The fact that lymphedema extremities show a 3-fold higher association with malignant skin tumours compared to unaffected extremities deserves attention. Using ICG lymphography, 4 different functional regions of lymphatic leg bundles were differentiated. The severity of the lymphoedema correlated with the kind of affected bundles. Vascularized lymph node transfer, which is a reconstructive lymphatic surgery procedure, was found to show evidence in terms of volume reduction, improved functionality, and better quality of life. The higher the BMI, the higher the risk of developing lymphoedema. Meta-analyses confirm the benefits of an active lifestyle with exercise and sporting activities in conjunction with patient education. Apparative systems for decongestion (intermittent pneumatic compression) usually force patients to remain immobile during application. Portable apparative compression systems are a promising alternative but are not yet available in Germany. Primary lymphoedema is not a uniform entity. The St. George’s classification system shows the association of primary lymphoedema with systemic or syndromic diseases and vascular malformations as well. As a work-in-progress algorithm, it is a valuable aid in classifying primary lymphoedema, confirming the diagnosis and finding therapeutic approaches.

Schlüsselwörter

Lymphödem - Kompressionstherapie - Erysipel - Lymphchirurgie

Keywords

Lymphedema - compression therapy - exercise - cellulitis

Publication History

Article published online:
21 February 2025

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