Treatment of Lymphedema:
Complete Decongestive Therapy (CDT)
Complete Decongestive therapy is also called Combined, Complex or Comprehensive Decongestive Therapy. All refer to the same method known as CDT. CDT is the main treatment for lymphedema. Experts who treat lymphedema consider CDT the "gold standard" of treatment. CDT has been shown to be safe and effective.
CDT consists of an initial reductive phase (Phase I) followed by a maintenance phase (Phase II). In Phase I, the main goals are reducing the size of the affected part and improving the skin, After Phase I, the person with lymphedema needs to continue into Phase II, an ongoing, individualized self- management phase to make sure the gains of Phase I are maintained long term.
Effects of CDT are to:
1 . decrease swelling
2. increase lymph drainage from the congested areas
3. reduce skin fibrosis and improve the skin condition
4. enhance patient's functional status
5. relieve discomfort and improve quality of life
6. reduce the risk of cellulitis and Stewart-Treves-Syndrome, a rare form of angiosarcoma
Components of CDT
1 . manual lymph drainage (MLD)
2. multi-layer, short-stretch compression bandaging
3. lymphatic exercise
4. skin care
5. education in lymphedema self-management, and elastic compression garments
Frequency and Duration of Phase I (Reductive) CDT
Optimally, CDT is performed dally (5 days/week) until the reduction of fluid volume has reached a plateau. Which can take 3 to 8 weeks. Some patients may have good results from CDT with modifications of the frequency and duration of treatment. CDT frequency and duration should be individualized to produce the greatest reduction of swelling and improvement of skin condition in the shortest period of time.
Maintenance (phase. II) CDT
At the completion of Phase I CDT, the person with lymphedema is set up on a self-management program that includes self-lymph drainage (sometimes called Simple Lymphatic Drainage), home lymphatic exercises, a skin care regimen, and compression garments or bandages that the individual learns to apply. Some individuals may require additional measures at home to maintain the gains achieved in Phase I. These measures may include garments with Velcro, specialized foam construction garments, and pneumatic compression devices. Phase II maintenance must be monitored and changed periodically, just as treatment for any other chronic medical condition.
Compression garments must be replaced every 4-6 months to be effective. Specialized equipment requires maintenance and replacement according to manufacturers' guidelines. Phase II CDT and periodic medical monitoring are essential to the long-term success of lymphedema treatment.
Therapists providing CDT should have completed at least 135 hours of training as recommended by the Lymphology Association of North America® (LANA®). (See NLN Position Paper: Training of Lymphedema Therapists.205)
Information taken NLN Position Paper:The Diagnosis and Treatment of Lymphedema